Thyroid And Neck Swellings

Question 1

goitre définition

Answer 1

Swelling of the thyroid

Question 2

Goitre classification

Answer 2

Simple
Toxic
Neoplastic
Inflammatory
Infective
Others

Question 3

What is simple goitre

Answer 3

Diffuse hyperplasia due to increased physiological demand like puberty or pregnancy, iodine deficiency , medications ( amiodarone, lithium)

Question 4

Population at risk of multinodular goitre

Answer 4

Middle aged women

Question 5

Chances of malignancy of multinodular goitre

Answer 5

5%

Question 6

Complications of multinodular goitre

Answer 6

hyper/hypothyroidism
Hemorrhage
Nodule rupture
Malignancy
Tracheal compression / deviation
Oesophageal compression
SVCO

Question 7

Man causes of toxic goitre

Answer 7

Graves disease

Question 8

Other causes toxic goitre

Answer 8

Thyroiditis
Carcinoma
TSH secreting pituitary tumor
Iatrogenic
Choriocarcinoma
Hydatidiform mole

Question 9

Types of benign tumor

Answer 9

Adenoma
Follicular tumor

Question 10

Primary malignant tumor

Answer 10

Papillary carcinoma
Follicular carcinoma
Medullary thyroid cancer
Anaplastic thyroid cancer
Lymphoma

Question 11

Type of inflammatory goitre

Answer 11

Autoimmune (hashimoto disease)
Granulomatous thyroiditis

Question 12

Types of infective goitre

Answer 12

Acute bacterial thyroiditis
Chronic tb
Viral thyroiditis sub acute

Question 13

WHO goitre grading

Answer 13

0 = no palpable goitre
1 = palpable goitre
1A = goitre detectable by palpation
1B = goitre palpable and visible
2= goitre visible with neck in normal position
3= large goitre from distance

Question 14

Investigations

Answer 14

Thyroid function tests
Autoantibody screen
Tumour markers : calcitonin
Ultrasound : consistency, nodule number, size, position
Chest x ray : tracheal compression
CT, MRI => size, anatomy, retrosternal extension
Radionuclide imaging
FNAC

Question 15

Treatment

Answer 15

Thyroxine
Radioiodine (thyrotoxicosis, euthyroid with large goiters)
Tetracycline ( cystic recurrence )
Thyroidectomy
Lobectomy

Question 16

Post operative complications

Answer 16

Hemorrhage
Tracheal compression
Nerve damage
Temporary Hypocalcemia
Parathyroid injury or excision
Wound infection
Recurrence
Thyroid storm

Question 17

Neck swellings

Answer 17

Sebaceous cyst
Lipoma
Neurofibroma
Capillary malformation
Tumors (SCC, melanoma, secondary metastasis )

Question 18

Muscular neck swellings

Answer 18

Sternomastoid tumor
Rhabdomyosarcoma
Fibroma

Question 19

Lymphadenopathy neck swellings

Answer 19

Acute infective
Chronic infective
Primary malignant
Secondary malignant

Question 20

Commonest congenital neck swelling

Answer 20

Thyroglossal cyst

Question 21

Thyroglossal cyst cause

Answer 21

Persistence of any part of Thyroglossal duct

Question 22

Characteristics Thyroglossal cyst

Answer 22

Non tender
Between thyroid and hyoid
Transilluminate

Question 23

Treatment Thyroglossal cyst

Answer 23

Excision

Question 24

What is Cystic hygroma

Answer 24

Congenital benign lymphangioma

Question 25

Characteristics of cystic hygroma

Answer 25

Neck and floor of mouth No spontaneous regression Clear lymph fluid Transilluminates

Question 26

Treatment cystic hygroma

Answer 26

Surgical removal

Question 27

Sublingual Dermoid cyst bulge all the time ?

Answer 27

No can be wholly intra oral

Question 28

Bronchial cyst occurs mostly before or after adolescence

Answer 28

After

Question 29

Causes of branchial cyst

Answer 29

Failure of fusion of 2nd and 3 branchial arches

Question 30

Treatment branchial cyst

Answer 30

Excision

Question 31

Examination inspection

Answer 31

Site location Asymmetry Color changes Sinuses Scars Punctum Movement on swallowing

Question 32

Examination palpation

Answer 32

Induration Tenderness Temp Mobility Limits definition Pulsatility Emptying Consistency Systematic back of the neck Cranial nerve assessment Direction of movement Transillumination

Question 33

Investigations

Answer 33

Radio. - plain x ray , ct, mri , sialography, ultrasound, barium swallow Angiography Immune studies Bone scan Histopathology - FNAB, biopsy Hemato - FBC, ESR, CRP Microbiology - AFBs, STIs

Question 34

What are the three strap muscles , fixing the lobes of thyroid to cartilage

Answer 34

Sterno thyroid muscle Sternohyoid muscle Superior belly of omohyoid

Question 35

The postero lateral surface of each lateral lobe of the thyroid gland is related to which structure

Answer 35

Carotid sheath

Question 36

Tractors related to the medial border of the lobes of the thyroid gland

Answer 36

Inferior constrictor cricothyroid muscles Oesophagus Upper six tracheal rings recurrent laryngeal nerve

Question 37

Two hormones produced by thyroid gland

Answer 37

T3 tri iodothyronine T4 thyroxine

Question 38

Function of thyroid hormones

Answer 38

Increase heart rate , contractility of heart, cardiac output Glycogen to glucose Glucose absorption Lipogenesis , lipolyses CNS function Growth , maturation

Question 39

Amount of iodine in gland

Answer 39

5000mg 90% storage of body

Question 40

Amount of iodine secreted by gland

Answer 40

100-120 microgram

Question 41

Main tests of thyroid function

Answer 41

In vitro test : Serum t3 concentration Serum free thyroxine Serum thyroid stimulating hormone TSH Test of hypothalamic pituitary axis

Question 42

Most sensitive indicator of hypothyroidism

Answer 42

Serum t3

Question 43

Most sensitive test for hypothyroidism

Answer 43

Serum TSH

Question 44

In vivo test

Answer 44

Isotope uptake test : high in hyperthyroidism , low in hypothyroidism TSH stimulation and uptake test

Question 45

Imaging techniques used

Answer 45

Plain x ray - soft tissue and calcification Ultrasound scan CT MRI Fine needle aspiration Test for auto immune antibodies Laryngoscopy