Neck And Thyroid

Front 1

Where are the baroreceptors and the chemoreceptors of the carotid artery?

Back 1

Baroreceptors - in the carotid sinus, a swelling at the base of the internal carotid

Chemoreceptors - in the carotid body, a small cluster of cells at the bifurcation of the carotid (into internal and external)"

Front 2

How does the carotid artery get into the skull?

Back 2

Leaves the neck via the carotid canal and enters the skull through the foramen lacerum

Front 3

"The thyroid receives blood from what? (2 arteries + their sources)

Which 3 veins drain the thyroid and what do they each drain into?"

Back 3

"The superior thyroid arteries from the external carotids. Inferior thyroid arteries from subclavian arteries.

Superior and middle thyroid veins drain to internal jugular. Inferior thyroid vein drains to LBCephalic vein



** Some people have a Thyroidea IMA artery branching up from the aorta"

Front 4

What would happen if a person got a hypogloassal nerve lesion? How would you tell if they instead had generalized neurodegeneration?

Back 4

"Atrophy of the tongue on one side.

Atrophy of the tongue on both sides"

Front 5

The npharynx will drain to which lymph nodes?

Back 5

the deep cervical and the retropharyngeal nodes of rouviere

Front 6

what could cause a horner's sydrome of the eye only (ie no skin involvement)

Back 6

In the sympathetic nerve fibers of the carotid were involved

Front 7

The palatine tonsil lays between which two muscles?

Back 7

The palatoglossus and the palatopharyngeal

Front 8

If an infected tonsil is left on it's own what will happen?

Back 8

The infection will spread to the soft palate forming an abscess known as a Quincy

Front 9

Explain the 80-20 rule about neck lumps?

Back 9

"In kids:

80% of neck lumps = bening

20% of neck lumps = malignant



In adults:

80% of neck lumps = malignant

20% of neck lumps = bening"

Front 10

What procedure is the major cause of hoarseness? why (ie damage to what causes what)?

Back 10

"Thyroid surgery with subsequent damage to the recurrent laryngeal nerve.

Hoarseness typically occurs b/c the fibers that go to the posterior cricoarytenoid muscles lie along the periphery of the recurrent laryngeal. So if the nerve is man-handled these are the first to be damaged!"

Front 11

How could you tell (with an otoscope) if someone had otitis externa?

Back 11

The cone of light (usually anterior and inferior) would be reflected all over as the tympanic membrane would now be convex (bulging out)

Front 12

"Which nerve controls a muscle that helps us accommodate for loud sounds. What does the muscle do?

Where is tensor tympani attached to?"

Back 12

"The facial nerve controls the stapedius muscle, which when contracted will rotate the stapes, thus decreasing it's ability to transmit sound.

T. Tympani - the handle of the malleus."

Front 13

"The thyroid gland develops as an endodermal downgrowth from which pharyngeal pouches?



The site from which it originates persists as the _____ ____ at the base of the tongue."

Back 13

"2nd & 3rd



Foramen Cecum



** The path that the gland takes may result in thyroglossal remnants (cysts) or ectopic thyroid tissue"

Front 14

Where does TSH come from?

Back 14

"Anterior pituitary



It stimulates both thyroid growth and the production & function of thyroid cells"

Front 15

The thyroid isthmus is situated immediately cephalic/caudal to the cricoid cartilage?

Back 15

Caudal! (Below)

Front 16

"In subacute thyroiditis.. what is the TSH? Radioactive Iodine uptake scan?



Explain?"

Back 16

"Low serum TSH and low uptake on the scan



The thyroid leaks T3/T4 which suppresses serum TSH and thus iodine uptake"

Front 17

What is the TSH and RAI scan results in Graves disease? Explain

Back 17

increased TSH - immunoglobulin levels that increase uptake on a scan despite low serum TSH levels

Front 18

"What are some causes of HYPER-thyroid?

(list the 2 most common first)"

Back 18

"1. Grave's disx (TSH Ig's)

2. Pummer disx (nodular toxic goiter)

3. amiodarone toxicity

4. TSH-secreting ant. pituitary tumors

5. hCG secreting tumors

6. Subacute thyroiditis

7. Cancer mets from thyroid"

Front 19

What are the 3 treatment options for hyperthyroidism, how does each work and when are they used?

Back 19

"1. Antithyroid drugs:

Propylthiouracil (300-1000mg/day), prevents the binding of iodine. Good for pre-op, or for reliable pts with small goitres. Get less rebound hypothyroid and 30% will get remission of Graves with this.



2. Radioactive iodine:

Can be given safely after the above. Great for old ppl (>40yo) and those who aren't good surgical candidates. Radiation will not increase risk of leukemia or congenital anomalies but will increase risk of benign thyroid tumors



3. SURGERY!

Rapid disease control and less HYPO. Usually spare ~5gm of tissue; only do a total for pt's with Graves Ophthalmopathy

Death <0.1%

Recurrent Laryngeal nerve injury: < 2%"

Front 20

What are some indications for surgical management of hyperthyroidism (6)?

Back 20

"1. Large or multinodular goiter

2. Current or desired pregnancy in 1yr

3. Ophthalmopathy

4. Amiodarone induced

5. Suspicion of malignancy

6. pts who would be unable to participate in long-term f/u"

Front 21

Describe the three treatments for thyroid storm:

1.
2.
3.

Back 21

1. Lugol: to prevent the release of pre-formed thyroid hormone

2. Propanolol: to antagonize the peripheral effects of thyroid hormone

3. Propylthiouracil: decreases thyroid hormone production and extra-thyroidal conversion of T4 -->3