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32 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Suprficial Neck Lumps - DDx
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Skin and Superficial Fascia
Lymph nodes Lymphatics Artery Salivary Glands Pharynx Branchial Arch Remnant Bone |
Skin and Superficial Fascia
- Lipoma - Sebacious cyst Lymph nodes - Infection - Malignant (lymphoma, lymphatic leukemia) Lymphatics - Cystic hygroma Artery - Carotid artery aneurysm - Carotid body tumour Salivary Glands - Submandibular salivary tumour - Sialectasis (dilation) - Tumour in the lower pole of the salivary gland Pharynx - Pharyngeal pouch Branchial Arch Remnant - Branchial cyst Bone - Cervical rib |
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Deep Neck Lumps - DDX
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Midline
Anterior Triangle Posterior Triangle |
Midline:
- Thyroid goitre or nodule - Thyroglossal cyst - Dermoid cyst - Subhyoid bursa Anterior Triangle: - Thyroid goitre, nodule - Lymph node - Submandibular gland stone, sialandentis or tumour - Parotid tumour - Branchial cyst (ant. border of SCM) - Carotid body tumour, aneurysm - SCM tumour - Laryngocele Posterior Triangle: - Cervical rib - Subclavian artery aneurysm - Pharyngeal pouch - Cystic hygroma |
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Thyroglossal Cyst
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- Embryological remnant of the thyroid
- Fluctuant swelling @ midline - moves on swallowing - moves upwards on portrusion of tongue |
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Neck Lymphadenopathy - DDx
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- Inflammatory (EBV, HIV, SLE)
- Granulomatous (TB, sarcoid) - 1o Malignancy - lymphoma, leukaemia - 2o Malignancy - Melanoma, carcinoma |
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Thyroidectomy - Complications
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1) Hormonal
2) Damage to related anatomical structures 3) General complications |
1) Hormonal
- Parasthesia - Tetany - Thyroid crisis - Hypothyroidism - Late recurrence of hyperthyroidism - Sympathetic chain 2) Damage to related anatomical structures - Recurrent laryngeal nerve (hoarseness) - Superior laryngeal nerve (pitch loss) - Trachea - Pneumothroax - Anterior thyroid arteries = hemorrhage (EMERGENCY) - Pneumothorax 3) General complications - Infection - wound, sepsis - Bleeding - Hypertrophic scar |
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Thyroidectomy - Hematoma post-op - Tx
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Immediate wound opening
Return to OR to control hemorrahge |
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Thyroidectomy - HypoPTH causing hypoCa++ - Tx
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- monitor serum Ca++
- Calcium gluconate - Vit D + Ca++ |
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Thyroidectomy - Pre-op preparation?
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1) Render euthyroid (carbimazole/PTU, propranolol, iodine)
2) Assess vocal cord function w/ laryngoscope 3) CXR 4) FBC 5) Bed rest - target BPM=60-70 |
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Chvostek sign
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Tap zygoma @ CN7 elicits facial spasm
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HypoCa++ > Na+ permeability > membrane depolarizes towards threshold potential > AP > excitability
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Thyroidectomy - Trousseau's sign
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Tourniquet placed around arm induces parasthesia or tetany
- spasms of hand and foot (carpopedal) |
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Hypercalcemia - Aetiology
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1) Hypoparathyroidism / Hyperthyroidism
2) Malignancy 3) Vit D excess 4) Drugs: Lithium 5) Addision's |
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1o HyperPTH
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80% parathyroid adenoma
Hyperplasia Carcinoma |
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MEN I
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1) Pancreatic tumour
2) HyperPTH 3) Adrenocortical tumour |
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MEN II
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1) Thyroid medullary ca
2) Phaeochromocytoma 3) HyperPTH - neurofibromas of tongue, lips, eyelids |
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HyperPTH.Hypercalcemia - Symptoms
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"Bones, Stones, Moans, Groans"
- Bones: pain, fracture - Stones: renal calculi - Groans (GIT): abdo pain, constipation - Moans (psych): depression, drowsiness, lethargy, weakness, proximal myopathy, coma - Polydipsia |
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HyperPTH.Hypercalcemia - Ix
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- Albumin (dehydration alters Ca++ reading)
- Phosphate - Low in 1o hyperPTH & osteomalacia; high in 2o/3o hyperPTH - ALP - Raised in hyperPTH, Paget's, MM - U&E - Check for CRF |
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++ Ca2+
++ PTH -- PO4 |
HyperPTH
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++ Ca2+
= or -- PTH |
Non-PTH aetiology hypercalcemia
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-- PO4
++ ALP |
Bone Disease
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HyperPTH.Hypercalcemia - Mx
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1) Diuresis - renal excretion of Ca++
2) Bisphosphonates - inhibit OC activity 3) Glucocorticoids - Decrease GIT Ca2+ absorption, increase renal Ca2+ excretion 4) Mithramycin |
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What is the lesion?
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Leukoplakia
- White hairy plaques - Cracked white paint appearance - Premalignant (25% evolve to ca) |
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Leukoplakia - Aetiology
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6 S's:
Smoking Spices Sharp/sore teeth Syphillis Spirits Sepsis (chronic superficial glossitis) |
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Leukoplakia - Pathology
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Epidermal proliferation
Hyperkeritanisation |
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Mouth Ulcers - Aetiology
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1) Trauma (sharp teeth)
3) Apthous ulcer (idiopathic) 4) IBD 5) Malignancy (Carcinoma) 6) HSV 7) Syphillitic ulcers 8) Drugs: sirolimus 9) Other: Behcet's syndrome, Reiter's syndrome, Wegener's granulomatosis, TB |
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Behcet's Syndrome
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Autoimmune vasculitis causing ulceration (genital, apthous/mouth, anywhere that is vascular)
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Reiter's syndrome
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Reactive arthritis
Autoimmune manifestation following infection |
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Wegener's granulomatosis
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Autoimmune vasculitis with lung and kidney involvement
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Oral Cancer - Suggested by:
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1) Leukoplakia (25% premalignant)
2) Smoking |
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Oral Cancer - Type of cancer
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Most are SCC
Other: Transitional cell ca Lymphoepithelioma |
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Oral Cancer - Features
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Plaque
Ulceration Fissure Papules |
Plaque - raised, firm, pearly plaques
Ulcer - Raised, irregular rolled margin & red indurated base Fissure - chronic w/ no signs of healing Raised lesions |
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Oral Cancer - Predisposing factors
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1) Chronic irritation
2) Leukoplakia 3) Iron Deficiency (glossitis) |
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Oral Cancer - Spread
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- Local infiltration
- Lymphatogenous common - Tongue tumours spread earlier than lip tumours (large, firm, fixed nodes) - Lower lip & tongue = submental LNs - Upper lip and anterior 2/3 tongue = submandibular LNs - Post 2/3 of tongue = superior deep cervical LNs (bilaterally) |
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