Neck Lumps

Front 1

What are the RF for multinodular goitre?

Back 1

Physiologic (puberty, menses or pregnancy)
Pathophysiologic (iodine deficiency, congenital defect in TH production, goitrogenic foods or drugs (lithium, amniogluethimide, sulfonamides, phenylbutazone)
Female

Front 2

What are the Sx of a goitre?

Back 2

Obstructive sx (dysphagia, stridor, hoarse voice, pemberton's sign due to obstruction of venous return at the thoracic inlet)

Functional Sx

Front 3

Lab findings in multinodular goitre?

Back 3

It depends if it is toxic or non-toxic
TFTs are usually normally (because patients may increase TSH production) - patients are usually euthyroid
If some nodules develop autonomy, patients may have suppressed TSH or become hyperthyroid

Front 4

Management of goitre?

Back 4

If euthryoid and small - no Rx
TH to patients with large goitres to reduce TSH stimulation of gland growth
Endemic goitres - iodine administration
Surgery - if no response to TH or obstructive, substernal extension, malignancy

Front 5

What are the indications for surgical management of a goitre?

Back 5

Obstructive Sx
Thyrotoxicosis
Suspicious or malignant changes on FNAB
strong fhx thyroid cancer, retrosternal extension, past hx - head and neck radiation

Front 6

What is the differential of a thyroid nodule?

Back 6

thyroid adenoma
cyst
benign multinodular goitre
hyperfunctioning nodule
thyroiditis
Hashimoto's thryoiditis
Abscess
Carcinoma/lymphoma
PTH carcinoma

Front 7

What investigations should be done for a thryoid nodule?

Back 7

Thyroid function tests
If euthyroid or hypothryoid --> FNAB
If toxic --> Iodine scan (cold - malignant)

Front 8

How do you tell the difference between a thyroglossal duct cyst and a thyroid nodule?

Back 8

They both change on swallowing but thyroglossal duct cyst moves on tongue protrusion

Front 9

What % of follicular adenoma will progress to follicular carcinoma?

Back 9

10%

Front 10

What is the most common cause of thyroid pain?
Cystic nodules or thryoiditis?

Back 10

Cystic thryoid nodules NOT thyroiditis

Front 11

What do most thyroid cystic nodules consist of?

Back 11

Partly solid structures that have undergone cystic degeneration (mixed or complex nodules)
They are predominanly autonomously functioning thyroid adenomas

Front 12

Rf for thryoid cancer?

Back 12

faminly history
radiation exposure
f > M

Front 13

What are orphan annie nuclie specific for?

Back 13

papillary thryoid cancer

Front 14

Where does papillary thyroid cancer met to?

Back 14

cervical nodes and lung

Front 15

Which thyroid cancer is not accurately diagnosed by FNAB?

Back 15

follicular

Front 16

Where does follicular cancer usually met to?

Back 16

lung and bone
Haematogenous spread

Front 17

What is medullary carcinoma associated with?

Back 17

MEN IIa or IIb
Amyloidosis

Front 18

Which cells is a thyroid medullary cancer derived from?

Back 18

paradollicluar C cells that prodcue calcitonin
Calcitonin (acts as a tumour marker, may produce hypocalcaemia and is converted into amyloid)

Front 19

Which demographic is anaplastic thyroid cancer most common in?

Back 19

Elderly women
Hx of differentiated thyroid ca (mostly papillary) or nodular goitres

Front 20

Which lymph nodes should be dissected if you have medullary thyroid cancer?

Back 20

median lymph nodes

Front 21

What is the most common form of benign parotid gland neoplasm?

Back 21

pleomorphic adenoma (most common)

Adenlymphoma (Warthin's tumour)

Front 22

If you have a lump in the area of the parotid gland and the facial nerve seems to be affected what could it be?

Back 22

SCC
NOT benign parotid neoplasm - facial nerve plane is not affected by these

Front 23

What is the most common parotid neoplasm?

Back 23

malignant melanoma invading from the skin

Front 24

What type of neoplasm do pleomorphic adenomas (parotid tumours) transform into?

Back 24

SCC

Front 25

Where is the carotid body located?
Fxn

Back 25

near the bifurcation of the common carotid artery
Detects changes in the the O2 concentration

Front 26

Which cells do carotid body tumour arise in?

Back 26

Glomus cells
- chromaffin tissue
called a paraganlioma - i.e. from paraganglia which are islands of cells derived from neural crest cells
Tumours that arise from these specialised neural crest cells have the ability to secrete neuropeptides and catecholamines

Front 27

How does a carotid body tumour present?

Back 27

Painless mass at the side of the neck below the angle of the jaw (palpable at the anterior border of the SCM)
Mobile laterally but not vertically
Hoarseness and horner's syndrome may result from pressure on the vagus or sympathetic nerves
Can also present with
Can be source of TIA
DDx: branchial cleft cyst, mixed tumour of salivary gland, carcinomas, aneurysms

Front 28

Investgiations in a suspected carotid body tumour?

Back 28

Angiogram - carotid artery with a vascular blush
FNA often yields blood but if cells are obtained FNA can be definitive

Front 29

Management of carotid body tumour?

Back 29

Surgical preop embolisation (minimises blood loss) and then surgical excision
Can use RT in elderly patients who are poor surgical candidates

Front 30

What is a branchial cyst?

Back 30

Remnant of the embryonic clefts which undergoes cystic enlargement

Front 31

How does a branchial cyst usually present?

Back 31

smooth, painless, slowly enlarging lateral neck mass, (anterior to the SCM) often following an URTI
If infected it will be tender and firm
Can also develop a fistula tract to the skin

Front 32

How do you manage a branchial cyst?

Back 32

control of infection then surgical removal of cyst

Front 33

What are the 3 types of branchial cleft cysts?

Back 33

1: typically apper face near auricle
2: most common - located just inferior to the angle of the mandible and anterior to SCM
3: anterio to SCM, lower in the neck than 2

Front 34

Management of thyroglossal duct cysts?

Back 34

En bloc cystectomy and excision of the central hyoid bone to minimise recurrence
NB: 1% are found to cintain cancer usually papillary

Front 35

What is a thyroglossal duct cyst?

Back 35

a vestigal remnant of the tract that the thyroid takes during gestation

Front 36

Difference in clinical features between thyroid lump and thyroglossal duct cyst?

Back 36

both move on swallowing
thyroglossal cyst will move on poking out tongue

Front 37

Difference between malignant and benign parotid gland tumor

Back 37

malignant affects facial nerve

Front 38

What is Warthin's tumor?

Back 38

benign adenoma of salivary gland, most likely parotid, less common than pleimorphic adenoma, association with cigarette smoking

Front 39

Midline neck pathology

Back 39

thyroglossal cyst, thyroid