Term
| commonest cause of neck lump. there may have been a preceding viral illness or local infection? |
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Definition
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Term
| a man has a rubbery painless lymphadenopathy. he also has night sweats and enlarged spleen. when he drank alcohol his lump hurt but otherwise it is painless. |
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Definition
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Term
| which direction do thyroid swellings move when swallowing? |
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Definition
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Term
| this midline lump is more common in pts <20 years old. it is found between the hyoid and the isthmus of the thyroid. when you ask the pt to stick their tongue out this cyst moves upwards. it is painful if it gets infected |
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Definition
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Term
| pharyngeal pouches are not usually seen as a lump but when they are big enough they are. where would the lump be located? |
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Definition
midline.
more common in older men. |
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Term
| I am a posteromedial herniation between the crico and the thyropharyngeus. I occur in older men. if I am big enough I appear as a midline lump and I gargle on palpation and give bad breath. other features include chronic cough, dyshphagia, aspiration and regurg. what the heck am I? |
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Definition
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Term
| I am usually found on the left side and am a congenital lymphangioma. I am evident at birth and around 90% of my type present before the age of 2 years |
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Definition
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Term
| which cyst presents in early adult hood that is located between the sternocleidomastoid muscle and the pharynx? what is this cyst caused by? |
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Definition
this is a branchial cyst
it is oval and mobile and due to failure of obliteration of the second branchial cleft in embryonic development |
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Term
| pulsatile lateral neck mass. it doesn't move on swallowing what is it? |
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Definition
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Term
| I occur more in females and can cause thoracic outlet compression leading to pins and needles in the affected side |
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Definition
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Term
| what red flag signs should you enquire about in a neck lump history to exclude cancer? |
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Definition
night sweats
weight loss
unexplained bruising
persistent fatigue
breathlessness |
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Term
| a person presents with a laryngocele. what would happen with blowing or valsalva manoeuvre? |
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Definition
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Term
midline lumps are likely to be thyroid or thyroglossals cysts
what about lumps in posterior triangle? |
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Definition
lymphadenopathy but these can also be in all areas of the neck.
parotid infection eg mumps tend to be bilateral and cross the mandibular angel |
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Term
| situations where you would refer for CXR within 2 weeks |
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Definition
supra clavicular lump (may be lung or upper GI cancer)
persistant cervical node in a person >40 years old |
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Term
| any new neck mass persisting beyond how many weeks should be referred? |
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Definition
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Term
| features that prompt 2 week referal |
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Definition
weight loss
other systemic symptoms suggesting cancer
change of voice
dyspnoea or dysphagia for > 3 weeks
haemoptysis
unexplained enlarged lymph node
diagnosis is unclear |
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Term
| if there are associated symptoms suggestive of lymphoma (weight loss, night sweats, fever, breathlessness, pruritus or bleeding) you should use the two-week wait referral in adults. what if this were in children or those < 24 years of age? |
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Definition
| 48-hour referral for children and young people up to the age of 24. |
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Term
| where do most salivary gland tumours occur? |
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Definition
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Term
common malignant tumours affecting major salivary glands are?
which type is most common in minor salivary glands? |
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Definition
mucoepidermoid
acinic
adenoid cystic
in minor glands the adenoid cystic is the most common |
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Term
| what is the most common benign tumour of salivary glands? |
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Definition
pleomorphic adenoma.
it is slow growing and asymptomatic |
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Term
| which benign salivary tumour is the second most common and occurs in women in the 6th decade and men in the 7th decade? |
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Definition
Warthins
smoking is an important risk factor |
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Term
| red flag features suggesting salivary gland malignancy? |
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Definition
facial nerve weakness
rapid increase in size
ulceration/induration of mucosa overlying skin
paraesthesia/anaesthesia of neighbouring sensory nerves
intermittent pain increasing relentlessly
hx of previous skin cancer, sjrogens or radiation to head and neck |
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Term
| what does facial palsy with salivary gland mass indicate? |
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Definition
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Term
| what is a carcinoma expleomorphic adenoma |
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Definition
| it is a pleomorphic adenoma that has undergone malignant change |
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Term
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Definition
can occur after parotid surgey
redness and sweating on the cheek, which can appear when eating, seeing or thinking about certain kinds of food which produce strong salivation |
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Term
red flag features.
STRIDOR associated with a thyroid mass would prompt?? |
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Definition
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Term
| thyroid masses prompting urgent 2 week referral |
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Definition
child with thyroid nodule
hoarse with goitre
painless mass enlarging rapidly over a few weeks
palpable cervical lymphadenopathy
other red flag signs:
FHx of thyroid cancer
Hx of previous irradiation or exposure to it
insidious or persistant pain last for several weeks |
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Term
| thyroid masses that need non urgent referal |
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Definition
thyroid nodules with abnormal TFTs
sudden onset of pain within a thyroid lump |
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Term
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Definition
USS
FNA
if suspecting medullary cancer then calcitonin and CEA levels |
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Term
| definitive rx for toxic multinodular goitre? |
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Definition
| biopsy or surgical excision followed by radio-iodine therapy |
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Term
| when is surgery indicated in thyroid disease |
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Definition
if it is compressing other structures such as the trachea
if there are substernal goitres as to biopsy these is difficult
the goitre cx to grow
it is cosmetically unacceptable |
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Term
| superior laryngeal nerve injury can occur due to thyroid surgery. what are the consequences of this? |
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Definition
external branch is motor to cricothyroid muscle
inability to creat high pitched voiced
career ending for professional singer |
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Term
| damage to which branch of the superior laryngeal nerve can be career ending for a singer. this is also the most common branch of the superior laryngeal nerve to be damaged in surgery |
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Definition
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Term
| causes of hyperthyroidism |
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Definition
most common is graves
toxic multinodular goitre
thyroiditis: destruction of thyroid cells releases hormone into circulation |
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Term
| recommended starting dose of carbimazole? |
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Definition
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Term
| describe block and replace technique and dose titration |
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Definition
in block and replace anti thyroid drugs are given with thyroid replacement
in dose adjustement only anti thyroid drugs are given and tritrated up |
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Term
| what can you use to medically rx hyperthyroid in pregnancy? |
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Definition
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Term
| what is the rx of choice in relapsed graves disease and multinodular goitre? |
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Definition
radio-iodine
given as a drink, taken up by throid gland where it destroys it. can take 3-4 months to take effect
definitive method to rx hyperthyroid. stop anti thyroid drugs 1 week b4 starting radio iodine as it reduces uptake of radio iodine |
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Term
can radio iodine be given in pregnancy and breast feeding?
what advice is given to women undergoing this treatment. |
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Definition
NO
advice women not to get pregnant for 6 weeks after rx
also cleared in urine so can be passed on. thus advised to avoid children and pregnant women for 3 weeks
hypothyroid is a common consequence |
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Term
| biochemical findings of hypothyroidism? |
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Definition
elevated CK
high cholesterol and trigylcerides
anaemia (normocytic or macrocytic)
these abnormalities usualy resolve with rx |
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Term
| the initial dose of levothyroxine is 50-100mcg. in what type of pts is the starting dose recommended at 25mcg? |
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Definition
those with cardiac disease
those over 50
those with severe hypothyroidism |
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Term
| which thyroid hormone does levothyroxine contain? |
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Definition
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Term
| DRUGS THAT CAN INTERFERE with t4 absorbtion? |
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Definition
ferrous sulphate
calcium supplements
rifampicin
amiodarone |
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Term
| the 2 common antibodies you would see in Graves disease |
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Definition
TSH receptor stimulating antibodies in 90%
anti TPO in 75% |
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Term
how would you initiate titration regime for hyperthyroid
starting dose of carbimazole
length of rx |
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Definition
start at 40mg and titrate down
rx duration 12-18 months
fewer side effects using titration versus treat and block method |
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Term
| how would you initiate block and replace method for hyperthyroid? |
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Definition
start carbimazole 40mg
when pt is euthyroid add thyroxine
rx lasts typically 6-9 motnhs |
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Term
| advice on radio iodine rx |
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Definition
used for recurrent relapses in rx hyperthyroid and multi nodular disease
avoid in pregnancy and those < 16
advice not to get pregnant for 4-6 months post treatment
can cause hypothyroid - dose dependent but majority of pts need thyroxine after 5 years
thyroid eye disease is a relative contrainidication and advise pt that it may worsen eye disease. |
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Term
toxic multi nodular goitre.
what does thyroid scan reveal?
what is the rx of choice? |
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Definition
nuclear scintigraphy reveals patchy uptake
rx of choice is radio iodine |
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Term
| what same findings would you see in sick euthyroid and secondary hypothyroidism? |
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Definition
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Term
| what same finding would you see in poor compliance with thyroxine and subclinical hypothyroid? |
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Definition
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Term
| CAUSES OG HYPERTHROIDISM? |
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Definition
GRAVES
TOXIC MULTINODULAR GOITRE
DRUGS
THYROIDITIS |
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Term
which drug causes hyperthyroid and hypothyroid
which one just causes hypothyroid? |
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Definition
amiodarone can cause both
lithium just hypothyroid |
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