Neck

Question 0

Anterior triangle lump Ddx

Answer 0

1. Brachial cyst (under top of SCM)
2. Carotid body tumour
3. Lymph node
4. Sebaceous cyst
5. Lipoma

Question 1

Midline neck lump Ddx

Answer 1

1. Goitre
2. Glossopharyngeal cyst
3. Lipoma
4. Sebaceous cyst

Question 2

Posterior triangle lump Ddx

Answer 2

1. Cystic hygroma (above clavicle)
2. Lymph node
3. Lipoma
4. Sebaceous cyst

Question 3

Goitre Ddx

Answer 3

1. Graves (diffuse)
2. Multinodular goitre
3. Solitary nodule
4. Hashimoto’s thyroiditis
5. Subacute thyroiditis
6. Iodine deficiency 90%+

Question 4

Hypothyroidism Ddx

Answer 4

1. Autoimmune (primary atrophic thyroiditis - no goitre, hasimoto’s initially)
2. Acquired (iodine deficiency, subacute thyroiditis,iatrogenic)
3. Secondary ( panhypopituitarism)

Question 5

Hyperthyroidism Ddx

Answer 5

1. Graves
2. Toxic MNG
3. Toxic nodule (usually adenoma)
4. Thyroiditis in the initial phase (hashimoto’s, post partum, subacute)
5. Secondary (TSHoma, hydatidiform mole, choriocarcinoma)
   90% of cases will be due to 1-3.

Question 6

Bilateral Parotid swelling Ddx

Answer 6

1. Viral/bacteria parotitis
2. TB
3. Alcohol
4. Pleomorphic adenoma
5. Sjogren’s
6. Sarcoidosis

Question 7

Unilateral parotid swelling Ddx

Answer 7

1. Duct blockage

2. Unilateral pleomorphic adenoma

Question 8

MNG toxic vs non-toxic

Answer 8

Toxic - hyperthyroid
Non-toxic - euthyroid
MNG may be smooth to feel

Question 9

Graves’ disease signs

Answer 9

1. Goitre
2. Thyrotoxicosis
3. Eye disease (exophthalmos, opthalmoplegia)
4. Pretibial myxodema
5. Thyroid acropachy
   3-5 unique to graves

Question 10

Graves vs MNG

Answer 10

1. Smooth (MNG rarely smooth)
2. Grave’s unique features
3. TSH receptor antibodies

Question 11

Graves indications for surgery

Answer 11

1. Cosmetic
2. Local compression
3. Failed medical Rx
4. Intolerant to medication

Question 12

Hyperthyroid eye signs

Answer 12

1. Lid retraction
2. Lid lag
3. Exophthalmos
4. Opthalmoplegia
   3-4 specific to graves

Question 13

Hyperthyroid Rx

Answer 13

1. Medical (symptomatic - b blocker, anti-thyroid - carbimazole)
2. Radioiodine
3. Surgical (cosmetic, compression, malignancy) - total/partial thyroidectomy
   Carbimazole may cause bone marrow suppression

Question 14

Contraindications for radioiodine

Answer 14

1. Pregnancy/breast feeding
2. Young children at home
3. Incontinent (elimination in urine)

Question 15

Early complications of thyroidectomy

Answer 15

1. Anaesthetic
2. Haemorrhage
3. Infection
4. Damage to surrounding tissue (recurrent laryngeal, trachea, oesophagus, neck musculature)
5. Transient hypoparathyroidism

Question 16

Late complications of thyroidectomy

Answer 16

1. Hypoparathyroidism
2. Recurrent hyperthyroidism
3. Hypothyroidism

Question 17

Brachial cyst - Ddx

Answer 17

Anterior triangle Ddx

1. Cancer - thyroid, lymphoma, metastases
2. Lymphadenopathy
3. Lipoma/sebaceous cyst
4. Goitre
5. Salivary gland stone/cyst
6. Thyroglossal duct cyst

Question 18

Bronchial cyst - investigation, management

Answer 18

Ix - CT neck, Fistulogram

Tx - surgical excision

Question 19

FNA vs Scintiscan

Answer 19

FNA - cold solitary nodules

Scintiscan - alternative