A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 17 years old male, presented with a painful neck swelling, The swelling was first noticed 10 years ago and was small and painless then. In the last two months, the swelling increased in size and became painful and started to cause slight discomfort on swallowing.
The presentation contains 50 slides, and is divided into the following parts :
1 - The case
2 - Thyroglossal cysts
3 - Imaging Thyroglossal cysts
4 - Differential diagnoses
This presentation was prepared by me and I will present it today in sha Allah in the tutorials of the Radiology Department of Sebha Medical Center.
Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 17 years old male, presented with a painful neck swelling, The swelling was first noticed 10 years ago and was small and painless then. In the last two months, the swelling increased in size and became painful and started to cause slight discomfort on swallowing.
The presentation contains 50 slides, and is divided into the following parts :
1 - The case
2 - Thyroglossal cysts
3 - Imaging Thyroglossal cysts
4 - Differential diagnoses
This presentation was prepared by me and I will present it today in sha Allah in the tutorials of the Radiology Department of Sebha Medical Center.
Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
The thyroid is a butterfly-like gland located in the lower half of the neck, below the larynx, and in front of the trachea. It consists of two lobes, each measuring between 2 and 4 centimeters, and interconnected by a central narrowed part. Thyroxine and triiodothyronine secrete their hormones into the blood. The work of the thyroid gland in physiological circumstances is controlled by the hypothalamus and pituitary gland. In the control of thyroid function, the most important is the pituitary gland, which uses thyrotropin to stimulate the thyroid gland to produce hormones, but also to grow, which can lead to an increase in the thyroid gland or goiter.
The thyroid is a butterfly-like gland located in the lower half of the neck, below the larynx, and in front of the trachea. It consists of two lobes, each measuring between 2 and 4 centimeters, and interconnected by a central narrowed part. Thyroxine and triiodothyronine secrete their hormones into the blood. The work of the thyroid gland in physiological circumstances is controlled by the hypothalamus and pituitary gland. In the control of thyroid function, the most important is the pituitary gland, which uses thyrotropin to stimulate the thyroid gland to produce hormones, but also to grow, which can lead to an increase in the thyroid gland or goiter.
this presentation discusses how to approach to the neck mass
and important DDx according to the site and age of onset
with clinical points about important etiologies
This simplified lecture gives an account of how to approach a patient with a neck mass. Moreover, it shows hoe master thyroid gland history taking and examination and general examination.
Additionally, the lecture is supported by many real-life scenarios to cover the topics from a clinical point of view.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. A Case of Goitre
History :
I- Type of Patient.
II- Symptoms.
III- Past history.
I) Type of Patient :
• Physiological goiter → at puberty or pregnancy.
• Colloid & primary toxicosis → 20 – 30 y.
• Nodulary & 2ry toxicosis → 30 – 50 y.
• Malign. Goiter → after 50 y.
• Except for carcinoma all diseases of thyroid are
common in male than female.
II) Symptoms :
1) Neck symptoms.
2) Eye symptoms.
3) Symptoms of thyrotoxicosis.
4) Features of malignancy.
5) Symptoms of myxoedema.
Neck Symptoms :
1) A lump in the neck.
2) discomfort during swallowing
3) Dyspnoea.
4) Pain.
5) Hoarseness.
III) Past History
• Trauma
• Operation
• Medication
- 2 -
5. Retrosternal goiter
Barium Swallow shows Dilated superior veins on
the
Trachea and Trunk and arm due to
oesophageal deviation obstruction of superior vena
Cava
- 5 -
6. II) Symptoms :
1) Neck symptoms.
2) Eye symptoms.
3) Symptoms of thyrotoxicosis.
4) Features of malignancy.
5) Symptoms of myxoedema.
1) Neck Symptoms :
1) A lump in the neck.
2) discomfort during swallowing
3) Dyspnoea.
4) Pain.
5) Hoarseness.
1) A lump in the neck :
• Onset, duration, size
Usually slowly growing and painless swelling, but painful
rapid enlargement suggests thyroiditis , malignancy or
hemorrhage within cyst sudden enlargement of a lump caused
by hemorrhage is usually painful but , a fast – growing
anaplastic carcinoma is not usually painful until it invades
nearly structures.
2) discomfort during swallowing
• large swellings → tugging sensation during swallowing and
this is not true dysphagia.
• The thyroid swellings rarely obstruct the oesophagus
because the oesophagus is a muscular tube which is easily
stretched and pushed aside however , because the thyroid
has to be pulled upwards with the trachea in first stage of
deglutition , an enlarged makes swallowing uncomfortable
and even difficult.
- 6 -
7. 3) Dyspnoea :
• due to deviation or compression of trachea by a mass in the
thyroid. This symptom is often worse when the neck is
flexed laterally or forwards.
• The whistling sound of air rushing through a narrowed
trachea is called "stridor".
4) Pain :
• It is not a common feature of thyroid swellings acute and
sub acute thyroiditis present with a painful gland and
Hashimoto's disease.
• Anaplastic carcinoma can cause local pain and pain related
to the ear if it infiltrates surrounding structures.
5) Hoarsness :
• It is significant symptom as it is probably caused by a paralysis
of one recurrent laryngeal n. with means that the lump is likely
to be an anaplastic carcinoma infiltrating the nerve.
- 7 -
8. 2) Eye Symptoms :
The patient may complain of staring or protruding eyes and
difficulty in closing her eyelids "exophthalmos".
- 8 -
9. 3) Symptoms of Thyrotoxicasis :
• C.N.S → Nervousness , irritability , insomnia , tremor.
• C.V.S → Palpitation , dyspnea on exertion , chest pain
• Metabolic → ↑in appetite but loss of wt
• Alimentary → Change of bowel habit usually diarrhea.
• Tolerance to cold weather and excessive sweating with
intolerance to hot
• Change in menstruation even amenorrhea.
4) Features of Malignancy :
• Features Suspicious of malignancy.
a solitary nodule in the thyroid gland.
• Features Suggestive of malignancy.
1- Rapid growth in size.
2- Hard consistency.
3- Fixity.
4- Pressure manifestations :
• On recurrent → hoarsness of vioce.
• On trachea → dyspnea.
• On oesophygous → dysphagia
• On carotid → absence of carotid pulsation
5- Pain indicate infiltration of nerves , expecially which
referred to the ear which passes along auricular br. Of the
vagus (Arnold’s nerve).
6- Increased vascularity.
7- Cold adenoma.
- 9 -
10. • Features Sure of malignancy.
Presnce of 2ry metastases and positive biopsy
Metastasis in the left parietal bone from a carcinoma
- 10 -
11. of the Thyroid.
5) Symptoms of Myxoedema :
• An increase of wt with deposition of fat across the back of
the neck and shoulders.
• Slow thought , speech and action.
• Intolerance to cold.
• Loss of hair (specially outer 43 of eye brows).
• Muscle fatigue.
• Dry skin.
• Constipation.
- 11 -
12. III) Past History :
- In thyroglossal fistula → past history of infected swelling .
- In every case →
past history of toxicosis .
- 12 -
13. Past history of medication.
Past history of previous operation.
Examination
I) General Examination :
1) Face.
2) Examination for signs of toxicosis :
A) Eye signs.
B) Tremor.
C) C.V.S.
D) Hands.
E) Legs.
3) Search for metastases.
In suspected Hashimoto's → liver and spleen should be
examined.
1) Face :
• Anxious stare é protruding eyes and fullness of thyroid
region → primary thyrotoxicosis.
• Pale puffy face é protruding tongue and thick
lips → cretinism.
2) Examination for signs of toxicosis :
A) Eye Signs :
11 Mild exophthalmos : "widening of palpebral fissure due to
retraction of the upper eye lids without any bulging of the
eyes".
• Stellwag's sign +ve.
• Von Graefe's sign +ve.
11 Moderate exophthalmos : "actual bulging of eyeballs from
increased deposition of retrobulbar fat".
• Dalymple's sign +ve.
• Joffroy's sign +ve.
11 Severe exophthalmos : "due to intra orbital aedema and
congestion" → marked protrusion of eyes.
• Mobius sign +ve.
- 13 -
14. 11 Malignant exophthalmos : " it is progressive form ,
particularly after thyroidectomy é impairment of corneal
sensitivity and paralysis of eye muscles.
B) Tremor :
Thyrotoxicosis causes a fine , fast tremor and demonstrated by :
1. Stretching out the hands.
2. Putting out the tongue for minute at least.
3. Closing the eye lids lightly for a while.
4. In severe cases , the whole body becomes shaky and
trembling.
C) C.V.S :
• Pulse → rate , rhythm , character
In thyrotoxicosis → ↑rate , irregular auricular
fibrillation.
• Signs of congestive Ht failure.
• B.P → ↑systolic ↓diastolic So pulse p. ↑
↑.
• Sleeping pulse :
Less than 90 Min → Mild
Less than 90 – 110 Min → Moderate
Over 110 Min → Severe
D) Hands :
• Fell the pulsation.
• In primary toxic goitre → warm / sweaty
• In neurosis → cold / clammy
• Detection of tremors
E) Legs :
Pretibial myxedema → rare sign but usually after
thyroidectomy starts bilateral pitting with arranged
coloured
pigmentation by time → solid oedema with red colour.
- 14 -
15. Pretibial myxedema
3) Search for metastases :
In suspected cases :
• Cervical lymph nodes.
• Bones → skull & long bones
• Chest , liver & Abdomen.
II. Local Examination
Inspection Palpation Percussion Auscultation
A) Lump.
B) Skin.
C) Neck.
A) For thyroid by
two methods.
B) Relations.
C) Lymph nodes.
Inspection
A) Lump :
• Site , size , shape , pulsations , particular features → moves
é deglutition.
B) Skin :
• Look for thyroglossal fistula.
• For scar of previous operation.
• For dilated veins over the neck and upper part of the chest.
- 15 -
16. C) Neck :
• For other swelling outside the thyroid region.
• For neck veins.
Palpation
A) For swelling and thyroid region
1) Palpate the neck from the front :
• The most important part of palpation is done from behind ,
but , it is preferred to place your hand on any visible
swelling while standing in front of the patient , to confirm
your visual impression of its size , shape and surface and to
find out if it is tender.
2) Palpate the neck from behind :
• Stand behind the patient , placing your thumbs on the nap
and tilt the head slightly forwards to relax the out neck M.
let the palmar surface of your fingers rest on either side of
the neck. They will be resting on the lat lobes of the thyroid
gland. A small lobe can be made prominent and easier to
feel by pressing firmly on the opposite side of the neck.
• If you are still doubtful → ask the patient to swallow while
you examining.
• By this maneuver you confirm the facts about , tenderness ,
shape , size , surface consistency.
- 16 -
17. B) Relations
1) To the skin : Pinch up a fold of skin and move it over the
swelling.
2) To sterno mastoid :
• To test one side , place your hand on the side of the
patient's chin opposite to the side of the lesion and tell him
to push against the resistance of your hand. To test both
sides simultaneously , put your hand under the point of the
chin and ask him to press down against resistance when
both stern mastoids are put into action. If the swelling lies
deep to the M. , which is a common occurrence , it
disappears under the M. either completely or partially
depending upon the size of the gland. It the swelling is
situated sup. to M. it will be more apparent and movable
over the contracted M.
3) To the trachea & larynx :
• Whether displaced by swelling or not. Thyroid swelling
may compress the trachea from both sides → giving rise
"scabbard Trachea" the presence of which can be
- 17 -
18. determined by Kocher's test i.e. slight pressure on lat lobes
produce stridor.
4) To carotid sheath :
• Along the post edge of swelling benign swelling → may
displace the carotid sheath backwards and outwards , while
malignant T. tends to surround the sheath completely and
obscure the carotid pulsation. "Berry's sign".
5) To suprasternal notch :
• Trying to insinuate the fingers between the supra sternal
notch and the lower border of the swelling. In retrosternal
type the lower border can not be left.
6) To the oesophagus :
• Displacement on compression of oesophagus by enlarged
gland may give to → dysphagia.
7) To recurrent laryngeal N. :
• In malignant cases → hoarseness of voice.
8) To the syphthic trunk :
• It may give to Horner's Syndrome
- 18 -
19. Ptosis → slight drooping of eye lid.
Enopthalmosis → slight sinking of eye ball into orbit.
Anhydrosis → absence of sweating of affect side.
Myosis → contraction of pupil.
C) Lymph nodes :
• Upper deep cervical → as sup. thyroid vein drained into it.
• Lower deep cervical → as middle thyroid vein drained into
it.
• Mediastinal L.N. → as inf. thyroid vein drained into it.
• The deeper and more medial lymphatics proceed to
pretracheal , prelaryngeal and recurrent laryngeal lymph
nodes before ending in the mediastinal gland.
Percussion
Over sternum to detect the presence of retrosternol goitre. It is not
practically helpful.
Auscultation
In primary Toxic → systolic or continuous murmur over the
gland.
Measurement of circumference of the neck at the most prominent
part of the lump to determine whether the swelling is increasing
or decreasing in size.
- 19 -
20. Oral and clinical Questions
1. What are other swellings moves é deglutition ?
• Pharyngeal diverticulum.
• Pretraceal L.N.
• Laryngeocele.
• Thyroglossal cyst.
• Subhyoid bursitis.
2. Sometimes thyroid swelling does not move during
swallowing. What are such cases ?
• Huge.
• Retrosternal.
• Malignant, due to infiltration .
• Riedel`s thyroditis, due to fibrosis.
3. What are the causes of painful goiter ?
• Malignancy
• Acute thyroiditis
• Hemorrhage in cyst.
4. What are the causes of dullness on manubrium
sterni ?
• Retrosternal goiter.
• Ectopic Thyroid tissue.
• Pre-tracheal lymph nodes.
5. Why vital sign stable in case of toxicity during
examination ?
- 20 -
21. • Because the pat. is controlled “under treatment” by anti
toxic drugs
6. What is the cause of unequal pulses in case of goitre ?
• If there is retrosternal extension.
7. What are the causes of water hummer pulse ?
• Thyrotoxicosis.
• Anemia.
• A.V. fistula.
• Hepatic failure.
• Hypoxic cor-pulmonale.
8. What are the causes of unilateral exophthalmos ?
• Orbital cellulitis .
• Orbital neoplasm.
• Orbital Aneurysm of ophthalmic artery.
• Cavernous sinus thrombosis.
9. What are the causes of pulsating exophthalmos ?
• Arterial - Exophthalmos
- Orbital aneurysm
- A.V. fistula between ICA & Cavernous sinus
10. What is the difference between fine & flapping tremors ?
• Fine Tremors :
due to increase in metabolites leading to irritation of
nerve ending resulting in tremors of a small joints of
hands
• Flapping Tremors :
due to increase of toxins leading to irritation of
Extra - pyramidal resulting in tremors of wrist joint of
hand.
11. What are the causes of liver enlargement in case of
goitre ?
• Thyrotoxic H.F.
• Auto immune “ Primary toxic & Hashimoto`s disease ”.
• Thyroid lymphoma .
- 21 -
22. • Liver metastasis .
12. What are the causes of spleen enlargement case of goitre ?
• Thyrotoxic H.F.
• Auto immune “ Primary toxic & Hashimoto`s disease ”.
• Thyroid lymphoma .
13. What are the causes of dyspnea in case of goitre ?
• Malignancy
• Retrosternal goitre
• Thyrotoxic H.F.
14. What are the causes of enlargement lymph node in case of
goitre ?
• Cancer thyroid “ papillary type ”
• Lymphoma
• Hashimoto`s disease
• Acute thyroditis
15. What are the neck swelling which moves with deglutition
and tongue protrusion ?
• Thyroglossal cyst
• Subhyoid bursitis
16. How can you differentiate between toxic goitre
& psychoneurosis ?
• In toxic goitre : there is polyphagia, warm sweaty hands,
tachycardia & abnormal thyroid function tests.
• In Psychoneurosis : There is anorexia , cold sweaty hands,
normal sleeping pulse & normal thyroid function tests.
17. What are the best laboratory tests ?
• Free thyroxine levels or total T4 & T3 resin uptake.
18. Does a “cold” nodule on thyroid scan indicate
malignancy ?
• All cysts & many benign adenomas show up as “cold”
nodules, conversely a few thyroid cancers appear as
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23. “warm” nodules. Therefore thyroid scans are reliable in
diagnosing malignancy.
19. What is the main difference in metastatic tendencies
between papillary & follicular cancers ?
• Papillary cancers metastasize to neck first. Follicular
cancer metastasize distantly ( Hematogenous )
20.What are the causes of diffuse enlargement of thyroid ?
• Physiological goitre little enlargement and soft.
• Colloid goitre may huge , always elastic
• Primary thyrotoxicosis may be minimal and soft.
• Hashimoto’s disease very firm.
• Riedel’s diseases woody thyroid.
Written Questions
2- Retrosternal goitre.
3- Management of malignant goitre.
4- Thyrotoxicosis :
• Investigation
• Treatment
5- Clinical evaluation and management of solitary
nodule.
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25. The problem of clinically solitary nodule and its
evaluation
Clinically only one macroscopic nodule is found , but
microscopic changes will be present throughout the gland. This is
one form of clinically solitary nodule which is refered to as
cystadenoma of the thyroid and its commonest site is at junction
of the isthmus with one lobe , and although it appears solitary
multiple small adenometa are scattered around it. When there is a
solitary nodule of thyroid it is must be differentiated from true
adenoma.
Solitary nodule True adenoma
- Poor encapsulation - Good encapsulation
- Variable structure - Uniform structure
- Similar in structure - Different from adjacent
of adjacent thyroid T. thyroid T.
- no compression on - Compression on
adjacent gland adjacent gland
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26. Causes of solitary nodule in thyroidCauses of solitary nodule in thyroid
11..solitary nodular goitersolitary nodular goiter..
22..Toxic nodular goiterToxic nodular goiter..
33..Malignant nodule (medullary adenomaMalignant nodule (medullary adenoma((
44..True adenoma of thyroidTrue adenoma of thyroid..
Adenoma of thyroid may beAdenoma of thyroid may be::
--Embryonal adenomaEmbryonal adenoma
11..--Fetal or micro-follicular adenomaFetal or micro-follicular adenoma
--Colloid or macro-follicular adenomaColloid or macro-follicular adenoma
--Hurthle-cell adenoma with acidophilic cytoplasmHurthle-cell adenoma with acidophilic cytoplasm
--Papillary cystadenoma highly suspicious of being malignantPapillary cystadenoma highly suspicious of being malignant..
InvestigationInvestigation of solitary noduleof solitary nodule::
11..Thyroid ScanningThyroid Scanning::
--Hot nodule = overactive noduleHot nodule = overactive nodule
Takes up isotope , while the surrounding tissue does not ,Takes up isotope , while the surrounding tissue does not ,
here , the surrounding. T. is inactive because the nodule ishere , the surrounding. T. is inactive because the nodule is
producing such high levels of thyroid hormones that T.S.H isproducing such high levels of thyroid hormones that T.S.H is
suppressedsuppressed..
--Worm nodule = active noduleWorm nodule = active nodule
Takes up isotope and so does normal surrounding tissueTakes up isotope and so does normal surrounding tissue
about itabout it..
--Cold nodule = inactive nodule Takes up no isotopeCold nodule = inactive nodule Takes up no isotope
D.D of cold noduleD.D of cold nodule::
degenerative cyst, calcification, haemorrhage, abscessdegenerative cyst, calcification, haemorrhage, abscess
or hydatid cystor hydatid cyst..
22..Ultrasound (echographyUltrasound (echography((
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27. ••It is helpful to differentiate solitary from multiple nodulesIt is helpful to differentiate solitary from multiple nodules
••It is also used for differentiating solid from cystic lesionsIt is also used for differentiating solid from cystic lesions..
33..BiopsyBiopsy
••FNAC or Trucut or Excisional biopsyFNAC or Trucut or Excisional biopsy..
Treatment of solitary noduleTreatment of solitary nodule::
11..EnucleationEnucleation::
Removal of the nodule from it`s capsule. But it is notRemoval of the nodule from it`s capsule. But it is not
recommended because recurrence is the rule as therecommended because recurrence is the rule as the
nodule is never solitarynodule is never solitary..
22..Resection EnucleationResection Enucleation::
Excision of the nodule with the surrounding thyroid tissueExcision of the nodule with the surrounding thyroid tissue..
It is the recommended operation asIt is the recommended operation as we remove the scatteredwe remove the scattered
small nodules around the clinical solitary nodulesmall nodules around the clinical solitary nodule..
33..HemithyroidectomyHemithyroidectomy::
Removal of the affected lobe together with the isthmus andRemoval of the affected lobe together with the isthmus and
pyramidal lobe. The specimen must be sent for biopsypyramidal lobe. The specimen must be sent for biopsy..
It is the operation of choiceIt is the operation of choice..
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