Hyperthyroidism and Thyroid Cancer Quiz
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Questions and Answers

What is a common cause of hyperthyroidism in patients with a toxic multinodular goiter?

  • Autonomous nodules producing excess thyroid hormones (correct)
  • Excess pituitary gland activity
  • Viral infections affecting the thyroid
  • Exposure to low iodine levels

Which test is used to confirm the biochemical diagnosis of hyperthyroidism in toxic multinodular goiter?

  • Complete blood count (CBC)
  • Thyroid function tests (TFT) (correct)
  • Magnetic Resonance Imaging (MRI)
  • CT scan

Which of the following is NOT a risk factor for thyroid cancer?

  • High radiation exposure
  • Age over 60
  • Family history of goitre
  • Chronic autoimmune thyroiditis (correct)

What clinical feature may indicate advancing thyroid cancer?

<p>Hoarseness of voice (D)</p> Signup and view all the answers

Which treatment is typically performed for hyperthyroidism due to toxic multinodular goiter?

<p>Surgical intervention after controlling hyperthyroidism (B)</p> Signup and view all the answers

What is the primary action of Propylthiouracil (PTU) in the management of hyperthyroidism?

<p>Inhibiting peripheral conversion of T4 to T3 (C), Inhibiting iodine binding and coupling of iodotyrosines (D)</p> Signup and view all the answers

Which of the following is a primary contraindication for radioactive iodine therapy?

<p>Pregnancy (A)</p> Signup and view all the answers

What is the purpose of administering Lugol’s iodine or supersaturated potassium iodide before surgery?

<p>To reduce gland vascularity and risk of thyroid storm (A)</p> Signup and view all the answers

What is the typical time frame for observing the effects of radioactive iodine therapy?

<p>Usually seen in 2 months (C)</p> Signup and view all the answers

Which surgical option is recommended for a patient with coexistent thyroid cancer?

<p>Near or total thyroidectomy (D)</p> Signup and view all the answers

What is the main goal of surgery in the treatment of hyperthyroidism?

<p>To control disease with minimum morbidity (D)</p> Signup and view all the answers

What condition does a hot nodule indicate during a radio-iodine uptake test?

<p>Benign autonomous nodule (C)</p> Signup and view all the answers

What must occur before surgical management of hyperthyroidism?

<p>The patient must be rendered euthyroid (A)</p> Signup and view all the answers

What is one benefit of adding lactate to a salt solution?

<p>It minimizes dilution of plasma components. (B)</p> Signup and view all the answers

Which component is included in Plasmalyte that may help patients with depletion?

<p>Magnesium (C)</p> Signup and view all the answers

What is a significant disadvantage of using calcium in solutions?

<p>It reduces the bioavailability of certain drugs. (A)</p> Signup and view all the answers

Which statement accurately reflects the characteristics of dextrose solutions?

<p>They enhance carbon dioxide production. (A)</p> Signup and view all the answers

What is a common agreement in the crystalloid vs colloid debate?

<p>Fluid overload is detrimental to patient health. (B)</p> Signup and view all the answers

What effect does interstitial oedema have on the gut?

<p>Reduced absorption and enhanced bacterial translocation (D)</p> Signup and view all the answers

What is a downside of using crystalloids over colloids?

<p>They cause greater interstitial edema. (D)</p> Signup and view all the answers

Which class of acute haemorrhage involves a blood loss of more than 2000 mL?

<p>Class IV (D)</p> Signup and view all the answers

How does the requirement of volume for crystalloid compare to colloid in critically ill patients?

<p>Colloid requires 2-6 times more volume. (A)</p> Signup and view all the answers

What is the recommended fluid for emergency resuscitation of trauma patients?

<p>Ringer’s lactate (B)</p> Signup and view all the answers

What is the pulse rate criteria for Class III acute haemorrhage?

<blockquote> <p>120 bpm (D)</p> </blockquote> Signup and view all the answers

What is a noted effect of fluid volume balance on patient survival?

<p>Positive fluid balance shows a negative correlation with survival. (A)</p> Signup and view all the answers

Which of the following is NOT an adverse effect of interstitial oedema?

<p>Increased blood pressure (C)</p> Signup and view all the answers

What combination of fluids is recommended for Classes III and IV haemorrhage?

<p>3:1 ratio of crystalloids and blood products (A)</p> Signup and view all the answers

Which of the following parameters is normal in Class I acute haemorrhage?

<p>Blood pressure (C)</p> Signup and view all the answers

What is the mental status of a patient in Class III acute haemorrhage?

<p>Anxious and confused (C)</p> Signup and view all the answers

What is the maximum allowable plasma sodium concentration for treatment purposes?

<p>130mmol/L (B)</p> Signup and view all the answers

Which symptom is NOT associated with hypernatraemia?

<p>Increased lacrimation (A)</p> Signup and view all the answers

What is the consequence of hypernatraemia on cellular hydration?

<p>Cellular dehydration (B)</p> Signup and view all the answers

Which is a common cause of hypernatraemia related to fluid intake?

<p>Thirst center dysfunction (C)</p> Signup and view all the answers

What fluid is most appropriate for gradually correcting pure water loss in hypernatraemia?

<p>5% dextrose water (D)</p> Signup and view all the answers

Which type of treatment is necessary when hypernatraemia is due to pure salt gain?

<p>Loop diuretics and 5% dextrose (B)</p> Signup and view all the answers

What physiological effect can hypernatraemia cause regarding potassium levels?

<p>Hyperkalaemia due to cellular efflux (B)</p> Signup and view all the answers

The aim is to achieve normal sodium levels over what duration when treating hypernatraemia?

<p>48 hours (C)</p> Signup and view all the answers

Which of the following is classified as a benign soft tissue tumour?

<p>Fibromatosis (A)</p> Signup and view all the answers

What type of malignant soft tissue tumour arises from fatty tissue?

<p>Liposarcoma (D)</p> Signup and view all the answers

Which tumour is categorized as aggressive in the histological classification of soft tissue tumours?

<p>Desmoid tumour (B)</p> Signup and view all the answers

Which of the following is NOT a type of malignant soft tissue tumour?

<p>Haemangioma (B)</p> Signup and view all the answers

Which classification scheme is the basis for the WHO classification system for soft tissue tumours?

<p>Tissue of origin classification (D)</p> Signup and view all the answers

What type of benign soft tissue tumour is derived from nerve sheath cells?

<p>Neurilemmoma (B)</p> Signup and view all the answers

Which soft tissue tumour is associated with blood vessels and is benign?

<p>Haemangioma (C)</p> Signup and view all the answers

Which of the following statements about soft tissue tumours is true?

<p>Environmental and genetic factors can predispose to soft tissue tumours. (D)</p> Signup and view all the answers

Flashcards

Electrolyte solutions

Solutions containing electrolytes to approximate plasma composition, minimizing dilution and acidosis.

Plasma electrolyte composition

The specific concentrations of electrolytes (e.g., potassium, calcium) present in healthy blood plasma.

Dextrose solutions

Solutions containing glucose (dextrose) used to provide calories, NOT as effective volume expanders.

Colloid solutions

Solutions with large molecules that expand intravascular volume more efficiently than crystalloids, but at a higher cost.

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Crystalloid solutions

Solutions containing smaller molecules that expand intravascular volume by fluid shifting from one compartment to another.

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Fluid overload

Excessive fluid in the body, harmful to critically ill patients regardless of solution type.

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Interstitial edema

Fluid accumulating in the tissues outside blood vessels, often a result of fluid resuscitation.

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Colloid vs crystalloid controversy

Ongoing debate about the best type of fluid for resuscitation, with no clear winner.

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Hypernatraemia

High sodium concentration in the blood (above 145mmol/L).

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Causes of Hypernatremia

Iatrogenic (e.g., infusions), increased losses (e.g., fever, thyrotoxicosis), decreased intake (e.g., unconscious patients), and increased water loss (e.g., diabetes insipidus).

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Symptoms of Hypernatremia

Dry mouth, decreased tear production, high body temperature, irritability, drowsiness, confusion, and coma, as well as decreased fluid in the body.

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Treatment (Pure Water Loss)

Replace fluids slowly with hypotonic solutions (e.g., tap water, dextrose) over 1-3 days to avoid cerebral edema.

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Treatment (Water and Salt Loss)

Expand the extracellular fluid with normal saline, then correct the water deficit with isotonic fluids over 1-3 days.

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Treatment (Pure Salt Gain)

Use loop diuretics and 5% dextrose to remove excess sodium before potentially using dialysis.

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Hypernatremia Consequences: Fluid shift

Water moves from inside cells to the blood, causing cellular dehydration, potentially leading to blood vessel damage in the brain.

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Hypernatremia Consequences: Hyperkalemia

High sodium levels drive potassium out of cells to maintain balance, potentially causing high potassium levels.

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Interstitial Edema Adverse Effects

Interstitial edema can cause problems in the brain (obtunded consciousness), lungs (gas exchange issues), heart (reduced pumping ability), wound healing (impaired), gut (reduced absorption and bacterial issues), and increased risk of abdominal compartment syndrome.

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Trauma Resuscitation Fluid Choice

Ringer's lactate is currently recommended for initial emergency trauma resuscitation, followed by blood products as needed.

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American College of Surgeons Acute Hemorrhage Classes

A system to classify acute blood loss based on blood loss volume, vital signs, and urine output.

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Class I Acute Hemorrhage

Minor blood loss (up to 750ml), normal vital signs, and good urine output.

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Class II Acute Hemorrhage

Moderate blood loss (750-1500 ml), minor vital signs changes, and some decrease in urine output.

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Class III Acute Hemorrhage

Significant blood loss (1500-2000 ml), decreased vital signs, reduced urine output, and anxiety.

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Class IV Acute Hemorrhage

Severe blood loss (>2000 ml), severely decreased vital signs, very low urine output, and confusion.

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Fluid Choice Recommendations

Crystalloids are sufficient for Class I and II, but crystalloids and blood (3:1 ratio) for Class III and IV.

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Toxic Multinodular Goiter

A condition where nodules in the thyroid become independent and cause hyperthyroidism, even if the patient had a nontoxic goiter previously.

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Jodbasedow Phenomenon

Hyperthyroidism caused by excess iodine intake, often from contrast media or drugs like amiodarone. It expands the body's iodine pool.

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RAIU Scan in Toxic MNG

A radioactive iodine uptake scan that shows multiple nodules with increased uptake, while the rest of the thyroid is suppressed.

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Treatment of Toxic MNG

Surgery (subtotal or near total thyroidectomy) is the main treatment after controlling hyperthyroidism. RAI ablation is problematic due to poor iodine uptake by non-functioning nodules.

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Thyroid Cancer Risk Factors

Radiation exposure, family history of goiter, inherited syndromes, age over 60, rapid growth and pain in the thyroid.

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Soft Tissue Tumours (STT)

Tumours arising from tissues like muscle, fat, nerves, and fibrous tissue.

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Tissue of Origin Classification

Categorizing STT based on the type of tissue they originate from.

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Benign STT

Tumours that grow slowly, are well-defined, and don't spread to other tissues.

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Aggressive STT

Tumours that grow faster than benign ones and may invade nearby tissues.

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Malignant STT

Cancerous tumours that can invade surrounding tissues and spread to other parts of the body.

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Fibrous STT

Tumours arising from connective tissue that provides support and structure.

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Adipose STT

Tumours originating from fat tissue.

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STT Aetiology

The study of the causes of STT, often a combination of environmental and genetic factors.

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Antithyroid drugs

Medications like propylthiouracil (PTU), methimazole, and carbimazole used to reduce thyroid hormone production. They block iodine binding and coupling of iodotyrosines, and some inhibit T4 to T3 conversion.

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Radioactive iodine therapy

Treatment for hyperthyroidism using radioactive iodine (I-131). It's a common option, avoiding surgery and reducing costs. It can lead to hypothyroidism, requiring lifelong thyroid hormone replacement.

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Contraindications for radioactive iodine

Reasons why radioactive iodine therapy is not suitable for all patients. Absolute contraindications include pregnancy and breastfeeding. Relative contraindications include young people, patients with thyroid nodules, and ophthalmopathy.

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Surgical treatment for hyperthyroidism

Surgery involves removing all or part of the thyroid gland after preparing the patient with antithyroid drugs. The goal is to control hyperthyroidism with minimal complications like nerve damage or hypoparathyroidism.

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Preparation for thyroid surgery

Patients undergo a series of steps before surgery: antithyroid drugs to bring thyroid hormone levels to normal, Lugol's iodine to reduce blood supply to the thyroid, and sometimes, potassium iodide to prevent thyroid storm.

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Toxic adenoma

A single, benign nodule in the thyroid gland that produces excess thyroid hormone, causing hyperthyroidism. It is usually visible on ultrasound and absorbs radioactive iodine more than the rest of the gland.

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Treatment for toxic adenoma

Surgery is the primary treatment for toxic adenoma, involving removal of the affected lobe and the connecting isthmus. Patients are made euthyroid prior to surgery.

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Propranolol for hyperthyroidism

Beta-blocker medication that reduces the peripheral conversion of T4 to T3 and lowers the catecholamine response associated with thyrotoxicosis.

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Study Notes

Lecture Notes in General Surgery – A Students Guide

  • The document is a compilation of topics forming the core of undergraduate teaching in General Surgery.
  • It serves as a guide for undergraduate students to direct their reading.
  • It's not a comprehensive overview; supplementation is needed.
  • The notes cover various surgical topics, including: fluids and electrolytes, nutrition in surgical patients, burns, thyroid, breast disorders, skin disorders, soft tissue tumors, approaches to various abdominal issues, vascular surgery, polytrauma, and more.
  • The document was edited in April 2012 by Prof B Singh and Mrs Moodley.

Content Outline

  • Foreword: Discusses the purpose of the lecture notes as a study guide for undergraduate General Surgery students.
  • Fluids and Electrolytes: Covers basic principles including fluid distribution, electrolyte composition, and fluid therapy for various patient types.
  • Nutrition in the surgical patient: Details the importance of nutrition in surgical recovery, who needs it, and assesses various indicators of nutritional status.
  • Burns: Provides an overview of burn assessment, acute management, wound management, and long-term care.
  • Thyroid: Discusses benign and malignant thyroid pathology including the clinical evaluation and investigations.
  • Breast: Describes benign breast disorders and breast cancer, covering risk factors, classification, diagnosis, and management.
  • Skin disorders: Includes infections (cellulitis, folliculitis, furuncles, and carbuncles; necrotizing fasciitis), pilonidal disease, and skin lesions (melanoma).
  • Soft Tissue Tumors: This section covers benign and malignant soft tissue tumors, their classification, aetiology, clinical features, investigations, and management options.
  • Approach to acute abdominal pain: Elaborates on the assessment of acute abdominal pain, including a description of the abdominal anatomy.
  • Vascular surgery: Covers peripheral vascular disease, intermittent claudication, critical limb ischemia, and vascular trauma.
  • Polytrauma: Outlines the approach to evaluating and managing multiple injuries.
  • Other topics: Additional topics include colorectal cancer, obstructive jaundice, acute pancreatitis, lower gastrointestinal bleeding, approach to dysphagia and more.

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UKZN General Surgery Lecture Notes PDF

Description

Test your knowledge on hyperthyroidism, particularly focusing on toxic multinodular goiter and its implications for treatment and diagnosis. This quiz covers common causes, risk factors for thyroid cancer, and therapeutic options, including radioactive iodine and surgery. Enhance your understanding of the clinical features and management strategies associated with these conditions.

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