Friday, March 27, 2009

Identification data - Anterior neck swelling


70 years old, lady, complained of difficulty in swallowing and shortness of breath for the past 5 months with an anterior neck swelling for the past 20 years. 5 months ago she notice that the swelling starts to grow more rapidly compared to previous years. Patient also complains of hoarseness of voice, loss of appetite, loss of weight roughly around 6 kg and pain at the swelling.

a) State the abnormality seen in this photograph.

b) State FOUR (4) clinical signs you would want to elicit in this patient.

c) State TWO (2) tests to assess the anatomical origin of the swelling.

d) State the most likely diagnosis.

e) Explain the cause of hoarseness of voice in this patient.

f) List THREE (3) investigations you would like to do and give reason for each.

g) Patient had undergone total thyrodectomy the next day. what you would like to prescribe for patient post-op

The answers:-

a) bilateral anteror neck swelling

b) Fine tremor

Lid lag

Lid retraction

Exopthalmus

Fine tremor

Brisk reflex

Tachycardia

Clubbing (thyroid acropatchy)

Carotid bruit

Stridor

Raised BP

c) Tongue protrusion test

Swallowing test

d) Thyroid ca secondary to long standing MNG

e) Compression of recurrent laryngeal nerve from vagus nerve

f) Thyroid function test - to assess thyroid status

FBC - to asess anemia

ECG - hyperthyroid may cause arrythmia

Neck X-Ray - To assess retrosternal extension

CT scan - to assess extension of thyroid mass

FNAC of swelling - To confirm thyroid ca

g) L-thyroxine

Calcium gluconate

Vitamin D supplement

21 comments:

Jacknaim on March 23, 2009 at 11:47 AM said...

ghani ko memang keji..bertaubatlah ko sebelum dibungkus ngan kain kapan dan ditanam kedalam tanah sedalam 5 kaki..

Ibnu Shaukani on March 23, 2009 at 11:51 AM said...

gani, deletelah gambar tu..

Ibnu Abas on March 23, 2009 at 12:33 PM said...

entah ghani.. ko jgn main2 GG..

aku ada seribu satu gambar ko yg zappp prappp...

upload kang...

Miss Independent on March 23, 2009 at 12:53 PM said...

to gg : sila la delete pic yg tak berkaitan itu

to jacknaim: len kali jgn upload pic2 yg tidak berkaitan, so nnti takde la isu2 sebegini muncul lagi

betul x incik admin? =)

maaf, kalo ada sesiapa terkecik ati... =)

Ibnu Shaukani on March 23, 2009 at 1:02 PM said...

haha..disebabkan blog ni blog umum, so, x digalakkan nak letak gambar sendiri atau gambar org len yg x berkaitan..tp kalu nak letak, it is at your own risk lah ye..pihak admin tak bertanggungjwb kalu ada apa2 brlaku pd gamba yang ada gambar anda.

p/s: jgn gulingkan admin eh..kalu x, nt kami para admin wat sidang tergempar bwh pokok nanti, n kami bg nama "pokok bloggers"! =P

gg on March 23, 2009 at 2:12 PM said...

ok, gambar bdk hot lg sexy tu dah delete dah...

tp bitch terunggul:-
u rock babe!!!

Anonymous said...

adakah ini yg dipanggil plummer syndrome?.

why wanna assess anemia in dis patient?.

ainaa ismail on March 24, 2009 at 8:19 AM said...

aaa,apa kaitan anaemia and thyroid?

ainaa ismail on March 24, 2009 at 8:20 AM said...

azizi,persidangan bawah pokok?kami,para admin takdapat official letter lagi.sapa s/u kita?=p

hulala gurl on March 24, 2009 at 12:05 PM said...

aina...klu dalam hypothyroid, kite akan dapat anaemia...ini di sebabkan hypothyroid akan dacrease kite nyer metabolism, bile decrease met, Oxsigen bnyk yg tak digune kan, so badan kite ingat kite da cukop oxygen la...tak yah nak wat RBC yg baru....decrease erytropoisis so anaemia... boleh bace buku hemato page 15...sbb ox concentration kawal EPO...

no name on March 25, 2009 at 7:03 AM said...

thyroxine stimulate EPO....when hypo kurang lew EPO stimulation so jd anemic...ade dlm notes FLM

no name on March 25, 2009 at 7:03 AM said...

thyroxine stimulate EPO....when hypo kurang lew EPO stimulation so jd anemic...ade dlm notes FLM

no name on March 25, 2009 at 7:04 AM said...

thyroxine stimulate EPO....when hypo kurang lew EPO stimulation so jd anemic...ade dlm notes FLM

cendera_wasih said...

how to differentiate either this patient got thyrotoxicosis or thyroid ca? kalo kt jwb differential diagnosis dia thyrotoxicosis kire salah ke?

soyabean~ said...

kalo x silap, tyrotoxicosis is a condition, bukan a diagnosis.(macam DIC jugak.)

mengikut kefahamanku, a condition x boleh dijadikan differential diagnosis.

kawan, btolkan kalo ku tersilap.

cendera_wasih said...

ape lg contoh2 lain antara condition ngn dz? cam anemia vs AML, peripheral neuropathy vs Gullain Barre syndrome dll. cam tu ke? arghh..sok da nak exam aku baru tw!

tq soyabean~

Ibnu Shaukani on March 28, 2009 at 12:11 AM said...

dr izani from medical dptment ada ckp, thyrotoxicosis tu = hyperthyroidism + sign&symptoms

kalu hyperthyroidism tu, adalah just increase thyroid hormone in serum.

ni die kata masa kelas klinikal thyroid examination, masa klinikal block.

soyabean~ said...

thyrotoxicosis ada yg associated with hyperthyroidism, and non-hyperthyroidism.
utk penjelasan lanjut, bleh refer robbin's page 759.
cepat refer b4 pro II tiba!,=D

cendera_wasih said...

hyperthyroidism is a HYPERFUNCTION of thyroid gland.

thyrotoxicosis is a HYPERMETABOLIC state by elecated circulating level of free T3 & T4

causes of thyrotoxicosis can be a/w: 1)hyperthyroidism - grave dz,hyperfunction adenoma, TSH secreting adenoma

2) non-hyperthyroidism - subacute granulomatus thyroiditis, subacute lymphocytic thyroiditis

SYed on May 5, 2009 at 6:22 AM said...

salam...erm..
SnSm len semua make sense..
yg saye(rasa mcm sopan plak) poning sket tang cretinism tuh..kenapa hypo bleh jd cretinism..tensen2..

hazirah on May 14, 2009 at 12:37 PM said...

cretinism refer to hypothyroidism developing in infancy and early childhood. Thyroid hormone ni function lebey kurang growth hormone ar..essential for cellular metabolism esp in skeletal system and CNS.
Doctor kata(x ingat doctor pa) hormone essential for growth ada 3. Thyroid hormone, growth hormone and sex hormone. The first to elevate in neonates is thyroid hormone followed by growth hormone later in life and sex hormone during puberty.
Sbb tu lack of thyroid hormone leads to cretinism.
Harap menjawab soklan =)

 

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