Thyroid, Parathyroid and Adrenal Glands Vascular Neurosurgery. Thyroid,

Thyroid, Parathyroid and Adrenal Glands Vascular Neurosurgery

Thyroid, parathyroid And Adrenal Glands

1- Signs and symptoms of hyperthytoidism include: (All correct except one) Decreased sweating. An irregular pulse rate. Cardiac failure. Diplopia. Loss of weight.

2- Symptoms of hyperthyroidism include: Intolerance to heat. Increased appetite. Emotional instability. Diarhoea. All of the above.

3- Medical therapy of hyperthyroidism: Is particularly indicated in the prfegnant patient. Will usually produce a long-lasting remission rate of 70 to 80 per cent after a 6 month course. Is occasionally complicated by bone marrow depression. Depends on the efficacy of the drugs in inhibiting the hypothalamic centres which govern thyroid stimulating hormone (TSH) release by the pituitary. B&D only.

4- Treatment of hyperthyroidism with radioactive iodine: Is complicated by the late occurrence of thyroid cancer. Should not be undertaken in patients below the age of 40. Is frequently complicated by the development of myxoedema. Is often complicated by a short-lived exacerbation of the hypethyroid state. A&B only.

5- The surgical treatment of hyperthyroidism: Is commonly followed by hypothyroidism. Has a high rate of recurrence. Can be safely effected without preoperative drug therapy. May be complicated by postoperative high parathormone levels. Non of the above.

6- a multinodular (adenomatous) goitre: Is more common in those patients having a deficient iodine intake. Is usually preceded by a diffuse goitre in early adult life Is rarely a precancerous condition. Is effectively treated in early stage with thyroid hormones to prevent further adenomatous changes. All of the above.

7- auto-immune thyroiditis (Hashimoto’s disease): Characteristically occurs in young females. Often presents with hyperthyroidism. Produces a soft diffuse enlargement of the thyroid gland. Is associated with regional lymph node enlargement. C&D only.

8- Hashimoto’s desease: Is often associated with increased levels of cerculating thyroid antibodies. Is characterised by lymphocytic infiltration and fibrosis of the thyroid gland. Is usually treated by sub-total thyroidectomy. Should be treated by anti-thyroid drugs. A&B only.

9- Thyroid cancer: Frequently produces multinodular enlargement of the gland. Usually diagnosed by preoperative needle biopsy of the gland. Can be excluded if there is a localised but soft enlargement of the gland. Often produces a bruit over the gland. Non of the above.

10- Papillary carcinoma of the thyroid: May follow radiation exposure in childhood. Is a slow growing tumour. Usually metastasises to lymph nodes. Is usually a multifocal tumour. All of the above.

11- Follicular carcinoma of the thyroid: (all correct except one) Is most common in females. Is most common above the age of 30 years. Usually metastasises to lymph nodes. Is associated with a relatively good prognosis in childhood. Usually treated by total thyroidectomy.

12- Undifferentiated carcinoma of the thyroid: Is most common in females. Is most common above the age of 60. Is often thyroid stimulating hormone (TSH) dependent. Often exhibits independent thyroid hormone production. Is usually treated by thyroidectomy.

13- The surgical treatment of thyroid cancer: Should be by total thyroidectomy in the potentially curable patient. Should include block dissection of the neighbouring lymph nodes whether or not they appear to contain tumour. Is most successful in the papilary type of cancer. Should be preceded by a therapeutic dose of iodin 131. A& C only.

14- Recurrent thyroid cancer can effectively be treated by: High doses of iodin 131. High doses of thyroid hormone. External irradiation. Chemotherapy All correct except d.

15- The earliest symptoms of hyperparathyroidism include: Diarrhoea. Polydipsia and polyuria. Unexplained weight gain. Mucle spasm C&D only.

16- Primary hyperparathyroidism: (All correct except one) Is most common in postmenopausal females. Is occasionally deagnosed by routine biochemical screening of patients. Should be considered when a patient presents with tatany. Can be caused by adenomas or hyperplasia of the glands. Usually presents by vague abdominal pain, bone pain and uretric calculi.

17- Renal symptoms of hyperparathyroidism: May be due to renal stones. May be due to nephrocalcinosis. Are frequently those of chronic renal failure. Are associated with hypertension. All of the above correct.

18- Acute adrenal insufficiency: In the newborn is due to haemorrhage into one or both adrenal glands. In the newborn typically occurs in the second week of life. In the adult usually follows a pneumococcal septicaemia. In the adult is most frequently encountere following the routine administration of steroid. All of the above correct.

19- Phaeochromocytomata: Are tumours of the spinal nerve roots. Are frequently multiple. Characteristically present with a yellow skin discolouration. Can be effectively managed by long term medical therapy. C&D only.

20- In cushing’s syndrome: There is usually an increased deposition of fat over the face and trunk. Hypotension ans hypokalaemia are frequently present. There is an increased production of adrenal hormones. The cause is most frequently an adrenal tumour. A&C only.

21- Cushing’s syndrome: (all correct except one) May be due to adrenal cortical hyperplasia, adrenal adenomata or adrenal carcinomata. May be associated with bronchogenic cancer. Is effectively treated by total bilateral adrenalectomy even when shown to be pituitary dependent. Should be managed medically unless complications develop. Usually treated by surgery.

22- A thyroglossal cyst: Usually presents in early adult life. Is a remnant of fifth pharyngeal arch mesoderm. Should usually be excised with the thyroid cartilage. Does not move with swallowing. Non of the above is correct.

23- Neuroblastomata: Usually arise in the renal substance. Are one of the commonest solid tumours of childhood. Usually metastasise via the blood stream. Are difficult to distinguish from wilms’ tumours on clinical examination. B&C only.

Vascular Systems

1- Acute arterial occlusion: Should be treated conservatively if the site of the occlusion is above the inguinal ligament. Demands the urgent use of vasodilator drugs. Of a limb is usually painless due to the anoxic damage produced in the peripheral nerves. May produce irreversible muscle necrosis after 6 hours. B&C only.

2- In chronic arterial occlusion of the lower limbs: Buttock claudication is suggestive of arterial occlusion above the inguinal ligament. Skin ulceration most commonly occurs along the medial border of the foot. Which is severe, there may be venous’ guttering on elevation of the legs. There is usually an associated peripheral neuropathy. Usually the peripheral pulses are present.

3- Abdominal aortic aneurysms: Arise from an atheromatous vessel in approximately 50 per cent of cases. Characteristically produce epigastric pain. Are associated with duodenal ulceration. Which are asymptomatic are relatively benign conditions and should not usually be resected. Which are less than 7cm in diameter should be treated surgically.

4- Raynaud’s disease: Is caused by an abnormal sensitivity of skin vessels to cold. Is marked by a characteristic pallor of the hands after cold stimulation followed by blue and then re colour changes. May be associated with scleroderma. Is permanently relieved by sympathectomy in the vast majority of cases. A & B only.

5- Common sites for atheromatous arterial aneurysms are: The femoral artery. The middle cerebral artery. The abdominal aorta. Intrarenal. A&C only

6- A dissecting aneurysm of the aorta: ( all correct except one) Usually starts around the aortic arch. Is so-called because of the extensive mediastinal destruction it produces when it ruptures. Is associated with pregnancy. Is a feature of marfan’s syndrome. Might reach its biforcation.

7-The long saphenous vein: Arises on the medial aspect of the sole of the foot. Passes 1cm in front of the medial malleolus. Passes in front the knee joint. Enters the femoral sheath by piercing the fascia lata. Related to the sural nerve

8- In deep venous thrombosis of the lower limb: One of the most common sites of origin is the short saphenous vein. One of the common sites of origin is in the iliofemoral segment. The diagnosis can usually be made by clinical examination. Tender swollen thrombosed veins are usually palpable. Usually associated with varicose vein.

9- The incidence of postoperative venous thrombosis can be reduced: (all correct except one) By raisin the foot of the operating table during surgery. By passive calf contractions during an operation. By administration of low molecular weight heparin during operation and on the first two postoperative days. By the prophylactic use of subcutaneous heparin. By early ambutation.

10-Venous ulcers of the lower limb: Are usually the result of longstanding varicose veins. Commonly follow deep venous thrombosis. Most commonly occur below the medial malleolus. Will usually heal when firm bandaging is applied. B&D only.

Neurosurgery

1- Intracranial aneurysms: Are the cause of the vast majority of cases of spontaneous subarachnoid haemorrhage. Are multiple in 20 per cent of cases. Rarely rebleed after an initial haemorrhage. Which have ruptured require surgical treatment which involves clipping of the appropriate middle cerebral artery. C&D only.

2- In head injuries the causes of a rising intracranial pressure: (all correct except one) Intracerebral haemorrhage. Cerebral oedema. Rhinorrhoea. Meningitis. Extradural hemorrhage.

3- In head injuries the signs of an expanding intracranial lesion include: A falling level of consciousness. A rising pulse rate. A falling blood pressure. Small pupils. B&C only.

4- Folloeing head injuries surgical intervention is usually required for: Linear skull fractures. Cerebral oedema. Depressed skull fractures. Extradural haemorrhage. C&D only.

5- Chronic subdural haematomata: (all correct except one) Are common in the young. Have a characteristic angiographic appearance. Should be treated surgically. Have a better postoperative prognosis than acute subdural haematomata. Are venous in orgin.

6- The characteristic signs of chronically raised intracranial pressure include: (all correct except one) A bitemporal hemianopia. Papilloedema. Epilepsy. Bradycardia. Six nerve pulsy.

7- In a patient with a lumber disc protrusion: Loss of the knee jerk is characteristic of a second lumbar nerve root lesion. Loss of dorsiflexion of the great toes indicates a third lumbar nerve root lesion. Loss of sensation over the sole indicates a fourth lumbar nerve root lesion. Loss of the ankle jerk indicates a first sacral root lesion. Loss of planter flexion of great toe indicates fifth lumber nerve root lesion.

8- In lesions affecting the common peroneal (lateral popliteal) nerve: Sensory loss is limited to the dorsal aspect of the first interdigital cieft. There is weakness of dorsiflexion of the foot. There is weakness of eversion of the foot. The toes become clawed. B&C only.

9- Birth injuries involving the fifth and sixth cervicaal nerve roots of the brachial plexus: Are known as klumpke’s palsy. Are rarely followed by full recovery. Are characterised by the arm being held in the pronated and internally rotated position. Show weakness and wasting of the small muscles of the hand. Non of the above correct.

10- Following a peripheral nerve injury: Loss of axon continuity is described as neuropraxia. Due to gunshot wounds primary nerve repair is desirable. Delayed suture is best performed one week after the injury. Delayed suture is best performed three months after the injury. None of the above is correct.