Ear infection Case Discussion

Outline
• Brief case History
• History
• Physical examination
• Investigation
• Management
• Complication
 Case
A 45 years old female patient was referred to
your clinic for the evaluation and management
of an anterior neck swelling.
The swelling is present for approximate one
year.
Neck swelling case
Neck swelling case
 Neck swelling case
• Describe how you will evaluate this patient
Evaluation
 History
• History of the presenting complaint:
Progressively enlarging lower midline neck
swelling
No associated compressive symptoms
No associated signs or symptoms of
hyper/hypothyroidism
No other associated swellings
 History
PMH: lymphoma treated with chemorads
PSH: neck biopsy
FH: thyroids disease
Allergy Hx: nil
Social Hx: alcohol occasionally, cigarettes:nil
ROS: no palpitation, no weight, no sob, normal
reproduction function, no GI symptoms, no visual
symptoms etc
 PE
Describe how you will examine this patient
Explain how you will examine the swelling in the
neck(thyroid)
 Neck swelling case -PE
General : well nourish female, no cp distress,
afebrile
HEENT: PERRL, no exopthalmos/ ptosis, no lid lag
or lid retraction, non tender cervical
lymphadenopathy lt side, no nuchal rigidity.
CNS: GCS 15
CVS: S1S2M0.
Respiration: bilateral air entry ,no creps
 Infection of the ear-PE
• Abdomen: B9, no organomegaly.
• MSK: no pretibial edema
• Skin : Nad
• Lymphatic: non-tender lt side cervical
lymphadenopathy.
Physical Examination
Neck swelling case -PE
PE Findings
 Neck swelling case
• Discuss thyroid physiology
• Discuss briefly the anatomy of the thyroid.
• Describe the lymph drainage of the thyroid
• What is your differential diagnosis for anterior
neck swelling?
Thyroid physiology
Cervical lymph Drainage
Anterior neck mass
Anterior neck mass
 Diagnosis and treatment
What investigations will you order?
Ultrasound
Ultrasound
Ultrasound
 Ultrasound
• What ultrasound features are indications for
FNAc?
• What ultrasound features are associated with
malignancy?
Thyroid function test
 Thyroid function test
• Interpret the results from this patient TFT
• Discuss thyroid hormone feedback loop
• What other test can you recommend?
• What is the role of molecular testing for
thyroid cancer?
Thyroid hormone
Fine needle aspiration cytology
 FNAc report
• Psammoma bodies, giant cells
FNAC
Molecular testing
 Histopathology of thyroid CA
• What are the histopathological features
associated with the various types of thyroid
cancers?
 FNAc
What is the FNAc categories of thyroid nodule?
What is the diagnostic accuracy of FNAc?
Briefly describe this procedure
What other methods are available for biopsy of
the types?
What are the advantages and disadvantages of
the methods
Nuclear thyroid medicine
Nuclear medicine
 Diagnosis
What is your definitive diagnosis?
What type does this patient has for thyroid cancer?
How do you stratify these patients?
Discuss the histopathological features of thyroid
cancer?
Discuss the clinical features of the various thyroid
cancers.
How would you stage this patient?
Discuss the prognosis of this patient
Thyroid CA
Staging
Staging
Risk stratification
 Treatment
• How would you treat this patient?
• Discuss the indications for thyroid surgery
• What are the complications of thyroid surgery
Treatment
Papillary thyroid carcinoma
Complications of thyroid surgery
 Follow -Up
• How would you follow up this patient?
Follow up