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L3 (1ST BMEX) > SURG 7 > Flashcards

SURG 7 Flashcards

1
Q

CJ, a 5-year-old male, was brought for consultation by his mother because of a slow growing, smooth, well defined, nontender mass at the anterior neck that moves with protrusion of the tongue. He has no other symptoms. What is the diagnosis?

A. Thyroglossal duct cyst
B. Lingual thyroid
C. Ectopic thyroid
D. Pyramidal lobe

A

A. Thyroglossal duct cyst

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2
Q

What is the projected 10-year survival rate of a patient diagnosed with papillary thyroid malignancy?

A. 65%
B. 75%
C. 85%
D. 95%

A

D. 95%

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3
Q

What is the risk of malignancy for cold thyroid nodules seen in scintigraphy scan?

A. 20%
B. 30%
C. 40%
D. 50%

A

A. 20%

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4
Q

Which of the following is suggestive of parathyroid carcinoma?

A. A palpable neck mass
B. An elevated serum calcium level greater than 14 mg/dL
C. An elevated PTH level greater than 5x the normaL

A

AOTA

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5
Q

What is the most widely used and accurate modality for detection of parathyroid adenomas?

A. Sestamibi scan
B. CT scan
C. MRI
D. Ultrasound

A

A. Sestamibi scan

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6
Q

Which establishes the diagnosis of primary hyperparathyroidism?

A. Elevated serum calcium with hypercalciuria
B. Elevated serum calcium without hypercalciuria
C. Elevated serum calcium with hyperkalemia
D. Elevated serum calcium with hypokalemia

A

B. Elevated serum calcium without hypercalciuria

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6
Q

Intraoperative rapid PTH assays provide guidance that all hyperfunctioning glands have been removed during parathyroidectomy. What criterion is used to indicate satisfactory resolution of the hyperparathyroidism during the procedure?

A. Greater than 50% fall in PTH level within 10 min of removal of parathyroid tissues
B. Greater than 25% fall in PTH level within 30 min of removal of parathyroid tissues
C. Greater than 90% fall in PTH level within 30 min of removal of parathyroid tissues
D. Greater than 25% fall in PTH level within 10 min of removal of parathyroid tissues

A

A. Greater than 50% fall in PTH level within 10 min of removal of parathyroid tissues

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7
Q

Which is TRUE regarding the blood supply of the thyroid gland?

A. Superior thyroid artery is a branch of the internal carotid artery which divides into anterior and posterior branches
B. The inferior thyroid artery is derived from the thyrocervical trunk
C. The thyroidea ima artery consistently courses beside the recurrent laryngeal nerve
D. The inferior thyroid veins drain directly into the internal jugular veins

A

B. The inferior thyroid artery is derived from the thyrocervical trunk

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7
Q

The recurrent laryngeal nerve arises from the vagus nerve. Which statement is true regarding its course?

A. The left recurrent laryngeal nerve arises from the vagus nerve near the bifurcation of the external and internal carotids, descends towards the aorta and
loops around the ligamentum arteriosum before it ascends medially towards the trachea
B. The left recurrent laryngeal nerve arises from the vagus nerve where it crosses the aortic arch and loops around the ligamentum arteriosum and ascends medially in the neck within the tracheoesophageal groove
C. The right recurrent laryngeal nerve arises from the vagus nerve at the bifurcation of the external and internal carotids, descends towards the subclavian artery and ascends medially within the tracheoesophageal groove
D. The right recurrent nerve arises from the vagus nerve at its crossing with the aortic arch and ascends obliquely towards the trachea

A

B. The left recurrent laryngeal nerve arises from the vagus nerve where it crosses the aortic arch and loops around the ligamentum arteriosum and ascends medially in the neck within the tracheoesophageal groove

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7
Q

TA, a surgical resident is performing a thyroidectomy for colloid goiter. He is very careful in identifying the recurrent laryngeal nerve (RLN). At what area is the RLN most likely to be injured?

A. At the level of the cricoid cartilage
B. At the tubercle of Zuckerkadl
C. At the ligament of Berry
D. At the most lateral and posterior extent of the thyroid gland

A

C. At the ligament of Berry

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8
Q

A 4-year-old female came in due to an anterior neck mass which was noticed for a week. The patient had a cough and colds 2 weeks ago. On physical examination, the mass in 2 cm in size and located at the anterior midline, which moves upward upon protrusion of the tongue. Which of the following statements is true regarding her condition?

A. Outright neck dissection should be carried out due to high probability of malignancy
B. A “Sistrunk operation” should be done which consists of removing the mass including the hyoid bone
C. Most common malignancy found in this condition is medullary thyroid cancer
D. Routine thyroid imaging is the necessary diagnostic test to be done

A

B. A “Sistrunk operation” should be done which consists of removing the mass including the hyoid bone

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8
Q

What condition results from excess of circulating thyroid hormone which leads to an increase in radioactive iodine uptake (RAIU)?

A. Toxic nodular goiter
B. Graves’ disease
C. Riedel’s thyroiditis
D. Increased hormone synthesis

A

B. Graves’ disease

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8
Q

What is given to a patient to decrease the risk of precipitating a thyroid storm during surgery for Graves’ disease?

A. Propranolol
B. Antithyroid drugs
C. Lugol’s iodine solution

A

C. Lugol’s iodine solution

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9
Q

What is the treatment of toxic multinodular goiter?

A. RAI
B. Subtotal thyroidectomy
C. Supersaturated potassium iodine solution
D. Antithyroid drug

A

A. RAI

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9
Q

What is the most common inflammatory disease of the thyroid and leading cause of hypothyroidism?

A. Acute suppurative thyroiditis
B. Subacute thyroiditis
C. Riedel’s thyroiditis
D. Hashimoto’s thyroiditis

A

D. Hashimoto’s thyroiditis

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9
Q

Which thyroid cancer is associated with radiation exposure?

A. Medullary ca
B. Follicular ca
C. Anaplastic ca
D. Papillary ca

A

D. Papillary ca

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10
Q

What is the significance of lateral aberrant thyroid?

A. Ectopic thyroid gland
B. Metastatic thyroid cancer
C. Abnormally located thyroid gland
D. Branchial cleft cyst

A

B. Metastatic thyroid cancer

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11
Q

Most common site of metastases of thyroid carcinoma

A. Lungs
B. Bone
C. Liver
D. Brain

A

A. Lungs

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11
Q

What is the most important test to determine during the surveillance of a patient who underwent total thyroidectomy for thyroid cancer?

A. T3 and T4
B. Thyroglobulin
C. TSH
D. RAI scan

A

B. Thyroglobulin

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12
Q

A 50-year-old woman has had an anterior neck mass for the last 10 years. A few months prior to consult, she noticed the mass to increase rapidly in size associated with pain, dysphasia, dysphagia and dyspnea. On physical examination, the mass is 10 cm in diameter and fixed to adjacent structures. Lymph nodes are
palpable. What is the most likely diagnosis?

A. Anaplastic carcinoma
B. Medullary carcinoma
C. Papillary carcinoma
D. Follicular carcinoma

A

A. Anaplastic carcinoma

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13
Q

Which condition does most lymphomas arise?

A. Hodgkin lymphoma
B. Non-Hodgkin lymphoma
C. Chronic lymphocytic thyroiditis
D. Anaplastic carcinoma

A

B. Non-Hodgkin lymphoma

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13
Q

A 43-year-old teacher came for consult complaining of dysphagia. On examination there is a 4-cm hard, woody, fixed anterior neck mass. What diagnostic modality should be employed to confirm the clinical impression?

A. Ultrasound
B. Open biopsy
C. FNAB Firm
D. CT scan

A

Dx: Riedel’s thyroiditis

B. Open biopsy

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14
Q

A law student came in because of a 2.5-cm anterior neck mass for which an FNAB revealed a benign colloid nodule. She denies any symptoms. What will be your medical advice?

A. RAI
B. Repeat FNAB
C. Levothyroxine
D. Surgery

A

B. Repeat FNAB

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15
Q

A 66-year-old nun sought consult for a 4-cm anterior neck mass. She complains of occasional dysphagia and hoarseness. FNAB was done revealing papillary carcinoma. Ultrasound of the neck showed a 4-cm solitary mass with no cervical lymphadenopathy. What is the clinical TNM stage of the patient?

A. Stage I
B. Stage II
C. Stage IVA
D. Stage IVB

A

B. Stage II

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16
Q

What is the role of radioactive iodine for differentiated thyroid malignancy?

A. Provides a marked improvement in survival
B. Effectively treats >70% of pulmonary micrometastases that are detected by chest x-ray
C. Reduces recurrence
D. Most sensitive for detecting metastatic disease

A

B. Effectively treats >70% of pulmonary micrometastases that are detected by chest x-ray

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16
Q

Aside from elevated PTH, which of the following biochemical changes can be found in primary hyperparathyroidism?

A. Low serum Ca++, low urine PO4
B. High serum Ca++, high urine PO4
C. Low serum Ca++, high urine PO4
D. High serum Ca++, low urine PO4

A

B. High serum Ca++, high urine PO4

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17
Q

A 37-year-old man with papillary thyroid ca 2x2 mass with grade 4 cervical lymphadenopathy. Had a total thyroidectomy. What to do after?

A. Close observation and thyroid hormone therapy
B. Thyroid hormone suppression only
C. Whole body RAI scan
D. Serial serum Tg determination

A

C. Whole body RAI scan

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17
Q

When all imaging modalities are available, what imaging to obtain for primary hyperparathyroidism?

A. CT scan
B. Ultrasound
C. Sestamibi scan
D. MRI

A

C. Sestamibi scan

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18
Q

This is TRUE regarding iodine metabolism

A. The average daily dietary iodine intake of 1.0 mg
B. Iodine is converted to iodide and observed into the bloodstream the distal ileum
C. Transport of iodide into the follicles is via an ATP-dependent active transport
D. Plasma iodine clearance is via GIT

A

C. Transport of iodide into the follicles is via an ATP-dependent active transport

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18
Q

What are the steps in thyroid hormone synthesis in sequence?

A. Oxidation – Iodide trapping – Deiodination – Hydrolyzation – Coupling
B. Iodide trapping – Oxidation – Hydrolyzation – Coupling – Deiodination
C. Iodide trapping – Oxidation – Coupling – Hydrolyzation – Deiodination
D. Oxidation – Coupling – Iodide trapping – Deiodination – Hydrolyzation

A

C. Iodide trapping – Oxidation – Coupling – Hydrolyzation – Deiodination

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18
Q

What is normally not released in the circulation but is dramatically increased during the destructive process of the thyroid like thyroiditis?

A. Thyroid antibodies
B. TRH
C. Serum Tg
D. Thyroid stimulating immunoglobulin

A

C. Serum Tg

18
Q

A 37-year-old female came in for consult due to enlarging anterior neck mass which has been present for 5 years. She noted occasional difficulty in swallowing, but no palpitations, tremors nor weight loss. On physical examination, the anterior neck mass is 10 cm, right, well-circumscribed, non-tender and moves with deglutition. How should the comprehensive PE of the neck be conducted?

A. The examining physician is at patient’s front palpating the thyroid gland with patient in upright position
B. The examining physician is at patient’s front palpating the thyroid gland and asking the patient to swallow
C. The examining physician is at the patient’s back palpating the thyroid gland including the cervical lymph nodes with the patient neck in mild extension
D. The examining physician is at the patient’s back palpating the lateral cervical lymph nodes avoiding the mid portion of the neck

A

C. The examining physician is at the patient’s back palpating the thyroid gland including the cervical lymph nodes with the patient neck in mild extension

19
Q

What is the most useful test in confirming the diagnosis of early hyperthyroidism?

A. Free T3
B. Free T4
C. Total T3
D. Total T4

A

B. Free T4

20
Q

What is an absolute contraindication to radioactive iodine therapy?

A. Breastfeeding mothers
B. Children and adolescents
C. Thyroid nodules
D. Eplithalmopathy

A

A. Breastfeeding mothers

20
Q

Jod-Basedow phenomenon is brought about by the intake of

A. amiodarone
B. propranolol
C. propylthiouracil
D. methimazole

A

A. amiodarone

21
Q

Pemberton’s sign is associated with

A. Graves’ disease
B. Substernal thyroid
C. Apical lung carcinoma
D. Follicular carcinoma thyroid

A

B. Substernal thyroid

21
Q

Thyroid ca from parafollicular cells with associated elevated calcitonin is consistent with

A. Papillary thyroid ca
B. Follicular thyroid ca
C. Hürthle thyroid ca
D. Medullary ca

A

D. Medullary ca

22
Q

In familial MTC, it is important to rule out coexisting pheochromocytoma to avoid precipitating hypertensive crisis and death. This is made possible through

A. Pentagastrin provocation test
B. Calcium-stimulated calcitonin level
C. RET point mutation
D. CEA

A

C. RET point mutation

22
Q

The FNAB consistent in anaplastic carcinoma would be the presence of

A. giant and multinucleated cells
B. presence of amyloid
C. intranuclear cytoplasmic inclusion (orphan Annie)
D. capsular and vascular invasion

A

A. giant and multinucleated cells

22
Q

The thyroid follicle initially appears by 8th week. At what age of gestation does colloid formation begin?

A. Ninth
B. Tenth
C. Eleventh
D. Twelfth

A

C. Eleventh

23
Q

What is the risk of malignancy of a benign colloid nodule?

A. <3%
B. <10%
C. 12%
D. 20%

A

A. <3%

23
Q

Which of the following statements is true of thyroid malignancies?

A. Follicular carcinoma is 80% of all malignancies
B. Dysphonia, dysphagia indicates local invasiveness
C. Diagnosis is made by excisional biopsy of thyroid
D. Poor prognosis

A

B. Dysphonia, dysphagia indicates local invasiveness

23
Q

Which of the following conditions would classify a patient as “low risk” in thyroid malignancy?

A. Incomplete surgical resection
B. Involvement of upper jugular veins
C. 43 years old
D. Tumor size of 2 cm

A

D. Tumor size of 2 cm

23
Q

Post thyroidectomy patient complained of numbness and tingling sensation of fingers and circumoral area. How should the patient be advised?

A. This is a life threatening condition
B. To be managed by reopen surgery
C. This is probably a transient condition
D. Initiate RAI

A

C. This is probably a transient condition

24
Q

What is the anatomic structure that is responsible for movement of the thyroid gland during swallowing?

A. Suspensory ligament of Cooper
B. Pretracheal fascia
C. Posterior suspensory condensation of the thyroid nodule
D. Deep cervical fascia

A

C. Posterior suspensory condensation of the thyroid nodule

25
Q

A 40-year-old male has a 4-cm thyroid nodule. FNAB of the nodule revealed the presence of follicular lesions. The appropriate surgical management for this patient includes

A. thyroid lobectomy with isthmusectomy
B. near total thyroidectomy
C. total thyroidectomy

A

A. thyroid lobectomy with isthmusectomy

26
Q

What is the most sensitive prognostic indicator for medullary thyroid carcinoma?

A. Serum calcium level
B. Calcitonin generated peptide
C. Carcinoembryonic antigen

A

C. Carcinoembryonic antigen

27
Q

A 50-year-old woman has an anterior neck mass for the last 10 years. A few months prior to consult she noticed the mass to increase rapidly in size associated with pain, dysphasia, dysphagia, and dyspnea. On physical examination, the mass is 10-cms in diameter and fixed to adjacent structures. Lymph nodes are
palpable. What is the most likely diagnosis?

A. Medullary carcinoma
B. Anaplastic carcinoma
C. Papillary carcinoma
D. Follicular carcinoma

A

B. Anaplastic carcinoma

27
Q

A 66-year-old nun sought consult for a 4cm anterior neck mass, she complains of occasional dysphagia and hoarseness. FNAB was done revealing papillary carcinoma. Ultrasound of the neck showed a 4cm solitary mass with no cervical lymphadenopathy. What is the clinical TNM stage of the patient?

A. Stage IV
B. Stage II
C. Stage IV
D. Stage III

A

B. Stage II

27
Q

What condition results from excess of circulating thyroid hormone which leads to an increase in radioactive iodine uptake (RAIU)?

A. Increased hormone synthesis
B. Toxic nodular goiters
C. Grave’s disease
D. Riedel’s thyroiditis

A

C. Grave’s disease

27
Q

What is the treatment of toxic multinodular goiter?

A. RAI
B. Supersaturated potassium iodide solution
C. Subtotal thyroidectomy
D. Antithyroid drug

A

A. RAI

27
Q

The recurrent laryngeal nerve arises from the vagus nerve. Which statement is true regarding its course?

A. The left recurrent laryngeal nerve arises from the vagus nerve near the bifurcation of the external and internal carotids, descends towards the aorta and
loops around the ligamentum arteriosum before it ascends medially towards the trachea.
B. The left recurrent laryngeal nerve arises from the vagus nerve where it crosses the aortic arch and loops around the ligamentum arteriosum and ascends medially in the neck within the tracheoesophageal groove.
C. The right recurrent laryngeal nerve arises from the vagus nerve at the bifurcation of the external and internal carotids, descends towards the subclavian
artery and ascends medially within the tracheoesophageal groove.
D. The right recurrent nerve arises from the vagus nerve at its crossing with the aortic arch and ascends obliquely towards the trachea.

A

B. The left recurrent laryngeal nerve arises from the vagus nerve where it crosses the aortic arch and loops around the ligamentum arteriosum and ascends medially in the neck within the tracheoesophageal groove.

27
Q

What is the most common inflammatory disease of the thyroid and leading cause of hypothyroidism?

A. Hashimoto’s thyroiditis
B. Acute suppurative thyroiditis
C. Riedel’s thyroiditis
D. Subacute thyroiditis

A

A. Hashimoto’s thyroiditis

27
Q

A 4-year-old female came in due to an anterior neck mass which was noticed for a week. The patient cough and colds 2 weeks ago. On physical examination, the mass is 2 cm in size and located at the anterior midline, which moves upward upon protrusion of the tongue. Which of the following statements is true regarding her condition?

A. Outright neck dissection should be carried out due to the high probability of malignancy.
B. Most common malignancy found in this condition is Medullary thyroid cancer.
C. A “Sistrunk operation” should be done which consists of removing the mass including the hyoid bone.
D. Routine thyroid imaging is the necessary diagnostic test to be done.

A

C. A “Sistrunk operation” should be done which consists of removing the mass including the hyoid bone.

27
Q

TA, a surgical resident is performing a thyroidectomy for Colloid goiter. He is very careful in identifying the recurrent laryngeal nerve (RLN). At what area is the RLN most likely to be injured?

A. At the most lateral and posterior extent of the thyroid gland
B. At the level of the cricoid cartilage
C. At the ligament of Berry
D. At the tubercle of Zuckerkandl

A

B. At the level of the cricoid cartilage

27
Q

CJ, a 5-year-old male was brought for consult by his mother because of a slow-growing, smooth, well-defined, non-tender mass at the anterior neck that moves with protrusion of the tongue. He has no other symptoms. What is the diagnosis?

A. Ectopic thyroid
B. Pyramidal lobe
C. Lingual thyroid
D. Thyroglossal duct cyst

A

D. Thyroglossal duct cyst

27
Q

Where do most thyroid lymphomas arise?

A. Non-Hodgkin’s lymphoma
B. Hodgkin’s lymphoma
C. Anaplastic carcinoma
D. Chronic lymphocytic thyroiditis

A

A. Non-Hodgkin’s lymphoma

27
Q

What is the significance of the lateral aberrant thyroid?

A. Cervical lymph node metastasis
B. Bronchial cleft cyst
C. Ectopic thyroid gland
D. Abnormally located thyroid gland

A

A. Cervical lymph node metastasis

27
Q

What is used to monitor tumor recurrence in differentiated carcinoma after total thyroidectomy and/or RAI?

A. Serum T3
B. Serum T4
C. Calcitonin
D. Serum Tg

A

D. Serum Tg

27
Q

What is the imaging modality of choice for a large, fixed goiter?

A. MRI
B. Skull xray
C. Ultrasound
D. CT scan

A

D. CT scan

27
Q

The thyroid follicles are usually present by 8 weeks of gestation, the colloid formation begins by ______?

A. 10th week AOG
B. 12th week AOG formation
C. 9th week AOG
D. 11th week AOG

A

D. 11th week AOG

27
Q

One of the following is NOT part of the classic triad of pheochromocytomas:

A. Diaphoresis
B. Palpitation
C. Headache
D. Diarrhea

A

D. Diarrhea

27
Q

What structure arises from the aorta or innominate artery in 1-4% of individuals; and it enters the isthmus or it may replace the inferior thyroid artery

A. Thyrocervical trunk
B. Anterior jugular veins
C. Internal carotid artery
D. Thyroidea IMA

A

D. Thyroidea IMA

28
Q

What is the step in the thyroid hormone synthesis which involves active transport of iodine across the basement membrane via an intrinsic membrane protein?

A. Coupling of DIT molecules
B. Hydrolyzation
C. Iodine trapping
D. Oxidation of iodide to iodine

A

C. Iodine trapping

29
Q

Pheochromocytomas can secrete excess amounts of all of the following EXCEPT:

A. Epinephrine
B. Norepinephrine
C. Dopamine
D. L-dihydroxyphenylalanine

A

D. L-dihydroxyphenylalanine

30
Q

What is the most common cause of primary hyperparathyroidism?

A. Parathyroid adenoma
B. Multiple adenoma
C. Multiple parathyroid hyperplasia
D. Parathyroid carcinoma

A

A. Parathyroid adenoma

30
Q

What is the half life of iodine 123?

A. 24 hours
B. 14-16 hours
C. 12-14 hours
D. 16-18 hours

A

C. 12-14 hours

30
Q

What is a sensitive marker for medullary thyroid carcinoma?

A. Parathyroid Hormone
B. Serum Calcitonin
C. Serum Calcium
D. Thyroid Stimulating Hormone

A

B. Serum Calcitonin

31
Q

What is the half life of iodine 131?

A. 1-2 days
B. 8-10 days
C. 3-5 days
D. 12-14 hours

A

B. 8-10 days

32
Q

What is the area of radionuclide imaging that trap less radioactivity?

A. Cold nodule
B. Hot nodule
C. Warm nodule
D. None of the above

A

A. Cold nodule

32
Q

A relative visits your house after a consultation with an endocrinologist. As a relative in medical school she asks you to further explain the result of her Iodine scan. She said the endocrinologist asked her to go through a procedure. Which of the following is true?

A. Iodine 123 is used in screening of malignancy because it has a longer half-life
B. Cold nodules are considered malignant
C. Cold nodule trap more radioactive isotopes
D. Iodine 123 studies emits high dose radiation with a half-life of 21 days

A

B. Cold nodules are considered malignant

32
Q

While on duty at the wards, the nurses call you because a post-thyroidectomy patient was complaining of difficulty of breathing. As an obedient clerk, you thank the nurse and you went immediately to see the patient. Upon seeing the patient, you saw him in extreme difficulty of breathing. Upon examination, you saw that the post-operative site was bulging and bluish in color, what should you do? You ask the nurses to call your resident while you __________.

A. Intubate the patient
B. Do an emergent tracheostomy at bedside
B. Do an emergent tracheostomy at bedside
D. Open the wound and pack

A

D. Open the wound and pack

33
Q

In cases where malignancy of the thyroid metastasizes to the cervical nodes, it is usually in __________.

A. Level IV, V, VI
B. Levels II, III, IV
C. Level III, IV, V
D. Levels I, II, III

A

B. Levels II, III, IV

34
Q

While doing rounds with your resident, you noticed one of your post-thyroidectomy patients complaining of tingling sensation on her fingers. Upon examination, your resident tells you, she is positive for Chvostek’s sign. This is more commonly seen in patients who go through _______________.

A. Modified radical neck dissection
B. Lobectomy, isthmusectomy
C. Total thyroidectomy
D. Total Thyroidectomy with central neck dissection

A

D. Total Thyroidectomy with central neck dissection

35
Q

In Japan, what is the size of Papillary Thyroid Malignancy where they choose to observe instead of offering surgery?

A. 3 cm
B. 1 cm
C. 4 cm
D. 2 cm

A

B. 1 cm

36
Q

A 50-year-old healthy appearing man undergoes evaluation of persistent hypertension. Serum chemistries reveal hypokalemia (<3.2 mmol/L) and imaging studies reveal a unilateral adrenal mass. What is the likely diagnosis?

A. Cushing syndrome
B. Pheochromocytoma
C. Cushing disease
D. Conn syndrome

A

D. Conn syndrome

L3 (1ST BMEX) (18 decks)

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