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The thyroid gland > Bailey > Flashcards

Bailey Flashcards

1
Q

The superior parathyroid glands develop from which pharyngeal pouch?

A. Second
B. Third
C. Fourth
D. Fifth

A

C.
the superior parathyroids develop from the fourth pharyngeal pouch.
The inferior parathyroids develop from the third pharyngeal pouch along with the thymus.

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2
Q

Which of the following structures develop from the third pharyngeal pouch?
(Multiple options correct)

A. Thymus gland
B. Inferior Parathyroid
C. Superior parathyroid
D. Ultimobranchial body

A

A and B

the inferior parathyroid and thymus both develop from the third pharyngeal pouch.
whereas the ultimobranchial body and the superior parathyroid develop from the 4th pharyngeal pouch.

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3
Q

What is the normal weight of the thyroid gland?

A. 10-15g
B. 15-20g
C. 20-25g
D. 25-30g

A

C - the normal weight of the thyroid is 20-25g.

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4
Q

Which of the following statements is true regarding anatomy of the thyroid?

A. Normal thyroid gland weighs 10-15g.
B. functioning unit of the thyroid is lobule supplied by multiple arterioles, whereas the follicles are supplied by a single arteriole.
C. each lobule contains 60-80 follicles
D. Follicles are lined with squamous epithelium.
E. the follicle contains colloid in which thyroglobulin is stored.

A

E. The follicle contains colloid in which thyroglobulin is stored.

  • Normal gland weighs 20-25g.
  • lobule is the functioning unit and it is supplied by a single arteriole.
  • each lobule contains 24-40 follicles, NOT 60-80.
  • the follicles are lined by cuboidal epithelium NOT squamous.
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5
Q

what percentage of the RLN on the right side are non-recurrent and enter the larynx from above?

A. 2%
B. 5%
C. 8%
D. 10%

A

A. 2% of the recurrent laryngeal nerves on the right are non-recurrent and enter the larynx from above.

RLN is a branch of the vagus that recurs around the arch of aorta on the left and the subclavian artery on the right.

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6
Q

Maximum risk of the injury to the RLN during surgery is at which point?

A. at the cricothyroid joint
B. level of Berry’s ligament
C. Tracheo-esophageal groove
D. Both A and B

A

A and B - the maximum risk of injury to the RLN during surgery is at the entry point of the larynx at the cricothyroid joint which lies at the level of Berry’s ligament.

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7
Q

which of the following is not a boundary of the Beahr’s triangle?

A. Recurrent Laryngeal Nerve
B. Tubercle of Zuckerkandl
C. Carotid Artery
D. Inferior thyroid artery

A

B. Tubercle of Zuckerkandl

the Beahr’s triangle is formed by the RLN in the TE-groove along with inferior thyroid artery and carotid artery.

Tubercle of Zuckerkandl - is the most posterolateral portion of the gland, lying below the which the RLN can often be found in the TE groove as the gland is mobilized laterally.

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8
Q

Arrange the following steps of thyroxine production in the correct order.

  1. oxidation of iodide
  2. coupling of monoiodotyrosine and di-iodotyrosine to form T3 and T4.
  3. Trapping of inorganic iodine from the blood
  4. Binding of iodine with tyrosine to iodotyrosine
  5. resorption of thyroglobulin complex into the cell and breakdown.

A. 4-2-1-3-5
B. 3-1-4-2-5
C. 3-1-2-4-5
D. 1-3-2-4-5

A

B. 3-1-4-2-5

a - Trapping of inorganic iodine from blood
b -Oxidation of iodide
c - Binding of iodine with tyrosine to form iodotyrosine
d - couping of monoiodotyrosine and di-iodotyrosine to form T3 and T4.
e - resorption of the thyroglobulin complex into the cell and breakdown.

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9
Q

thyroxine is bound to all of the following in blood except -

A. Albumin
B. TBPA
C. Thyroglobulin
D. TBG

A

ans C -

in blood thyroxine is bound to albumin, Thyroid binding pre-albumin (TBPA), thyroid binding globulin (TBG).

Thyroglobulin complex is present in the colloid within the gland.

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10
Q

what percentage of T4 and T3 remains unbound or free in circulation, and therefore active -

A. 0.01% and 0.1%
B. 1% and 0.1%
C. 0.03% and 0.3%
D. 0.3% and 0.1%

A

Ans - C.

  1. 03% of thyroxine of T4 remains free or unbound or fT4
  2. 3% of the T3 remains free or unbound or fT3
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11
Q

what is the average duration of action of T4.

A. few minutes
B. few hours
C. few days
D. few months

A

Ans C -
T4 is slow acting and remains active for 4-14 days.
T3 is fast acting and acts within few hours.

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12
Q

what is the normal level of TSH?

A. 0.1 to 1.1 mU/L
B. 0.2 to 2.2 mU/L
C. 0.3 to 3.3 mU/L
D. 7 to 9 mU/L

A

Ans C -

normal levels of TSH - 0.3 to 3.3 mU/L

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13
Q

What is the normal level of fT4 in serum?

A. 1 to 10 nmol/L
B. 10-30 nmol/L
C. 30-60 mmol/L
D. 90-100 nmol/L

A

Ans - B

10-30 nmol/L

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14
Q

what is the normal level of fT3 in serum?

A. 1.5-3.5 umol/L
B. 3.5-7.5 umol/L
C. 7.5-10 umol/L
D. 10-12.5 umol/L

A

Ans B -

3.5 to 7.5 umol/L

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15
Q

A patient presents with undetectable TSH, with fT4 45 nmol/L and fT3 of 5 umol/L.
What could be the possible cause?

A. Hypothyroidism
B. Suppressive T4 therapy
C. thyrotoxicity
D. T3 toxicity

A

Ans B - supressive T4 therapy

undetectable TSH with raised fT4 (normal levels are 10-30 nmol/L) and normal or raised fT3 (3.5-7.5 umol/L) is suggestive of supressive T4 therapy.

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16
Q

which of the following statements is TRUE regarding the thyroid stimulating antibodies or TRAbs?

A. they belong the IgM class of immunoglobulins
B. they are responsible for virtually all cases of thyrotoxicosis other than autonomous toxic nodules
C. they have a duration of action of 1.5-3 hours on TSH receptors
D. their measurement is necessary to make the diagnosis.
E. they are largely produced in the serum

A

Ans B - they are responsible for virtually all cases of thyrotoxicosis other than autonomous toxic nodules.

  • they belong to IgG class.
  • TSH acts for 1.5 to 3 hours, whereas TRAbs act for longer duration - 16-24 hours.
  • their measurement is NOT necessary to make the diagnosis.
  • they are largely produced in the thyroid itself.

Bailey 27e pg 802, 803.

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17
Q

What are the levels above which TPO antibodies are considered positive ?

A. 10 U/mL
B. 15 U/mL
C. 20 U/mL
D. 25 U/mL

A

ans D - 25 U/mL

Serum levels of antibodies against Thyroid peroxidase and thyroglobulin are useful in determining the cause of thyroid dysfunction and swellings.

Autoimmune thyroiditis may be associated with thyroid toxicity, thyroid failure or euthyroid goitre.

Bailey 27 e pg 803.

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18
Q

What are the titres of Anti-thyroglobulin which are considered significant -

A. 1:10
B. 1:100
C. 1:1000
D. 1:10000

A

Ans B -
Titres of anti-thyroglobulin greater than 1:100 are considered significant.
The presence of anti-thyroglobulin antibodies interferes with the assays of serum thyrogobulin and thus have implications in follow up of thyroid cancers.

Bailey 27e pg 803.

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19
Q

Which of the following is considered the workorse investigation in case of thyroid disease

A. TSH
B. USG
C. FNAC
D. TRab

A

ans B - USG is considered the workhorse investigation in thyroid disease.

Bailey 27e Pg 803.

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20
Q

Imaging modality of choice for retrosternal extension of goitre ?

A. USG
B. X ray Chest
C. CT Chest
D. MRI

A

ans C - CT chest is the investigation of choice for retrosternal extension as well as when metastatic disease is detected.

Bailey 27e Pg 803

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21
Q

Best investigation to comment upon invasion of the pre-vertebral fascia in thyroid cancer ?

A. USG
B. CT
C. MRI
D. Radioisotope scintigraphy

A

Ans - MRI is superior in determining presence of prevertebral fascia invasion.

CT is useful for determining the extent of airway invasion.

Bailey 27e Pg 803.

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22
Q

What percentage of ‘cold’ and ‘warm’ thyroid nodules are malignant?

A. 80% cold, 5% warm
B. 20% cold, 5% warm
C. 20% cold, 1 % warm
D. 80% cold, 1% warm

A

ans B - 20% cold and 5% warm.

Bailey 27e Pg 804.

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23
Q

investigation of choice in discrete thyroid swellings?

A. FNAC
B. USG
C. CT
D. Radioisotope scintigraphy

A

Ans A - FNAC

Bailey 27e Pg 804.

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24
Q

As per the British Thyroid associated classification for FNA in thyroid swellings, non-neoplastic is ?

A. Thy 1
B. Thy 2
C. Thy 3
D. Thy 4
E. Thy 5
A

ans B - Thy 2 is considered non-neoplastic.

As per the british thyroid association classification for FNA -

Thy 1 - nondiagnostic
Thy 1c - nondiagnostic cystic
Thy 2 - non-neoplastic
Thy 3 - Follicular
Thy 4 - Suspicious for malignancy
Thy 5 - malignant.

Bailey 27e pg 805.

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25
Q

Which of the following is a granulomatous thyroiditis ?

A. Chronic Lymphocytic thyroiditis
B. Reidel’s thyroiditis
C. Chronic Tuberculous Thyroiditis
D. de Quervain’s thyroiditis

A

Ans D - de Quervain’s thyroiditis is a granulomatous thyroditis.

Bailey 27e Pg 805.

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26
Q

which of the following statements is not true ?

A. TSH is the only stimulus for thyroid follicular cell proliferation
B. Daily requirement of iodine is 0.1-0.15 mg.
C. thiocyanates and perchlorates interfere with iodine trapping
D. Carbimazole and PTU interfere with oxidation of iodine.

A

ans A - TSH is not the only stimulus for the thyroid follicular cell proliferation. Other GF and immunoglobulins are also involved.

Bailey 27 e pg 805, 806.

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27
Q

Which of the following statements is not true?

A. Thiocyanates and perchlorates interfere with iodine trapping

B. Carbimazole and PTU interfere with oxidation of iodine

C. Iodine in large quantities interferes with binding of iodine to tyrosine

D. Excessive iodine intake leads to increased incidence of thyroid disease

E. None of the above

A

Ans - E none of the above.

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28
Q

which of the following is false regarding diffuse hyperplastic goitre ?

A. first stage of natural history of simple goitre.

B. in endemic areas it commonly occurs at puberty

C. goitre may regress if TSH stimulation regresses.

D. Tends to recur at times of stress such as pregnancy

E. A colloid goitre is a late stage of diffuse hyperplastic goitre.

A

ans B -

In endemic areas it commonly appears in childhood, whereas in sporadic cases it usually occurs at puberty.

Bailey 27 e pg 806.

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29
Q

which of the following is a FALSE statement ?

A. nodules appear early in endemic and later in sporadic goitre (20-30 years of age)

B. No estrogen receptors are present in thyroid tissue

C. All types of simple goitre are more common in females.

D. the patient is usually euthyroid in simple goitre.

A

ans B -

Estrogen receptors are present in thyroid tissue and this may be one of the reasons why simple goitre is more common in women.

Bailey 27e Pg 806.

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30
Q

Gold standard investigation for simple goitre ?

A. USG
B. Thyroid function
C. Thyroid antibodies
D. FNAC

A

Ans A - USG is the gold standard assessment.

FNAC is only required for a nodule within the goitre that demonstrates ultrasonic features of concern. This may or may not be the dominant nodule.
Bailey 27e Pg 807.

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31
Q

Best investigation to assess tracheal and esophageal compression in a case of simple goitre?

A. USG
B. X ray
C. CT scan
D. FNAC

A

Ans - C -CT scan

if there are swallowing and breathing symptoms then a CT scan of the thoracic inlet is the best modality to assess tracheal and esophageal compression.

Bailey 27e Pg 807

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32
Q

which of the following is not an indication for surgery in MNG?

A. Suspicion of Malignancy
B. Cosmetics
C. Compressive symptoms
D. Asymptomatic

A

ans D -

Most patients with multinodular goitre are asymptomatic and do not require surgery.

Bailey 27e Pg 807.

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33
Q

what percentage of clinically discrete thyroid swellings are dominant swellings?

A. 30%
B. 50%
C. 70%
D. 90%

A

ans - A

30% of the clinically discrete thyroid swellings are dominant and 70% are isolated.

Bailey 27e Pg 808.

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34
Q

what is the treatment of choice of MNG involving both lobes of the thyroid in a young patient with cosmetic concerns?

A. Subtotal thyroidectomy
B. Dunhill Procedure
C. Total Thyroidectomy
D. Conservative

A

Ans C
most surgeons are preferring total thyroidectomy with lifelong thyroid replacement over subtotal thyroidectomy in young patients.

Bailey 27e Pg 807.

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35
Q

What constitutes a Dunhill Procedure ?

A. Removal of all the thyroidal tissue in both lobes.
B. Total lobectomy on involved + Isthmectomy + Subtotal Lobectomy on less involved
C. Total Lobectomy + isthmectomy
D. none of the above.

A

ans B -

total lobectomy on the involved side and subtotal lobectomy on the less involved side.

Bailey 27e Pg 807.

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36
Q

‘rule of 12’ relates to ?

A. risk of malignancy in thyroid swellings
B. Pheochromocytoma
C. Meckel’s diverticulum
D. risk of follicular adenoma in thyroid swellings

A

ans A - risk of malignancies in thyroid swellings can be expressed as “Rule of Twelve”.

Bailey 27e pg 808

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37
Q

which of the following is not True regarding the risk of malignancy in thyroid swellings?

A. Women > Men
B. Isolated swelling > Dominant Swelling
C. Solid Swelling > Cystic Swelling
D. None of the above.

A

Ans - A -

as per the rule of twelve the risk of malignancy is greater in isolated swelling vs dominant; men vs women and solid vs cystic swellings.

Incidence of follicular adenoma or malignancy in clinically dominant swellings is approximately half of that in truly isolated swellings. But it is still substantial and cannot be ignored.
15% of isolated swellings are malignant and another 40% are follicular adenomas.

Bailey 27e Pg 808.

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38
Q

gold standard investigation to characterise physical characteristics of thyroid swellings?

A. USG
B. CT
C. MRI
D. FNAC

A

Ans - A - USG is the gold standard investigation to determine the physical characteristics of thyroid swellings.

Bailey 27e pg 808.

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39
Q

which of the following sonographic findings is diagnostic of malignancy ?

A. Microcalcifications
B. Increased vascularity
C. Nodal involvement
D. Microscopic capsular breach

A

Ans C -

The findings that are suggestive of malignancy on USG include -

  • microcalcifications
  • increased vascularity
  • Nodal involvement
  • Macroscopic capsular breach

Out of this nodal involvement and macroscopic capsular breach are considered diagnostic.

Bailey 27e Pg 808

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40
Q

which of the following is TRUE -

A. Circulating antibodies increase the risk of thyroid failure after lobectomy

B. a reassuring appearance of a thyroid swelling on ultrasound mitigates the need for FNAC.

C. FNAC is recommended for all nodules that do not fulfill U2 classification (fully benign)

D. All of the above

A

Ans D -

all the statements are true.

Bailey 27e Pg 809

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41
Q

Which of the following statements is true regarding thyroid swellings ?

A. incidence of thyroid carcinoma in women is about 3 times that of men.
B. A discrete swelling in a male is more likely to be malignant than in a female.
C. A discrete swelling in a teenager of either sex must be provisionally diagnosed as carcinoma
D. All of the above

A

Ans - D - All of the above statements are true -

Bailey 27e Pg 809

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42
Q

which of the following findings are DO NOT increase the suspicion of the thyroid swelling being neoplastic ?

A. Fixity
B. Hoarseness
C. Occlusive Cough
D. recurrent cyst
E. Male sex
F. Teenager
A

Ans - Occlusive cough

Non-occlusive cough is suggestive of RLN palsy.

Bailey 27e Pg 809 and 810.

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43
Q

which of the following is more often seen in total thyroidectomy compared to subtotal thyroidectomy?

A. Recurrence
B. Thyroid Failure
C. Hypoparathyroidism
D. Need for Followup

A

Ans - C - hypoparathyroidism.

Recurrence - nearly absent in total and 5% in subtotal thyroidectomy
Thyroid failure - 100% in total, and upto 100% at 30 years in sub-total.
Hypoparathyroidism - 5% risk in total and 1% risk in subtotal thyroidectomy.
Need for followup is greater in subtotal thyroidectomy.

Also large remnants in small glands - higher risk of recurrence, lower risk of failure.

Small remnants in large glands - higher risk of failure, lower risk of recurrence.

Bailey 27e Pg 810.

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44
Q

Which of the following is true statements?

A. in grave’s disease it is better to err on the side of removing too much thyroid tissue

B. >95% of the retrosternal goitres can be removed trans-cervically

C. Cross sectional imaging for retrosternal goitre should ideally performed in surgical position.

D. all of the above

A

Ans -D

All of the statements are true.

Bailey 27e Pg 811.

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45
Q

Which of the following DOES NOT increase the likelihood of median sternotomy in Retrosternal goitre -

A. Revision cases
B. extension into anterior mediastinum
C. malignant cases
D. diameter of goitre > diameter of thoracic inlet.

A

Ans - B -

Extension of the goitre into the posterior mediastinum increases the risk of median sternotomy.

Bailey 27e Pg 811.

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46
Q

which of the following is a histological pattern associated with hyperthyroid tissue?

A. Cuboidal Epithelium
B. scalloped pattern adjacent to thyrocytes.
C. homogenous colloid
D. none of the following

A

Ans - A - cuboidal epithelium and homogenous colloid are typical of normal thyroid gland.

High columnar epithelium, with scalloped pattern adjacent to thyrocytes is a feature of hyperthyroid tissue.

Bailey 27e Pg 811.

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47
Q

recurrence of hyperthyroidism is a certianity in which of the following after discontinuation of anti-thyroid drugs?

A. Toxic Nodular Goitre
B. Grave’s disease
C. Solitary Toxic Nodule
D. Diffuse Toxic Goitre

A

Ans -C Solitary toxic nodule
because these are autonomous and therefore recurrence is certain.

Bailey 27e Pg 812.

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48
Q

what is duration of treatment with anti-thyroid drugs in severe hyperthyroidism

A. 3 months
B. 6 months
C. 1 year
D. 2 year

A

Ans - D

severe cases are usually treated for 2 years before stopping anti-thyroid drugs.
mild cases are usually treated for 6 months.

Bailey 27e Pg 812.

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49
Q

which of the following statements is FALSE regarding the treatment of hyperthyroidism -

A. Surgery may result in reduction of TSH-R Ab.
B. Patient must be quarantined while radiation levels are high after radioiodine therapy
C. Eye signs may be aggravated after Radioiodine therapy
D. surgery is the first line of treatment in Grave’s disease
E. Toxic Nodular goitre can still further enlarge with anti-thyroid drugs.

A

Ans - D -

in diffuse toxic goitre the first line of treatment is anti-thyroid drugs with radioiodine for relapse.
The exception to this is - Large goitres, Progressive eye signs, pregnancy.

The first line of treatment for toxic nodular goitre is however surgery - since they respond poorly to anti-thyroid drugs and radioiodine and may even enlarge with the use of anti-thyroid drugs.

For Toxic nodule in patient aged >45 years - Radioiodine is a preferred treatment option, whereas surgery is preferred in younger patients.

Bailey 27e Pg 812.

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50
Q

Drug of choice for the preparation of a hyperthyroid patient for surgery ?

A. Propylthiouracil
B. Carbimazole
C. Beta Blockers
D. Iodine

A

Ans B - Carbimazole at 30-40mg per day is the DOC for preparation.

Bailey 27e Pg 812.

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51
Q

Carbimazole renders a patient euthyroid in ?

A. 1 week
B. 2 week
C. 4 week
D. 8 week

A

Ans D - carbimazole renders a patient euthyroid in 8-12 weeks with a dose of 30-40mg/day, and once the patient is euthyroid the dose can be reduced to 5mg TDS or 15mg/day.
Last dose of carbimazole is given on the EVENING BEFORE surgery.

Bailey 27e Pg 813.

52
Q

which of the following drugs is not used alone for rendering a patient euthyroid before surgery ?

A. Iodide
B. Carbimazole
C. Propythiouracil
D. Nadolol

A

Ans - A - Iodides are not used alone.

Bailey 27e Pg 813.

53
Q

what is the appropriate dose of propanolol for rendering a patient euthyroid before surgery?

A. 10 mg TDS
B. 40 mg TDS
C. 120 mg OD
D. 160 mg OD

A

Ans - 40mg TDS is the dose for propanolol. Whereas 160mg OD is the dose for Nadolol.

Bailey 27e Pg 813.

54
Q

Which of the following drugs allows most rapid conversion to euthyroid states?

A. Iodide
B. Carbimazole
C. PTU
D. Propanolol

A

Ans D -

Beta Blockers have rapid response and patient rendered clinically euthyroid in days rather than weeks.
A larger dose may be used -
Propanolol 80mg TDS
Nadolol 320 mg OD

Bailey 27e Pg 813.

55
Q

when beta blockers are used for rendering the patient euthyroid for thyroid surgery, they are continued for how many days post op before levels fall ?

A. 2 days
B. 5 days
C. 7 days
D. 10 days

A

Ans C -

Beta blockers do not interfere with the synthesis of thyroid hormones and therefore the levels remain high in the post op period after thyroidectomy, and therefore they are continued for 7 days post op.

Bailey 27e Pg 813.

56
Q

which of the following is a FALSE statement -

A. Iodides are started 10 days before the surgery
B. Iodides cannot be used alone to render patient euthyroid before surgery
C. Iodides increase safety by decreasing vascularity
D. none of the above

A

Ans D - none of the above statements is false

Bailey 27e Pg 813.

57
Q

If required the strap muscles are divided at what site in thyroid surgery?

A. Superiorly
B. Inferiorly
C. medially
D. Laterally

A

Ans - A - superiorly.

Bailey 27e Pg 813.

58
Q

which of the following statements is True regarding nerve monitoring in thyroid surgery?

A. Intermittent nerve monitoring provides the opportunity to identify a nerve when function is threatened.

B. Intermittent nerve monitoring requires an electrode placed on the vagus

C. Continuous nerve monitoring requires electrode placement on the endotracheal tube between the vocal cords.

D. There is no evidence to show substantial difference in outcomes with the use of intra-operative nerve monitoring.

A

ans D -

Statement D is true.

A - intermittent nerve monitoring allows identification of damaged nerve, whereas continuous nerve monitoring in theory allows identification of a nerve when function is threatened, eg. by excessive traction.

B and C. Intermittent nerve monitoring electrodes are placed on the endotracheal tube whereas continuous nerve monitoring electrodes are placed on the vagus nerve.

Bailey 27e Pg 814.

59
Q

Which of following is a maximally invasive technique?

A. Video assisted thyroid surgery
B. Robotic techniques via axillary incision
C. Conventional thyroidectomy
D. none of the above

A

Ans - B -

robotic techniques via the axillary incision require extensive dissection of the chest wall and they are considered maximally invasive techniques.

Bailey 27e Pg 814.

60
Q

Most frequent life threatening complication of thyroid surgery is ?

A. Hemorrhage
B. RLN injury
C. Tracheal injury
D. thyrotoxic crisis

A

Ans - A - hemorrhage is the most frequent life threatening complication.

Bailey 27e Pg 814.

61
Q

which of the following statements is true regarding hemorrhage following thyroid surgery?

A. occurs within 72 hours in almost all cases.
B. cause of death is venous edema of the vocal cords.
C. wound drains are protective
D. watertight closure of the strap muscles is recomended

A

Ans B -

A - almost all cases occur within the first 24 hours and this is the reason why thyroid surgery remains an inpatient procedure.

B. Cause of death is venous edema of the vocal cords.

C. wound drains are not protective.

D. Strap muscles are loosely approximated to prevent the adhesion of trachea to the skin and water tight closure is avoided.

Bailey 27e Pg 815.

62
Q

which of the following statements is false regarding RLN injury during thyroid surgery?

A. the RLN palsy rate is 1.8% at 1month and declines to 0.5% at 3 months post op.

B. early routine post-op laryngoscopy reveals a much higher rate of transient cord paralysis.

C. voice and cord functions are assessed on first follow up at 4 weeks.

D. the rates of permanent paralysis are higher if the nerve is seen during surgery

A

Ans D -

RLN should be identified during the surgery and permanent paralysis is rare if the nerve is identified at operation.

Bailey 27e pg 815.

63
Q

which of the following statements is false regarding RLN injury?

A. if transected ends are identified then they should be re-anastomosed.

B. if a length of the nerve is removed (d/t invasion by malignancy) then ansa cervicalis should be anastomosed.

C. anastomosis of trasected nerve to ansa cervicalis restores the mobility of the vocal cord in some patients.

D. permanent vocal cord paralysis should be treated conservatively with speech therapy

A

Ans C -

Anastomosis of ansa-cervicalis does not return the vocal cord mobility.
However it maintains neurological input to the muscles of the larynx and thus avoids muscle atrophy and thus improves vocal quality.

Bailey 27e Pg 815.

64
Q

Which of the following is true regarding SLN injury in thyroid surgery ?

A. SLN is injured more commonly than RLN
B. loss of tension in the vocal cord with diminished power and range.
C. any thyroid operation will result in change in voice even in the absence of nerve trauma.
D. Changes in most cases are subtle and only seen on formal voice assessment.
E. All of the above

A

Ans E - All of the above statements are true.

65
Q

most common mechanism for hypoparathyroidism after thyroid surgery

A. iatrogenic removal of all parathyroid glands
B. Vascular injury
C. Nerve injury
D. Thermal injury to the gland

A

Ans - B - vascular injury is the most common mechanism behind hypoparathyroidism following thyroid surgery.

Bailey 27e pg 815.

66
Q

which of the following surgeries carry the maximum risk of hypoparathyroidism

A. Lobectomy
B. Subtotal thyroidectomy
C. Total Thyroidectomy
D. Total Thyroidectomy with central LN dissection

A

Ans - D - total thyroidectomy and central LN dissection places the parathyroids and their vascular supply at great risk of injury and should only be performed if there is clear indication.

Bailey 27e Pg 815.

67
Q

Hypoparathyroidism following thyroid surgery usually manifests in -

A. 1 day
B. 2-5 days
C. 1 week
D. 2 weeks

A

Ans - B 2-5 days.

Very rarely the onset is delayed for 2-3 weeks or a patient with marked hypocalcemia remains asymptomatic.

Bailey 27e Pg 815.

68
Q

specific treatment of thyrotoxic storm does not include which of the following?

A. Carbimazole 10-20 mg 6 hourly
B. Lugol's Iodine 10 drops 8 hourly
C. Sodium Iodide 1g iv 
D. Propanolol 1-2 mg iv or 40mg 6 hourly PO. 
E. hydrocortisone 100mg iv 12 hourly
A

Ans E - Hydrocortisone is supportive and not specific treatment.

Lugol’s iodine or sodium iodide both can be given.

Supportive treatment includes -

  • diuretics for cardiac failure
  • ice packs
  • oxygen
  • digoxin
  • sedation
  • iv hydrocortisone

Bailey 27e Pg 815.

69
Q

thyroxine replacement following total thyroidectomy starts from -

A. 1st day
B. 2nd day
C. 1st week
D. 1st month

A

Ans - A 1st day.

Bailey 27e Pg 815.

70
Q

arrange them in order of decreasing incidence -

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

A

Ans C-A-B-D - papillary carcinoma - 80% > Follicular carcinoma 10% > anaplastic 5% > Medullary carcinoma 2.5%.

Bailey 27e Pg 816.

71
Q

which of the following is not derived from follicular cells -

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

A

Ans - Medullary Carcinoma - derived from Parafollicular C cells.

Bailey 27e Pg 816.

72
Q

most common source of metastases to thyroid gland?

A. Breast Cancer
B. Lung Cancer
C. Renal Cell carcinoma
D. Esophageal Cancer

A

Ans -C Renal cell carcinoma

Bailey 27e Pg 816.

73
Q

most important identifiable etiological factor in differentiated thyroid carcinoma ?

A. History of irradiation of thyroid under 5 years of age
B. Family history of thyroid cancer
C. Endemic Goitre
D. Smoking

A

Ans A - history of irradiation of thyroid under 5 years of age is the most important identifiable etiological factor in differentiated thyroid carcinoma.

Bailey 27e Pg 816.

74
Q

Which of the following thyroid malignancies is common in areas of endemic goitre?

A. Papillary Cancer
B. Meduallary cancer
C. Follicular cancer
D. Anaplastic cancer

A

Ans C - Follicular cancer is common in areas of endemic goitre, possibly due to TSH stimulation.

Bailey 27e Pg 816.

75
Q

which of the following malignancies develops in autoimmune thyroiditis?

A. Medullary Carcinoma
B. Follicular Carcinoma
C. Anaplastic Carcinoma
D. Lymphoma

A

Ans - D - lymphoma

Bailey 27e pg 816.

76
Q

short latency aggressive papillary cancer is associated with which of the following

A. BRAF
B. ret/PTC 3 oncogene
C. ret/PTC 1 oncogene
D. p53

A

Ans B - ret/PTC3 oncogene is associated with short latency aggressive papillary cancer.

less aggressive cancers are seen in ret/PTC1 oncogene.

Bailey 27e Pg 816.

77
Q

most common presenting feature of thyroid cancer?

A. Dysphagia or Dyspnea
B. Hoarseness of voice
C. thyroid swelling
D. Lateral aberrant thyroid

A

Ans - C - thyroid swelling is the most common presenting feature.

Bailey 27e Pg 817.

78
Q

incidence of which of the following thyroid malignancies is increasing rapidly across the world?

A. Papillary thyroid carcinoma
B. Follciular Carcinoma
C. Anaplastic Carcinoma
D. Medullary Carcinoma

A

Ans A - papillary thyroid carcinoma incidence is rapidly increasing due to imaging detecting previously occult disease.

Bailey 27e Pg 817.

79
Q

Which of the following statements is false regarding PTC?

A. most common thyroid malignancy
B. 30% patients who die of non-thyroid causes have deposits of PTC on autopsy
C. Lymph nodes are more common in younger patients
D. high rate of occult metastases - upto 40% in clinically N0
E. none of he above

A

Ans E- none of the above.

Bailey 27e Pg 818.

80
Q

Which of the following statements is false regarding papillary microcarcinoma?

A. PTC < 10mm in size.
B. not associated with adverse outcomes, recurrence or survival.
C. nearly 2/3 of these may progress
D. avoid diagnosing by limiting biopsies to lesions > 10mm.

A

Ans C -

Atleast 2/3 of the papillary microcarcinoma never progress.

Bailey 27e Pg 818.

81
Q

which of the following cells predominate the histology in Hurthle Cell cancers?

A. Askanazy cells
B. Oxyphil Cells
C. Hurthle Cells
D. All of the above

A

Ans D - all of the above.

These three terms are synonymous.

Bailey 27e pg 818.

82
Q

which of the following statements is false regarding differentiated thyroid carcinoma?

A. Nodal metastases in younger patients are associated with decreased survival.
B. Nodal metastases are a marker for distant metastases in older patients and decreased survival.
C. AJCC eighth edition has raised the age cut off to 55 years for differentiated thyroid cancers.
D. none of the above

A

Ans - A -

Nodal metastases in younger patients are associated with increased recurrence but not decreased survival.

Bailey 27e Pg 819.

83
Q

Drug of choice for acute viral thyroiditis causing severe hyperthyroidism?

A. Carbimazole
B. Propanolol
C. Thyroxine
D. Prednisolone

A

Ans D - Prednisolone 10-20mg daily for 7 days and then gradually taper. Bailey 27e Pg 822.

84
Q

which of the following has no role in treatment of Riedel’s thyroiditis?

A. Propanolol
B. Prednisolone
C. Thyroxine
D. Tamoxifen

A

Ans A - propanolol

Tamoxifen, thyroxine and high dose steroids are all used in treatment of Riedel’s thyroiditis.

Bailey 27e Pg 822.

85
Q

which of the following is the most common endocrine malignancy ?

A. Thyroid Carcinoma
B. Salivary gland Tumors
C. Pancreatic NETs
D. Breast Cancer

A

ANS A -

Thyroid carcinoma represents the most common endocrine malignancy -

MD Anderson 6e Pg 746.

86
Q

which of the following is the most rapidly diagnosed cancer?

A. Breast Cancer
B. Lung Cancer
C. Thyroid Cancer
D. Prostate Cancer

A

Ans C - Thyroid cancer.

MD Anderson 6e Pg 746.

87
Q

most common thyroid malignancy in patients exposed to radiation -

A. Papillary Thyroid Cancer
B. Follicular
C. Medullary
D. Anasplastic

A

Ans A - Papillary Thyroid cancer is most common in patients exposed to radiation.

MD Anderson 6e Pg 747.

88
Q

Which of the following findings is not pathognomic of Papillary thyroid cancer?

A. Nuclear Grooving with cytoplasmic inclusions
B. Orphan Annie Nuclei
C. Psammoma Bodies
D. None of the above

A

Ans C -
Psammoma bodies are calcified deposits of sloughed cells deposited in stroma or lymphatics that are present in 50% of papillary thyroid carcinoma. Alhough highly suggestive they are not pathognomic of it.

They are also found in -

Papillary Renal Cell Carcinoma
Micropapillary subtype of Lung AdenoCa. 
Papillary cystadenocarcinoma of ovary
Papillary Serous Endometrial Ca
Meningioma
Mesothelioma
Somatostatinoma
Prolactinoma
Glucagonoma

MD Anderson 6e Pg 747.

89
Q

What percentage of patients have occult nodal metastases in PTC at presentation?

A. 10-20%
B. 20-30%
C. 30-50%
D. >80%

A

Ans C -
nearly 30-80% may have lymph node involvement in PTC at presentation although most are microscopic in size.

MD Anderson 6e Pg 747.

90
Q

Peak age of incidence of Follicular Thyroid Cancer?

A. 30-40 years
B. 40-60 years
C. 50-70 years
D. 70-90 years

A

Ans - B 40-60 years of fifth to sixth decade of life is the peak age of incidence of follicular carcinoma of thyroid.

MD Anderson 6e Pg 748.

91
Q

which of the following mutations is not associated with increased risk of follicular thyroid carcinoma?

A. Inactivating mutations of APC
B. PTEN mutations
C. WRN Mutations
D. PRKAR1a mutations

A

Ans - A - inactivating mutations of APC or Familial adenomatous polyposis syndrome is associated with PTC and not FTC.

PTEN mutations - Cowden disease - PTC and FTC.
WRN mutations - Werner Syndrome - PTC, FTC and ATC
PRKAR1a mutations - Carney Complex - PTC and FTC.

MD Anderson 6e Pg 749.

92
Q

Which of the following syndromes is associated with Anaplastic Thyroid carcinoma -

A. Carney Complex
B. MEN 2A and MEN 2B
C. FAP
D. Werner Syndrome
E. Cowden Disease
A

Ans - D - Werner syndrome - is associated with mutations in the WRN gene and this is associated with PTC, FTC and ATC.

MD Anderson 6e Pg 749.

93
Q

What is the ten year survival rate of Follicular thyroid carcinoma?

A. >95%
B. 70-95%
C. 50-70%
D. <50%

A

Ans - B - 70-95% - this is slightly worse than the mean 10 year survival rate of PTC.

MD Anderson 6e Pg 749.

94
Q

what percentage of MTC are sporadic ?

A. 25%
B. 50%
C. 75%
D. 90%

A

Ans - C - 75% of the MTC are sporadic and they are usually unifocal. Whereas the MTC asociated with hereditary syndromes are often multifocal and occur in 3-4th decade.

MD Anderson 6e Pg 749.

95
Q

Which of the following statements is NOT true regarding MTC?

A. non-encapsulated and ill defined tumors
B. heterogenous mix of fibrous septa and amyloid.
C. IHC staining of the amyloid aids in diagnosis
D. Stains positive for Calcitonin and CEA.
E. Rapidly growing tumors

A

Ans - E -

MTC are slow growing tumors, but they have a high propensity for metastases and often have metastasize before the primary reaches the size of 2 cm.

Infact the 10 year survival for disease confined to the thyroid is nearly 90% for MTC, whereas with distant metastases the 10 year survival is only 20%.

MD Anderson 6e Pg 749.

96
Q

which of the following is FALSE statement regarding anaplastic thyroid carcinoma?

A. originates from a focus of differentiated thyroid carcinoma that de-differentiates over time

B. peak incidence is in the 7th decade of life.

C. tumor are non-encapsulated and often unresectable at initial presentation

D. Surgery has no role in treatment

A

Ans D -

with new treatment options that may slow growth or show significant tumor response surgical discussion both curative and palliative has become more common.

MD Anderson 6e Pg 750.

97
Q

Highest rate of regional metastases at presentation is seen in -

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

A

Ans - D - anasplastic carcinoma - nearly 90% have regional metastases at presentation, whereas the rates are

30-80% in papillary, often microscopic.
50% in medullary thyroid carcinoma.

MD Anderson 6e Pg 750.

98
Q

Pain of palpation with significant flushing and diarrhea is suggestive of which of the following?

A. MTC
B. ATC
C. FTC
D. PTC

A

ans - A MTC can cause pain on palpation with flushing and diarrhea due to the production of 5-Hydroxytryptamine (Serotonin) and Prostaglandins.

MD Anderson 6e Pg 751.

99
Q

FNA is recommended for thyroid swellings in -

A. High suspicion sonographic findings 10mm or more in size.
B. intermediate suspicion sonographic findings 10mm or more in size.
C. low suspicion sonographic findings 15mm or more in size.
D. very low suspicion sonographic findings 20mm or more in size

A

Ans - All are correct.

although observation without FNA is also an option in the very low suspicion swellings more than 20mm in size.

FNA is not recommended for nodules that are purely cystic.

MD Anderson 6e Pg 752.

100
Q

Which of the following sonographic findings is not highly suspicious of malignancy in thyroid?

A. Taller than Wide swelling
B. Extra-thyroidal extension
C. Lateral lymph node
D. Hypoechoic with irregular margins
E. Partially cystic with eccentric solid area
A

Ans E -

partially cystic swellings with eccentric solid area although cannot be labelled as benign and do need FNA evaluation they however still fall in the low suspicion category.

High risk features : 
Taller than Wide swelling
Hypoechoic swelling
Lymph node
Extra-thyroidal extension
Irregular margins
solid Swellings
Low risk features : 
Isoechoic or Hyperechoic
Regular margins
Cystic swellings 
spongiform appearance.

MD Anderson 6e Pg 753.

101
Q

the accuracy of FNA for diagnosis of thyroid swellings is highest for -

  1. <1cm
  2. 1-4cm
  3. > 4cm
  4. Equally accurate for all of the above
A

Ans B - 1-4 cm

<1cm swellings are more difficult to sample
>4cm swellings are more likely to have sampling error.

MD Anderson 6e Pg 752.

102
Q

Atypical cells of undetermined significance (ACUS) or Follicular lesions of undetermined significance fall in which category of Bethesda system ?

A. Category I
B. Category II
C. Category III
D. Category IV
E.  Category V
F. Category VI
A

ans C - category III

Category I - non diagnostic - 1-4% estimated risk - repeat FNA with USG guidance.

Category II - Benign (0-3%) - Follow up

Category III - Atypical cells of Undetermined significance (5-15%) - repeat FNA

Category IV - Follicular Neoplasm or suspicious for follicular neoplasm (15-30%) - Surgical Lobectomy

Category V - suspicious for malignancy (60-75%) - total thyroidectomy or surgical lobectomy

Category VI - Malignant - 97-99% - total thyroidectomy

MD Anderson 6e Pg 753.

103
Q

Which of the following categories of Bethesda system has the lowest risk of malignancy

A. Category I
B. Category II
C. Category III
D. Category IV

A 
Ans B - category II 
this is benign category whereas category I is nondiagnostic. 
Category I - 1-4% risk
Category II - 0-3% risk. 
Category III - 5-15% risk
Category IV - 15-30% risk
Category V - 60-75%.

MD Anderson 6e Pg 753.

104
Q

Lesions labelled as category V on FNA with suspicion for papillary tumor are most commonly which variant of papillary thyroid cancer?

A. Follicular variant
B. Tall cell variant
C. Diffuse sclerosing variant
D. Solid variant

A

Ans - A - Follicular variant.

MD anderson 6e Pg 754.

105
Q

which of the following statement is FALSE

A. Category III lesions are often due to inferior quality of sample (Hypocellularity, poor fixation, blood)

B. Category IV lesions should undergo intraoperative frozen section at the time of lobectomy

C. for tumors >4cm, local invasion or palpable nodal disease CT is the is used for preoperative planning.

D. None of the above

A

Ans B - category IV lesions are suspicious of follicular neoplasm, however intra-operative frozen section is not recommended to differentiate between adenoma and FTC.

MD Anderson 6e Pg 755.

106
Q

which of the following statements is true?

A. activation of Ras oncogene occurs as a late event in the tumorigenesis of thyroid cancer.

B. BRAF-v600E PTC is a homogenous group of tumors.

C. BRAF kinase normally dependent on Ras activation in order to propagate extra-cellular signal transduction

D. BRAF like PTCs signal through both MAPK and PI3K pathways

A

Ans C -

A - activation of Ras oncogene is seen in both malignant and benign thyroid swellings and it is an early even in tumorigenesis of PTC and FTC.

B. BRAF-v600E PTC is a heterogenous group of tumors.

D. BRAF like PTC signal primarily through MAPK pathway, whereas Ras like PTC signal through both MAPK and PI3K pathways.

Ras mutations are more prevalent in FTCs, Follicular variant of PTC and Follicular adenomas.

MD Anderson 6e Pg 756.

107
Q

Radiation induced PTC harbor -

A. BRAF v600E mutations
B. RET/PTC mutations
C. PAX8/PPARG mutations
D. Ras mutations

A

Ans - B - radiation induced PTC harbor RET/PTC mutations.

MD Anderson 6e Pg 756.

108
Q

RET proto-oncogene is located on -

A. Chromosome 10
B. chromosome 9
C. Chromosome 8
D. Chromosome 11

A

Ans A - Chromosome 10.

MD Anderson 6e Pg 756.

109
Q

which of the following statements is FALSE?

A. 80% of MTC are Hereditary.
B. germline mutations in RET proto-oncogene in MTC are mis-sense activating mutations.
C. 95% of inherited MTC carry RET Proto-oncogene mutations
D. 40% of sporadic MTC carry RET proto-oncogene mutations
E. 6-10% of sporadic MTC carry germline RET Proto-oncogene mutations.

A

Ans A - 80% of MTC are sporadic and not hereditary.

Statements B, C, D and E are all true.

MD Anderson 6e Pg 756.

110
Q

Which of the following codon of RET Proto-oncogene is most commonly mutated in sporadic MTC ?

A. 634.
B. 918
C. 883
D. 721

A

Ans - B Codon 918 is the most commonly found RET proto-oncogene mutation in sporadic cases of MTC.

MD Anderson 6e Pg 756.

111
Q

p53 mutations are implicated in which of the following thyroid malignancies -

A. FTC
B. PTC
C. ATC
D. MTC

A

Ans - C - Anaplastic thyroid carcinoma - p53 mutations are frequently found and therefore p53 mutations are involved late in the tumorigenesis of thyroid malignancies since they are related to de-differentiation.

MD Anderson 6e Pg 756.

112
Q

Primary outcome of interest in PTC in deciding the optimal treatment strategy?

A. recurrence
B. mortality
C. Morbidity
D. Cosmesis

A

Ans - A -recurrence has become the primary outcome of interest in PTC when deciding upon the optimal treatment strategy.

MD Anderson 6e Pg 757.

113
Q

which of the following is considered a high risk feature in differentiated thyroid cancers?

A. Microscopic Extrathyroidal extension
B. Aggressive histology
C. Vascular invasion
D. lymph node >3cm

A

Ans D - lymph node >3cm

High Risk features -

  • Gross extra-thyroidal extension
  • incomplete tumor resection
  • distant metastases
  • lymph node >3cm

Intermediate risk features

  • Microscopic extra-thyroidal extension
  • aggressive histology
  • vascular invasion
  • > 5 involved lymph nodes (0.2 to 3cm)

Low risk features

  • intra-thyroidal DTC
  • <5 LN micrometastasis (<0.2 cm)

MD Anderson 6e Pg 772.

114
Q

in patients with 1-4 cm well differentiated cancer which of the following factors is not relevant to decision making as to the extent of thyroidectomy - viz. total thyroidectomy or thyroid lobectomy?

A. Contralateral thyroid nodules
B. Coexistent thyroid pathology
C. Suspicion of extrathyroidal extension
D. Loco-regional and/or distant metastasis
E. None of the above
A

Ans - E non of the above.

Typically in a well differentiated carcinoma of thyroid measuring <1cm thyroid lobectomy is the treatment of choice.
Whereas in well differentiated carcinoma of thyroid measuring 1-4 cm the decision of whether to proceed for thyroid lobectomy or total thyroidectomy depends on the presence or absence of these factors.

If any of these factors are present then the decision leans in the favor of total thyroidectomy.

Pg 758.

115
Q

which of the following level of cervical nodes is not routinely excised in lymph nodal dissection for thyroid carcinoma?

A. Level II a
B. Level II b
C. Level III
D. Level VI

A

Ans - B - Level IIb -

Often for primary tumor >4cm or when extrathyroidal extension is diagnosed either preoperatively or at the time of surgery, then an ipsilateral central lymph nodal dissection is done.

When there is evidence of preoperative biopsy proven central or lateral compartment disease or central compartment nodal disease that is found intraoperatively - then bilateral therapeutic central lymph node dissection is done.

levels IIb, V and VII are dissected only based on the the preoperative imaging or intraoperative findings in PTC.

Va and IIb are not routinely included in the lateral compartment neck dissection.

MD Anderson 6e Pg 759.

116
Q

what is the treatment of choice for medullary carcinoma thyroid?

A. Total lobectomy
B. Total thyroidectomy
C. Total Thyroidectomy with bilateral prophylactic central lymph node dissection
D. Total Thyroidectomy with ipsilateral prophylactic MRND with bilateral prophylactic central node dissection

A

Ans - C -
total thyroidectomy with bilateral prophylactic central lymph node dissection.

MD Anderson 6e Pg 759.

117
Q

most common location of the superior pararthyroid glands?

A. related to the upper pole of the thyroid
B. Paraesophageal below the inferior thyroid artery
C. In carotid sheath
D. within 1cm of the intersection of the RLN and inferior thyroid artery

A

Ans D - within 1cm of the intersection of the inferior thyroid artery and recurrent laryngeal nerve is the most common location - nearly 80% of cases.

MD Anderson 6e Pg 760.

118
Q

which of following is not a border of the central lymph node dissection?

A. Hyoid bone
B. Cricoid cartilage
C. Carotid arteries
D. Innominate artery

A

Ans - B - Cricoid cartilage.

The boundaries of the central compartment for lymph node dissection is -
Superior - Hyoid bone
Inferior - Innominate artery
Lateral - Carotid Arteries.

Goal is to clear all prelaryngeal, pretracheal and paratracheal lymphatic tissue on the side of the tumor.

MD Anderson 6e Pg 762.

119
Q

Most superior for predicting the survival in thyroid cancer is -

A. AGES
B. AMES
C. MACIS
D. AJCC TNM

A

Ans D - AJCC TNM has been found to be superior in predicting cancer related mortality.

however none of these systems have high predictive value in forecasting recurrent disease.

AGES - Age, Grade, Extent, Size
AMES - Age, Metastasis, Extent. Size
MACIS - Metastasis, Age, Completeness of resection, Invasion, Size

MD Anderson 6e Pg 766.

120
Q

prognosis of patients with well differentiated cancer is based on all of the following except -

A. Age
B. Gender
C. Extent of the disease
D. Size of the primary
E. Lymph nodal status
A

Ans - E Lymph nodal status

male gender is associated with more aggressive disease and it is a independent predictor of survival.

Age is one of the most important predictors of survival.

Lymph nodal status and prognosis is still debated, since lymph node involvement predicts local recurrence but does not contribute significantly to patient survival.

Lymph node involvement affects survival in those patients older than 55 years of age.

MD Anderson 6e Pg 767.

121
Q

a well differentiated thyroid malignancy with gross extra-thyroidal extension involving the strap muscles is T stage?

A. T1b
B. T3a
C. T3b
D. T4a

A

Ans - C - T3b

T1a - 1cm or less, limited to thyroid.
T1b - more than 1cm, upto 2cm or less; limited to thyroid.
T2 - more than 2cm, upto 4cm or less; limited to thyroid.
T3a -more than 4cm limited to thyroid.
T3b - gross extra-thyroid extension involving the strap muscles only.
T4a - gross extra-thyroid extension involving soft tissue, larynx, trachea, esophagus or RLN (Resectable)
T4b - gross extrathyroid extension involving prevertebral fascia, encasing carotid artery or mediastinal vessels. (Unresectable)

MD Anderson 6e Pg 767.

122
Q

which of the following is considered as N1a disease in thyroid cancer?

A. Level II
B. Level III
C. Level IV
D. Level VII

A

ans D - Level VII

Level VI (Pretracheal, paratracheal and prelaryngeal/Delphian nodes are considered level VI)
Level VII (Upper mediastinal)

level VI and VII are considered N1a disease.

Whereas level II, III, IV or V are considered N1b disease.

MD Anderson 6e Pg 768.

123
Q

A 54 year old female presents with papillary carcinoma of thyroid presents with a 5x6cm thyroid mass with complete encasement of the carotid artery and no evidence of distant metastasis.
What is the stage of the disease?

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

A

Ans - A Stage I

as per AJCC 8th edition, the cut-off for age in well differentiated thyroid cancer is at 55 years of age.
With all M0 tumors below the age of 55 years are considered Stage I whereas all M1 tumors below the age of 55years are considered Stage II.

MD Anderson 6e Pg 768.

124
Q

A 56 year old female presents wit papillary carcinoma of thyroid presents with a 5x6 cm thyroid mass with gross extrathyroidal extension to the sternothyroid muscle. No evidence of distant metastases or nodal metastases. What is the stage of the disease?

A. Stage I
B. Stage II
C. Stage III
D. Stage IVa

A

Ans B. Stage II

stage of the disease is T3bN0M0 and age 55 years or more.

Therefore the stage of the disease is stage II.

Stage I - T1N0 and T2N0 disease (intra thyroidal tumor measuring 4cm or less in size with no involvement of nodes or extrathyroidal spread)

Stage II - T1N1, T2N1, T3Nany disease (Intrathyroidal disease of any size with nodal mets OR Extrathyroidal disease of any size involving the strap muscles only with or without nodal metastases)

Stage III - T4a disease (Extrathyroidal disease which can be resected enbloc with/without nodal mets - i.e. involving larynx/esophagus/trachea/RLN)

Stage IVa - T4b disease (Extrathyroidal disease which cannot be resected - i.e. involving carotid encasement/prevertebral fascia/mediastinal vessels)

Stage IVb - M1 disease (distant mets)

MD Anderson 6e Pg 769.

125
Q

A 12 year old female patient presents with anaplastic carcinoma of thyroid measuring 1x1 cm in size without nodal involvement or distant metastases. What is the stage of the disease?

A. Stage II
B. Stage III
C. Stage IVa
D. Stage IVb

A

Ans C - Stage IVa -

Anaplastic carcinoma of the thyroid irrespective of the age is classified as stage IV.
stage IVa - Intrathyroidal disease of any size without nodal mets.
Stage IVb - extrathyroidal disease or nodal mets.
Stage IVc - metastatic disease.

MD Anderson 6e Pg 769.

The thyroid gland (1 decks)

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