EXAM #1: THYROID CANCER

Question 1

What is the difference between a tyroglossal duct cyst and a cervical cyst?

Answer 1

Midline= thyroglossal duct cyst 
Lateral= cervical cyst

Question 2

Where does the superior thyroid artery come from?

Answer 2

External carotid artery

Question 3

Where does the inferior thyroid artery come from?

Answer 3

Thyrocervical trunk

Question 4

What is a potential complication of a tracheostomy that results in excessive bleeding?

Answer 4

Transsection of a “Thyroid ima artery” that runs along the anterior trachea

Question 5

Where does the Inferior thyroid vein drain?

Answer 5

Brachiaocephalic

Question 6

Where do the superior and middle thyroid veins drain?

Answer 6

Internal jugular vein

Question 7

What nerve do you need to be especially conscious of when performing a thyroidectomy?

Answer 7

Recurrent laryngeal nerve of the vagus

*Most common is Injury to the external branch of the superior laryngeal nerve–not a big deal. Most dreaded is injury to the recurrent laryngeal bilaterally.

Question 8

What does the recurrent laryngeal nerve innervate?

Answer 8

All intrinsic muscles of the larynx EXCEPT the cricothyroid muscle

Question 9

Where does the recurrent laryngeal nerve lie?

Answer 9

tracheoesophageal groove

Question 10

What is the differential diagnosis for a thyroid nodule?

Answer 10

1) Cyst
2) Thyroid adenoma
3) Infection/ thyroiditis
4) Developmental abnormality
5) Carcinoma
6) Thyroid lymphoma

*Note that most are NOT malignant

Question 11

What is an important historical feature to ask patients about when taking a thyroid related history?

Answer 11

Radiation exposure

Question 12

What is the most reliable and cost effective method for diagnosing thyroid nodules? When is this absolutely indicated?

Answer 12

FNA

*Note that this is indicated for any nodule greater than 1 cm; less than 1 cm is less clear

Question 13

What information can you discern from a thyroid US?

Answer 13

1) Solid vs. cystic

2) Homogenous vs. heterogenous

Question 14

If a radionuclear scan of the thyroid is performed, which is more likely to be malignant–hot or cold nodule?

Answer 14

Cold nodule

Question 15

What are the differentiated thyroid cancers? How are these followed and treated?

Answer 15

1) Papillary
2) Follicular
3) Hurthle Cell

*Followed with thyroglobulin and treated with radioactive iodine

Question 16

What is the c-cell cancer?

Answer 16

Medullary Thyroid Cacner

Question 17

What is pathognomonic for papillary thyroid cancer?

Answer 17

Psammoma bodies

Question 18

What is Follicular Thyroid Cancer?

Answer 18

Neoplastic proliferation of thyroid follicles that invades the capsule

Question 19

How is follicular thyroid cancer spread?

Answer 19

Hematogenously

Question 20

Where does follicular thyroid cancer commonly metastasize?

Answer 20

• Bone
• Lung
• Liver
• CNS

Question 21

What is Hurtle Cell Cancer?

Answer 21

Variant of Follicular Thyroid Cancer

*Difficult to determine if benign or malignant via FNA

Question 22

What is Medullary Thyroid Cancer?

Answer 22

Malignant neuroendocrine tumor of parafollocular C-cells

Question 23

What are the markers for Medullary Thyroid Cancer?

Answer 23

Calcitonin

CEA

Question 24

What do you need to screen for in patients with Medullary Thyroid Cancer?

Answer 24

1) Pheochromocytoma

2) Hyperparathyroidism

Question 25

What syndromes are associated with Medullary Thyroid Cancer?

Answer 25

MEN 2A and 2B

Question 26

Is medullary thyroid cancer response to radioactive iodine?

Answer 26

NO

Question 27

What do you need to measure after surgery for medullary thyroid cancer?

Answer 27

Calcitonin

Question 28

What are the clinical features of anaplastic thyroid cancer?

Answer 28

- Rapidly enlarging - Painful - Symptomatic

Question 29

What is the primary treatment for anaplastic thyroid cancer?

Answer 29

Chemoradiation

Question 30

What is Thyroid Lymphoma?

Answer 30

Rare lymphoma that develops from the thyroid gland

Question 31

What is the treatment for thyroid lymphoma?

Answer 31

Chemoradiation

Question 32

If a thyroid tumor is less than 1 cm in size, what surgical procedure should be performed?

Answer 32

Lobectomy

Question 33

What stage are all anaplastic carcinomas considered?

Answer 33

Stage IV--worst prognosis

Question 34

What are the best relative 5-year survival rates for the thyroid cancers?

Answer 34

1) Papillary 2) Follicular 3) Medullary

Question 35

When is lymph node dissection warranted?

Answer 35

Grossly positive nodes on physical exam or imaging--no consensus otherwise

Question 36

What are the post-surgical complications of a thyroidectomy?

Answer 36

1) Hematoma 2) Nerve injury 3) Hypocalcemia

Question 37

What is Chovstek's sign?

Answer 37

Tapping on the cheek causes spasm

Question 38

What is Troussseau's sign?

Answer 38

Carpopedal spasm with BP cuff

Question 39

Should you give a patient thyroid hormone after thyroid surgery?

Answer 39

NO--send to an Endocrinologist