Thyroid Masses

Question 1

Most thyroid nodules exceeding __ in max diameter should be evaluated further.

Answer 1

1.5 cm

Question 2

This is the most effective method for dagnosing malignancy in a thyroid nodule.

Answer 2

FNA

Question 3

Most physicians use a __ gauge needle for FNA procedures.

Answer 3

25

Question 4

An FNA is performed with a MNG when there is a…

Answer 4

dominant nodule.

Question 5

Would you rather have a solitary ‘cold’ thyroid nodule or a cold MNG?

Answer 5

A cold MNG. (Solitary ‘cold’ nodules are more likely to be malignant.)

Question 6

What sonographic features are associated with benign vs malignant thyroid nodules?

Answer 6

1. internal consistancy
2. echogenicity
3. margination
4. calcification
5. peripheral sonolucent halo

Question 7

T/F? True simple thyroid cysts are extremely common.

Answer 7

FALSE, rare.

Question 8

T/F? A nodule with a significant cystic component is usually benign.

Answer 8

true

Question 9

Thyroid cancers are usually __echoic relative to the adjacent normal tissue.

Answer 9

hypo-

Question 10

A __echoic thyroid nodule is more likely to be benign.

Answer 10

hyper-

Question 11

T/F? Benign thyroid nodules tend to have sharp, well-defined margins.

Answer 11

true

Question 12

T/F? Malignant thyroid nodules tend to have sharp, well-defined margins.

Answer 12

FALSE, benign

Question 13

This is the most reliable feature of a benign nodule.

Answer 13

peripheral or eggshell calcification

Question 14

Calcifications that are ___ are more suggestive of malignancy.

Answer 14

fine and punctate

Question 15

A thin complete halo is more likely to be seen with a __ nodule.

Answer 15

benign

Question 16

A ___ halo is more likely to be seen with a malignant nodule.

Answer 16

thick incomplete

Question 17

This is the most common primary thyroid cancer accounting for 75-90% of all cases.

Answer 17

Papillary carcinoma

Question 18

What age person is likely to get papillary carcinoma?

Answer 18

Someone is their 30s or 70s.

Question 19

This is the major route of spread of papillary carcinoma.

Answer 19

lymphatics to nearby cervical lymphnodes

Question 20

Sonographically, papillary carcinoma appears as __echoic, ___ calcifications, __vascularity, __ metastases.

Answer 20

hypo-, micro-, hyper-, cervical lymphnode

Question 21

This is the second most common thyroid cancer accounting for 5-15% of cases.

Answer 21

follicular carcinoma

Question 22

This is the major route of spread of follicular carcinoma.

Answer 22

bloodstream leading to distant mets

Question 23

Often encapsulated, this thyroid cancer looks similar to benign adenomas.

Answer 23

follicular carcinoma

Question 24

This is a rarer form of thyroid cancer accounting for around 5% of cases.

Answer 24

medullary carcinoma

Question 25

This thyroid cancer secretes 'calcitonin', a useful serum marker.

Answer 25

medullary carcinoma

Question 26

This thyroid cancer is frequently familial and is a component of MEN type II syndromes.

Answer 26

medullary carcinoma

Question 27

T/F? Medullary carcinoma is unilateral about 90% of the time with a low incidence of lymphnode mets.

Answer 27

FALSE, bi-, high incidence

Question 28

Sonographically, medullary carcinoma appears as a __echoic solid mass with __ calcifications, and __ metastases.

Answer 28

hypo-, coarse, lymphnode

Question 29

This is a rare and lethal thyroid cancer of the elderly, accounting for only <2% of cases.

Answer 29

anaplastic thyroid carcinoma

Question 30

This thyroid tumor presents as a rapidly enlarging mass extending beyond the gland and invading adjacent structures.

Answer 30

anaplastic carcinoma

Question 31

These are small endocrine glands in the neck.

Answer 31

parathyroid glands

Question 32

These control the amount of calcium in the blood and within the bones.

Answer 32

parathyroid glands

Question 33

T/F? The parathyroids are anterior to the thyroid.

Answer 33

FALSE, posterior

Question 34

Sonographically, this appears as an oval hypoechoic mass posterior to the thyroid.

Answer 34

parathyroid adenoma

Question 35

This is the most common type of hyperparathyroidism.

Answer 35

primary hyperparathyroidism

Question 36

This is due to the development of an adenoma associated with one of the parathyroid glands.

Answer 36

primary hyperparathyroidism

Question 37

This is suspected with an increase in serum calcium levels.

Answer 37

primary hyperparathyroidism

Question 38

Primary hyperparathyroidism is confirmed by what lab values?

Answer 38

elevated serum parathyroid hormone (PTH) and elevated serum calcium

Question 39

This endocrine condition occurs in patients with chronic renal failure.

Answer 39

secondary hyperthyroidism

Question 40

In secondary hyperthyroidism, the inability of the kidneys to filter results in elevated amounts of...

Answer 40

serum phosphates.

Question 41

The inability to synthesize vitamin D depresses the ___ which stimulates parathyroid gland hyperplasia.

Answer 41

serum calcium

Question 42

In secondary hyperparathyroidism, how many parathyroid glands will enlarge?

Answer 42

all four

Question 43

Secondary hyperthyroidism is confirmed by what lab values?

Answer 43

elevated phosphates and decreased serum calcium

Question 44

Name three kinds of extrinsic neck masses.

Answer 44

1. thyroglossal duct cyst 2. branchial cleft cyst 3. cystic hygroma

Question 45

This is a superficial cystic midline neck mass.

Answer 45

thyroglossal duct cyst

Question 46

This neck mass is commonly seen in adolescents following an URI.

Answer 46

thyroglossal duct cyst

Question 47

T/F? Carcinoma may develop in a thyroglossal duct cyst.

Answer 47

true

Question 48

T/F? Most thyroglossal duct cysts are located just superior to the hyoid bone.

Answer 48

FALSE, inferior

Question 49

This is a solitary predominantly cystic lateral neck mass.

Answer 49

branchial cleft cyst

Question 50

This is a congenital lymphatic malformation, a cystic multiloculated cervical mass.

Answer 50

cystic hygroma

Question 51

The left CCA and SCA originate from the...

Answer 51

aortic arch.

Question 52

The innominate artery is also known as...

Answer 52

the brachiocephalic trunk.

Question 53

The right CCA and SCA origniate from the...

Answer 53

brachiocephalic trunk.

Question 54

The CCAs ascend in the neck __ to the IJVs.

Answer 54

medial

Question 55

The ICA has a __ resistance waveform.

Answer 55

low

Question 56

The ECA has a __ resistance waveform.

Answer 56

high

Question 57

The 1st branch of the ICA is the __ artery.

Answer 57

ophthalmic

Question 58

The 1st branch of the ECA is the __ artery.

Answer 58

superior thyroid

Question 59

The IJV is __ to the CCA.

Answer 59

lateral

Question 60

The IJV and SCV drain into the __ veins bilaterally.

Answer 60

innominate (brachiocephalic)

Question 61

The external jugular vein is located superficially on the __ aspect of the neck.

Answer 61

lateral