URR 56

Question 1

usually presents as painless hypothyroidism

Answer 1

Hashimoto Disease

Question 2

Patients with Hashimoto Disease have an increased risk of __, ___, ___, ___, ___, and ___

Answer 2

thyroid, breast, lung, GI tract, urogenital, blood cancers

Question 3

diffuse enlargement of thyroid glands; hypoechoic, coarse echotexture; remains mostly homogenous in texture; increased vascular flow

Answer 3

Hashimoto disease

Question 4

recurrent thyroiditis or untreated thyroiditis; gland atrophies and fibrosis occurs; dense areas of fibrosis may form at the gland shrinks in size

Answer 4

chronic thyroiditis

Question 5

Sonographic appearance of chronic thyroiditis

Answer 5

small gland; heterogeneous; varied echotexture

Question 6

What structure attaches the thyroid gland to the pharynx?
a. pyramidal lobe
b. strap muscle
c. thyroglossal duct
d. cervical ligaments

Answer 6

c

Question 7

The pyramidal lobe typically projects from:
a. the mid right lobe
b. the lower left lobe
c. the isthmus
d. the lower right lobe

Answer 7

c

Question 8

The ___ muscles lie anteromedial to the thyroid while the ___ muscles lie posterior to the thyroid.
a. strap, longus colli
b. levator ani, strap
c. sternocleidomastoid, strap
d. sternocleidomastoid, longus colli

Answer 8

a

Question 9

Which of the following would cause thyromegaly?
a. chronic hepatitis
b. acute hepatitis
c. radioactive iodine treatment
d. all the above

Answer 9

b

Question 10

The superior thyroidal artery branches from the __, while the inferior thyroidal artery branches from the __.
a. external carotid artery, internal carotid artery
b. subclavian artery, aorta
c. external carotid artery, subclavian artery
d. internal carotid artery, external carotid artery

Answer 10

c

Question 11

What 2 vessels merge to form the innominate vein?
a. subclavian and cephalic
b. internal and external jugular
c. internal jugular and subclavian
d. right and left subclavian

Answer 11

c

Question 12

The ___ releases thyrotropin which stimulates the ___ to release thyroid stimulating hormone (TSH).
a. hypothalamus gland, pituitary gland
b. pituitary gland, hypothalamus gland
c. pancreas, kidneys
d. kidneys, pancreas

Answer 12

a

Question 13

TSH levels control the production of what 2 hormones?
a. Iodine and calcitonin
b. thyroxin and thyroglobulin
c. thyrotropin and trypsin
d. T3 and T4

Answer 13

d

Question 14

Calcitonin levels are opposed by levels of what other hormone?
a. T3
b. T4
c. Parathyroid hormone
d. thyrotropin

Answer 14

c

Question 15

Which of the following is a symptom of hyperthyroidism?
a. anxiety
b. tachycardia
c. hypercalcemia
d. all the above

Answer 15

d

Question 16

Which of the following is a symptom of hypothyroidism?
a. High T3 and T4 levels with low TSH
b. Low T3 and T4 levels with high TSH
c. sweating
d. weight loss

Answer 16

b

Question 17

What is recommended to best evaluate the thyroid isthmus?
a. high frequency curved array
b. stand off pad
c. dual screen imaging
d. panoramic imaging

Answer 17

b

Question 18

When evaluating a thyroid gland with multiple nodules:
a. measure the largest nodule on each side
b. measure all nodules greater than 2 cm in diameter
c. Measures the largest nodule in each pole of both sides
d. Measure all nodules present

Answer 18

c

Question 19

Which of the following is demonstrated as a target-like structure posterior to the left lobe?
a. common carotid artery
b. internal jugular vein
c. longus colli muscle
d. esophagus

Answer 19

d

Question 20

Elastography is used to evaluate what characteristic of a thyroid nodule?
a. stiffness
b. vascularity
c. border characteristics
d. all the above

Answer 20

a

Question 21

Papillary carcinoma of the thyroid __%

Answer 21

75

Question 22

Follicular carcinoma of the thyroid __%

Answer 22

10

Question 23

Medullary carcinoma of the thyroid _%

Answer 23

5

Question 24

Anaplastic carcinoma of the thyroid __%

Answer 24

<5

Question 25

Lymphoma of the thyroid _%

Answer 25

<5

Question 26

Sarcoma of the thyroid is ___

Answer 26

rare

Question 27

Most primary cancers originate in the ____ cells

Answer 27

parafollicular

Question 28

Risk factors for thyroid cancer

Answer 28

history of MENS syndrome head and neck irradiation family history of thyroid cancer

Question 29

Signs and symptoms of thyroid cancer

Answer 29

palpable firm neck mass enlarged cervical lymph nodes hoarseness voice changes or cough trouble swallowing or breathing

Question 30

Most common thyroid cancer

Answer 30

Papillary

Question 31

Strong indications of thyroid malignancy

Answer 31

absent halo sign microcalcifications intranodular flow patterns

Question 32

Microcalcifications are also known as:

Answer 32

psammoma bodies

Question 33

Color Doppler commonly demonstrates _____ in malignant nodules.

Answer 33

central and perinodular hypervascularity

Question 34

Color Doppler commonly demonstrates ____ in benign nodules.

Answer 34

perinodular hypervascularity

Question 35

Most thyroid tumors are ___ and appear as cold nodules on nuclear medicine evaluation

Answer 35

benign

Question 36

Hot nodules are typically:

Answer 36

hyperfunctioning benign adenomas

Question 37

75-90% thyroid malignancies

Answer 37

papillary carcinoma

Question 38

Papillary carcinoma is more common in __

Answer 38

women

Question 39

painless neck lump; slow growing; usually a solitary nodule; malignant tumor

Answer 39

papillary carcinoma

Question 40

Treatment for papillary carcinoma

Answer 40

thyroid lobectomy hormone therapy

Question 41

Heterogeneous, hypoechoic solid mass; may see microcalcifications; most cases hypervascularity

Answer 41

papillary carcinoma

Question 42

Papillary carcinoma is associated with enlarged cervical lymph nodes due to __

Answer 42

metastasis

Question 43

rare thyroid malignancy; frequency increases with age; usually solitary mass; slow growing

Answer 43

follicular cancer

Question 44

Follicular cancer is more common in __

Answer 44

women

Question 45

May be similar appearance to benign adenoma but can demonstrate irregular margins; thickened halo; chaotic arrangement of internal blood vessels

Answer 45

follicular cancer

Question 46

Adenocarcinoma is a rare thyroid malignancy and is ____ aggressive

Answer 46

moderately

Question 47

hard bulky mass; secretes calcitonin; most commonly bilateral and/or multicentric

Answer 47

medullary carcinoma

Question 48

Medullary carcinoma is usually found in the __ or __ decades

Answer 48

5th 6th

Question 49

medullary cancer + parathyroid cancer + pheochromocytoma

Answer 49

Sipple Sydrome

Question 50

Medullary carcinoma is associated with ___

Answer 50

MEN syndrome

Question 51

Medullary carcinoma tumors secrete ___

Answer 51

calcitonin

Question 52

encapsulated masses, well circumscribed, may invade surrounding tissues; usually punctate calcifications seen within masses; similar to papillary carcinoma

Answer 52

medullary carcinoma

Question 53

10-12% thyroid malignancies, slow growing

Answer 53

Hurthle Cell Cancer

Question 54

Giant and Spindle Cell cancer is also known as ___

Answer 54

anaplastic cancer

Question 55

Giant and spindle cell cancer accounts for __% of thyroid malignancies

Answer 55

10

Question 56

Very aggressive; most lethal type of thyroid malignancy

Answer 56

giant and spindle cell cancer

Question 57

hard, fixed mass with rapid growth; usually invades surrounding neck structures; can cause death by compression of trachea or infiltration into trachea occluding airway

Answer 57

giant and spindle cell cancer

Question 58

usually hypoechoic with ill-defined borders; neck muscle and/or blood vessel invasion; encases blood vessels; compresses trachea and/or esophagus

Answer 58

giant and spindle cell cancer

Question 59

Most common primary cancers to metastasize to thyroid

Answer 59

melanoma breast renal lung

Question 60

post-surgical thyroid bed evaluation is performed to evaluate ___, ___, and ___

Answer 60

residual recurrent metastatic disease

Question 61

___ and ___ levels are monitored in thyroidectomy patients.

Answer 61

thyroglobulin thyroglobulin antibody levels

Question 62

If the patient had a complete thyroidectomy, there should be no ____ present in the blood/.

Answer 62

thyroglobulin

Question 63

Increasing thyroglobulin levels and thyroglobulin antibody levels in a post-surgical patient can indicate:

Answer 63

recurrence

Question 64

Normal lymph nodes sonographic appearance

Answer 64

ovoid shape no posterior enhancement hyperechoic hilum with hypoechoic cortex

Question 65

abnormal lymph nodes sonographic appearance

Answer 65

round shape "plump" anechoic cortex causes decreased visualization of central hilum Posterior enhancement

Question 66

How many levels of lymph nodes are there?

Answer 66

7

Question 67

In the upper neck you can find the ___, ___, ___ and ____ regions

Answer 67

submental submandibular parotid jugulodiagastric

Question 68

Levels III and IV lymph nodes are found at the level of the ___

Answer 68

clavicle

Question 69

Level III and IV nodes are ___ to the carotid artery, while VI nodes are ___ to the carotid artery

Answer 69

lateral medial

Question 70

Level __ and __ lymph nodes are most commonly affected by tumor recurrence

Answer 70

III IV

Question 71

What is a contraindication for a biopsy in the neck

Answer 71

post-traumatic neuroma

Question 72

hypoechoic mass lateral to the spine that in continguity with its associated nerve

Answer 72

post- traumatic neuroma

Question 73

Ectopic thyroid tissue is most commonly found in the ____ area and the most common located outside of the neck is in the ____

Answer 73

sunlingual mediastinum

Question 74

most common congenital neck cyst

Answer 74

thyroglossal duct cyst

Question 75

most common solid lesion of the thyroid

Answer 75

adenomas

Question 76

most commonly caused be decreased levels of iodine in diet/body

Answer 76

multinodular goiters

Question 77

Graves' disease and Hashimoto thyroiditis are common causes of __

Answer 77

diffuse thyroiditis

Question 78

most common cause of hyperthyroidism

Answer 78

Graves' disease

Question 79

most common cause of hypothyroidism

Answer 79

Hashimoto disease

Question 80

most commonly bilateral and/or multicentic

Answer 80

medullary cancer

Question 81

Level __ and __ lymph nodes are most commonly affected by tumor recurrence

Answer 81

III IV

Question 82

Most primary cancers originate in the: a. stromal tissue b. follicle tissue c. parafollicular cells d. isthmus

Answer 82

c

Question 83

Which of the following is a strong indicator of thyroid malignancy? a. absent halo sign b. microcalcifications c. intranodular flow patterns d. all the above

Answer 83

d

Question 84

Psammoma bodies is another term for: a. microcalcifications b. fibrous nodules c. cystic nodules d. hypervascular nodules

Answer 84

a

Question 85

After a thyroidectomy due to cancer, why are serial neck ultrasound exams performed annually on these patients? a. to evaluate for the regrowth or normal thyroid tissues b. to evaluate for scar tissue from the surgery c. to evaluate the cervical lymph nodes d. to evaluate the surgical bed for fluid collection

Answer 85

c

Question 86

Psamomma bodies are commonly seen in what type of cancers? a. metastatic b. papillary c. anaplastic d. follicular

Answer 86

b

Question 87

Which type of thyroid malignancy appears similar to a benign thyroid adenoma, but has irregular borders? a. medullary b. papillary c. anaplastic d. follicular

Answer 87

d

Question 88

Which type of thyroid cancer is associated with MEN syndrome? a. medullary b. papillary c. anaplastic d. follicular

Answer 88

a

Question 89

What hormone is secreted by a medullary carcinoma mass? a. epinephrine b. testosterone c. estrogen d. calcitonin

Answer 89

d

Question 90

What is the most aggressive and lethal type of thyroid cancer? a. anaplastic/giant cell b. medullary c. papillary d. follicular

Answer 90

a

Question 91

What antibody levels are monitored in thyroidectomy patients? a. TSH b. T4 c. T3 d. thyroglobulin

Answer 91

d

Question 92

Which of the following is a sign of an abnormal lymph node? a. ovoid shape b. no visible hilum c. no posterior enhancement d. all the above

Answer 92

b

Question 93

Lymph nodes located adjacent to which of the following structures should be evaluated in a post-thyroidectomy patient? a. sternocleidomastoid muscle b. common carotid artery c. internal jugular vein d. all the above

Answer 93

d

Question 94

The parathyroid glands arise from the 3rd and 4th pharyngeal pouches at __ weeks gestational age

Answer 94

7

Question 95

located on the mid and lower posterior regions of the thyroid

Answer 95

parathyroids

Question 96

The inferior pair of parathyroid glands are usually more ___ than the superior pair

Answer 96

anterior

Question 97

The inferior pair of glands arise from the ___ pouch and migrate to the ____ of the thyroid on each side

Answer 97

3rd lower posterior portion

Question 98

The superior pair of parathyroid glands arise from the __ pouch and migrate to the ____ portion of the thyroid on each side

Answer 98

4th upper posterior

Question 99

The parathyroid glands are ___ or ___ shaped

Answer 99

disc bean

Question 100

The normal parathyroid measures __-__ mm in length

Answer 100

5 7