Head Neck Thyroid Parathyroid

Question 1

Mucous retention cyst of sublingual gland

Answer 1

Ranula

Question 2

Benign tumor of the tongue derived from schwann cells?

Treatment?

Answer 2

Giant cell myoblastoma (ABRIKOSSOF TUMOR)

Tx: wide excision

Question 3

Arise from dental lamina associated with impacted tooth
Presents as painless mandibular mass
Xray: “soap bubble appearance”

Answer 3

Ameloblastoma

Question 4

Cyst of oral mucosa due to rupture of ductal system hence submucosal accumulation of mucus

Answer 4

Mucous retention cyst

Question 5

Where does left Recurrent LN crosses?

Answer 5

Aorta

Question 6

Where does right Recurrent LN crosses?

Answer 6

Subclavuan artery

Question 7

In radionuclide imaging, what kind of iodine is used to see residual thyroid after surgery or for metastatic cancer?

Answer 7

Iodine-123 (half life: 12-14 hours)

Question 8

In radionuclide imaging, what kind of iodine is used to screen and treat well differentiated thyroid cancers?

Answer 8

Iodine-131 (half life: 8-10 days)

Question 9

Adverse effect of methimazole

Answer 9

Congenital aplasia

Question 10

Adverse effect of anti-thyroid drugs

Answer 10

Granulocytopenia/ agranulocytosis
Peripheral neuritis
Aplastic anemia (irreversible)

Question 11

Action of PTU and methinazolr

Answer 11

Inhibit iodine organification and coupling of iodotyronine

PTU: also inhibit peripheral conversion of T4 to T3

Question 12

Disadvantage of Radioactive iodine therapy

Answer 12

Progression of ophthalmopathy

Increased rate of cardiovascular mortality

Question 13

Advantage of RAI in hyperthyroidism

Answer 13

Eurhyroid in 2 months

Question 14

Absolute contraindication for RAI

Answer 14

Pregnant and breastfeeding

Question 15

Indication of RAI

Answer 15

Elderly male with small-moderate goiters

relapse after surgery

Question 16

What are the components of hartley-dunhill procedure?

Answer 16

Total ipsilateral lobectomy
Isthmusectomy
Contralateral subtotal thyroidectomy

Question 17

Signs and symptoms are sinilar to grave’s but extrathyroidal sx are absent

Answer 17

Toxic multinodular goiter

Question 18

Occurs in young patient with long standing nodule with hyperthyroidism

Answer 18

PLUMMER’s disease (Toxic Adenoma)

Question 19

If with recurrent acute thyroiditis, suspect what anomaly?

Answer 19

3rd branchial cleft anomaly

Persistent PYRIFORM SINUS fistula

Question 20

Thyroiditis common in children, preceded by URTI

Answer 20

Acute suppuratice thyroiditis

Question 21

Kind of thyroiditis viral in origin

Answer 21

Subacute thyroiditis PAINFUL type

Question 22

Sub acute Thyroiditis that is auto immune in origin

Answer 22

Subacute thyroiditis PAINLESS Type

Question 23

Most common inflammatory disorder of thyroid gland

Answer 23

Hashimoto’s/ Lymphocytic/Chronic thyroiditis

Question 24

Leading cause of hypothyroidism

Answer 24

Hashimoto’s/ Lymphocytic/Chronic thyroiditis

Question 25

Hard woody thyroid gland Painless hard anterior mass Compressive

Answer 25

REIDEL'S thyroiditis/ invasive fibrous thyroiditis

Question 26

Single most important test in evaluation of thyroid nodules

Answer 26

FNAB (gauge 23 needle)

Question 27

Diagnostic procedure for HURTLE CELL and FOLLICULAR CA

Answer 27

Tissue biopsy/ frozen section | They can't be diagnosed with FNAB

Question 28

In FNAB of thyroid nodule, components of optimum cytology

Answer 28

6 follicles 10 cells/ follicle In 2 aspirates

Question 29

After thyroidectomy, how many weeks will you give RAI?

Answer 29

6 weeks

Question 30

Dose of maintenance LT4 post op

Answer 30

1.5 mcg/kg

Question 31

Test to request after TSH in the evaluation od thyroid nodule

Answer 31

Euthyroid/ hypothyroid: FNAB | Hyperthyroid: RAI SCAN

Question 32

Diagnostic for non palpable thyroid nodule

Answer 32

Ultrasound

Question 33

Management of simple thyroid cyst

Answer 33

Aspiration (up to 3x) | But for >4cm and complex cyst: unilateral lobectomy

Question 34

Management for colloid adenoma

Answer 34

3cm: lobectomy+isthmusectomy

Question 35

Common thyroid CA in children, radiation exposure and iodine sufficient

Answer 35

Papillary CA

Question 36

Orphan annie nuclei | Psamomma bodies

Answer 36

Papillary thyroid CA

Question 37

Type of thyroid carcinoma with presence of vascular invasion

Answer 37

Follicular thyroid CA

Question 38

Marker for recurrence of well differentiated (papillary/follicular) thyroid CA

Answer 38

Thyroglobulin

Question 39

Thyroid CA secondary to germ line mutation at the ret proto oncogene

Answer 39

Medullary thyroid CA

Question 40

Arisea from parafollicular cells at superolateral lobe of thyroid gland

Answer 40

Medullary thyroid CA

Question 41

Hormones produced in medullary thyroid CA

Answer 41

``` Calcitonin CEA CGRP Histaminidase Serotonin ```

Question 42

Pre malignant lesion of medullary thyroid CA

Answer 42

Chief cell hyperplasia

Question 43

Diseases in MEN 2A

Answer 43

Medullary thyroid CA Pheochromocytoma Prinary hyperparathyroidism

Question 44

Diseases in MEN 2B

Answer 44

Medullary thyroid CA Pheochromocytoma Marfanoid habitus Mucocutaneous ganglioneuromatosis

Question 45

Diagnostics for postoperative follow up of medullary Thyrois CA

Answer 45

Annual CEA and calcitonin

Question 46

When is total thyroidectomy done in MEN 2A patients?

Answer 46

Before 6 years old

Question 47

When is total thyroidectomy done in MEN 2B patients?

Answer 47

Before 1 year old

Question 48

Arises usually from hashimoto's thyroiditis with similar symptoms with anaplastic carcinoma but painless

Answer 48

Thyrois lymphoma | Tx: CHOP

Question 49

Most common metastasis to thyroid

Answer 49

Renal cell CA

Question 50

Bleeding under platysma

Answer 50

Bull neck deformity | Involves middle thyroid vein

Question 51

Blood supply of parathyroid

Answer 51

Inferior thyroid artery

Question 52

Most common location of supernumerary glands

Answer 52

Thymus

Question 53

Most common location of ectopic parathyroid

Answer 53

Paraesophageal

Question 54

Most common cause of primary hyperparathyroidism?

Answer 54

Parathyroid adenoma 2nd: hyperplasia

Question 55

Primary hyperparathyroidism pentad

Answer 55

``` Kidney stones Bone pains Abdominal groans Psychic moans Fatigue overtone ```

Question 56

Treatment for parathyroid CA

Answer 56

En bloc resection + ipsilateral thyroid lobe

Question 57

Mainstay treatment for hypercalcemic crises

Answer 57

IV 0.9 saline hydration

Question 58

3 esophageal narrowing

Answer 58

Cricopharyngeus Left mainstem bronchi Diaphragmatic hiatus

Question 59

Hallmark of intestinal metaplasia in barret's esophagus

Answer 59

Intestinal goblet cells | 30-100x risk for adenoCA

Question 60

Gold standard diagnostic for persistent GERD

Answer 60

24 hour pH monitoring