Surgery Flashcards
A 28yo female noted a 2cm midline anterior neck mass that moves with deglutition. Ultrasound revealed a well-defined cystic mass superior to normal looking thyroid gland. Which of the following malignant thyroid histologies is NOT associated with this cyst?
A. Papillary cancer
B. Anaplastic carcinoma
C. Medullary thyroid cancer
D. Hürtle cell carcinoma
C. Medullary thyroid cancer
A 26 yo female was diagnosed with hypothyroidism. Ultrasound showed an echogenic structure near the hyoid bone. No thyroid lobes were visualized in its usual position. What is the most likely diagnosis?
A. Post-thyroidectomy
B. Ectopic thyroid thyroid glands and additional thyroid gland in the different region of your thyroid
C. Lingual thyroid
D. thyroid agenesis failure for the thyroid to develop
C. Lingual thyroid
With regards to the recurrent laryngeal nerve RLN, which of the following statements is NOT TRUE
A. Superiorly, RLN will connect with the superior laryngeal nerve to form your nerve of Galen
B. The superior parathyroid gland is dorsal to the plane of the nerve and the inferior gland is ventral
C. The left RLN is a branch of the vagus nerve and the right RLN is from the “wandering” nerve superior laryngeal nerve is affected
D. The type 2A injury to the RLN occurs during mass ligation of the superior thyroid poles
D. The type 2A injury to the RLN occurs during mass ligation of the superior thyroid poles
With regards to the recurrent laryngeal nerve RLN, which of the following statements is NOT TRUE
A. Superiorly, RLN will connect with the superior laryngeal nerve to form your nerve of Galen
B. The superior parathyroid gland is dorsal to the plane of the nerve and the inferior gland is ventral
C. The left RLN is a branch of the vagus nerve and the right RLN is from the “wandering” nerve superior laryngeal nerve is affected
D. The type 2A injury to the RLN occurs during mass ligation of the superior thyroid poles
D. The type 2A injury to the RLN occurs during mass ligation of the superior thyroid poles
Which of the following thyroid patients would benefit most from surgery?
a. 45 yo male with solid thyroid nodule of 20 g , hot nodule on 131I uptake
b. 22 yo unemployed female from the hinterland with hypothyroidism
c. 33 yo euthyroid female on mycophenolate mofetil with Pemberton’s sign
d. 28 yo pregnant female with diffuse goiter, Free T3 of 5 pmol/L normal range ft3
c. 33 yo euthyroid female on mycophenolate mofetil with Pemberton’s sign
A 55 yo male was diagnosed to have papillary thyroid carcinoma measuring 4 cm occupying the inferior pole of the right lobe. There is another 2 cm nodule on the left lobe. Where is the most common region of lymph node metastasis?
a. Region II
b. Region V
c. Region VI
d. Region VII
c. Region VI
The thyroid gland is formed from the embryonic median anlage. What structure is created during the downward migration that is composed of (functional) thyroid follicular cells?
a. Pyramidal lobe
b. C cells
c. Thyroglossal duct
d. Isthmus
a. Pyramidal lobe
A 57 yo male underwent total thyroidectomy with median sternotomy for a very large thyroid mass with thoracic extension. After extubation, the anesthesiologist informed there was paramedian paralysis of the vocal cords - there is an airway obstruction (so bilateral). What would be the most plausible explanation?
a. Nerve impingement due to the large lesion caused the paralysis and will return to function now that the lesion has been removed.
b. Bilateral recurrent laryngeal nerve injury was iatrogenic and requires tracheostomy to bypass airway obstruction.
c. That is a chronic manifestation of an enlarged thyroid pathology and is manageable with speech therapy
d. Surgical dissection led to nerve trauma. Reintubate the patient and maintain ET tube for 5 days to allow inflammation to subside
b. Bilateral recurrent laryngeal nerve injury was iatrogenic and requires tracheostomy to bypass airway obstruction.
Low TSH. Elevated FT4. Goiter. Pretibial myxedema. Gynecomastia
a. thyroid cancer
b. MEN 2A
c. toxic multinodular goiter
d. Factitious thyrotoxicosis
e. Grave’s disease
E. Grave’s disease
Low TSH. Elevated TT4, TT3. Diffused goiter. Fever. CNS depression. Congestive heart failure
a. Toxic adenoma
b. struma ovarii
c. Hamburger thyrotoxicosis
d. thyroid storm
d. thyroid storm
Which of the following state of hypothyroidism is NOT congenital in nature?
a. cretinism
b. Hasimoto’s thyroiditis
c. Pendred’s syndrome
d. Turner’s syndrome
b. Hasimoto’s thyroiditis
A 21 yo female complained of an anterior neck mass. Ultrasound showed a solitary thyroid nodule occupying the right lobe, cystic in consistency. Biopsy of the mass showed no malignant cells. What would be the appropriate management?
a. Observe
b. Aspiration
c. Repeat fine needle aspiration biopsy with ultrasound guidance
d. Lobectomy
b. Aspiration
A 21 yo female complained of an anterior neck mass. Ultrasound showed a solitary thyroid nodule occupying the right lobe, colloid in consistency. Biopsy of the mass showed no malignant cells. What would be the appropriate management?
a. Fine needle aspiration biopsy with ultrasound guidance
b. Observe
c. Lobectomy
d. Aspiration
b. Observe
Which of the following statements regarding papillary thyroid malignancy is NOT TRUE:
a. Node dissection is not routinely done because lymph node metastasis is rare
b. Papillary carcinoma is an epithelial malignancy with follicular cell differentiation
c. Genetics play a significant role with RET protooncogene mutations dominant in Familial PTC.
d. Age is the most important risk factor used for prognostication
c. Genetics play a significant role with RET protooncogene mutations dominant in Familial PTC.
Which of the following statements regarding medullary thyroid malignancy is NOT TRUE
a. Medullary carcinoma occurs in the parafollicular cells concentrated in the superolateral pol
b. Lowering the calcitonin levels after removal of MTC would lead to significant hypercalcemia
c. Distribution is multicentric for syndromic occurences
d. Genetics play a significant role with RET protooncogene mutations dominant in Familial MTC.
b. Lowering the calcitonin levels after removal of MTC would lead to significant hypercalcemia
