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A. MLA Map ENT > Thyroid Nodules and Cancer > Flashcards

Thyroid Nodules and Cancer Flashcards

1
Q

What is a thyroid nodule?

1 - malignant mass that forms in the thyroid
2 - hyperplasia of thyroid cells
3 - hypertrophy of thyroid cells

A

2 - hyperplasia of thyroid cells

  • not normally cancerous but can become malignant
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2
Q

What % of adults in the UK have thyroid nodules?

1 - 0.4 - 0.7%
2 - 4-7%
3 - 40-70%

A

2 - 4-7%

  • highest incidence in men >60 y/o
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3
Q

4-7 % of adults in the UK have thyroid nodules. What % of these become malignant?

1 - 0.5 - 1.0%
2 - 5-10%
3 - 15-30%
4 - >75%

A

2 - 5-10%

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4
Q

Are women or men more likely to develop thyroid nodules?

A
  • females
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5
Q

Although thyroid nodules are normally benign, there are occasions that are concerning. Which of the following is NOT a concern for a thyroid nodules?

1 - >65 y/o
2 - single nodule getting bigger
3 - family history of thyroid cancer
4 - previous radiation to neck
5 - stridor
6 - cervical lymphadenopathy
7 - unexplained hoarseness
8 - weight loss

A

8 - weight loss

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6
Q

If we are suspicious about a thyroid nodule, we need to do the CRP (triple assessment). Which one of this is not part of this?

1 - clinical examination/history
2 - class II thyroids exam
3 - radiology
4 - pathophysiology

A

2 - class II thyroids exam

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7
Q

When we measure bloods in a patient with a thyroid nodule, which of the following is the least important?

1 - thyroid stimulating hormone
2 - thyroxine (T4)
3 - triiodothyronine (T3)
4 - reverse T3

A

4 - reverse T3

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8
Q

In hyperthyroidism, what would we expect to see in TSH, T3 and T4?

A
  • TSH is low or normal
  • T3 and T4 are high
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9
Q

In hypothyroidism, what would we expect to see in TSH, T3 and T4?

A
  • TSH is high
  • T3 and T4 are low
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10
Q

If someone has a thyroid nodule, what is often the first line imaging that is used?

1 - ultrasound
2 - CT scan
3 - PET scan
4 - iodine 123 scan

A

1 - ultrasound

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11
Q

If someone has a thyroid nodule and they have hyperthyroidism, what scan do they need?

1 - ultrasound
2 - CT scan
3 - PET scan
4 - iodine 123 scan

A

4 - iodine 123 scan

  • iodine would be found in high levels in the nodule
  • this is called a hot nodule
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12
Q

If a patient has a nodule but is hypothyroidism, what can be done?

1 - surgery
2 - iodine therapy
3 - levothyroxine
4 - Carbimazole or Propylthiouracil

A

3 - levothyroxine

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13
Q

If a patient has a nodule but is euthyroid, we need to identify if a nodule is dominant or is just diffusely swollen. If it is a dominant nodule we would do 3 of the following, which one is incorrect?

1 - fine needle aspiration biopsy
2 - ultrasound
3 - iodine 123 scan
4 - FDG-PET

A

3 - iodine 123 scan

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14
Q

Which of the following is not a typical sign of hyperthyroidism?

1 - Nervousness
2 - Sweating
3 - Palpitations
4 - Fatigue
5 - Weight gain
6 - Diarrhoea
7 - Increased appetite
8 - Tachycardia
9 - Tremor

A

5 - Weight gain

  • typically lose weight due to increased metabolism
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15
Q

Which of the following is not a typical sign of hypothyroidism?

1 - Weakness and lethargy
2 - Dry skin
3 - Slow speech
4 - Sensitivity to cold
5 - Constipation
6 - Weight loss
7 - Loss of appetite
8 - Memory impairment

A

6 - Weight loss

  • normally weight gain due to lowered metabolism
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16
Q

If a patient has a nodule and is euthyroid they will require a fine needle aspiration biopsy guided by ultrasound. This can be analysed by cytology and scored out of 5 as in the image. What levels requires surgery based on the biopsy to confirm diagnosis?

1 - all
2 - >2
3 - >3
4 - 5 only

A

3 - >3

17
Q

What is the gold standard for diagnosing a patient who has a nodule and is euthyroid?

1 - core biopsy
2 - ultrasound
3 - fine needle aspiration biopsy
4 - iodine 123 scan

A

3 - fine needle aspiration biopsy

  • needs to be ultrasound guided
18
Q

How many cases of thyroid cancer are there each year?

1 - 4
2 - 40
3 - 400
4 - 4000

A

4 - 4000

  • approx 400 deaths
  • deaths are mainly in older patients
19
Q

What is the peak incidence of thyroid cancer in women?

1 - 20-30
2 - 44-49
3 - 50-70
4 - 70-74

A

2 - 44-49

  • women are more likely to develop thyorid cancer
20
Q

What is the peak incidence of thyroid cancer in men?

1 - 20-30
2 - 44-49
3 - 50-70
4 - 70-74

A

4 - 70-74

21
Q

In patients with thyroid cancer, survival depends on 3 key factors. Which of the following is NOT one of these factors?

1 - age
2 - diabetes
3 - pathological subtype
4 - metastatic disease

A

2 - diabetes

  • thyroid cancer is the only cancer where age is included in the TNM staging
22
Q

There are 4 different types of thyroid cancer pathology. Which one of the following is NOT a subtype?

1 - papillary
2 - follicular
3 - medullary
4 - anaplastic
5 - carcinoma in-situ

A

5 - carcinoma in-situ

23
Q

There are 4 different types of thyroid cancer pathology. Which one of the following is most common?

1 - papillary
2 - follicular
3 - medullary
4 - anaplastic

A

1 - papillary

  • accounts for 50-60% of all thyroid cancers
  • excellent prognosis if no metastasis
24
Q

Papillary cancers are the most common cause of thyroid cancers. Which of the following is NOT true about these tumours?

1 - caused by RET and BRAF gene mutations
2 - linked with childhood ionising radiation
3 - contain high protein and DNA in their cells
4 - name comes from appearance like papillae (finger like projections)

A

3 - contain high protein and DNA in their cells

  • they have LOW proteins and DNA and are called Orphan Annie Eye Nucleus
25
Q

Follicular thyroid cancers are the 2nd most common type of thyroid cancer. Which of the following is NOT true about these cancers?

1 - linked with mutations in RAS (oncogene) and PTEN (tumour suppressor gene)
2 - develops from follicular cells, breaking-out of fibrous capsule
3 - invade near by blood vessels and lymph nodes
4 - spread to the lungs, liver, bone, and brain
5 - cannot be distinguished from adenocarcinomas

A

3 - invade near by blood vessels and lymph nodes

  • do not typically spread to lymph nodes
26
Q

Medullary thyroid cancer grows from a specific cell type and account for approx 10% of all thyroid cancers. What do these tumours originate from?

1 - C cells
2 - B cells
3 - follicular cells
4 - follicular capsule

A

1 - C cells

  • C cells produce calcitonin that controls plasma Ca2+
    • these tumours have a good prognosis
27
Q

Anaplastic tumours have odd cell appearance, which is where they get their name from. Which of the following is NOT true about these tumours?

1 - they are rare
2 - have a poor prognosis
3 - locally invade
4 - always cause hyperthyroidism

A

4 - always cause hyperthyroidism

28
Q

When we decide which patients need treatment there are a number of specific cases that do. Which of the following would NOT need surgery?

1 - Cancer
2 - Pressure symptoms (stridor, tracheal deviation)
4 - Grave’s disease
5 - Cosmesis
6 - Hashimoto’s thyroiditis
7 - Diagnostic uncertainty

A

6 - Hashimoto’s thyroiditis

  • this would be treated with levothyroxine
29
Q

The following are different types of surgery. If a patient has a solitary toxic nodule with diagnostic uncertainty, which surgery would generally be performed?

1 - hemi-thyroidectomy
2 - total thyroidectomy
3 - radioiodine
4 - Carbimazole or Propylthiouracil

A

1 - hemi-thyroidectomy

30
Q

The following are different types of surgery. If a patient has graves disease, proven cancer and/or multi nodular goitre, which surgery would generally be performed?

1 - hemi-thyroidectomy
2 - total thyroidectomy
3 - radioiodine
4 - Carbimazole or Propylthiouracil

A

2 - total thyroidectomy

31
Q

In thyroid surgery blood vessels can be damaged. Which 2 of the following could be damaged leading to oedema and obstruction of the upper airway?

1 - external carotid artery
2 - superior thyroid artery
3 - inferior thyroid artery
4 - right subclavian artery

A

2 - superior thyroid artery
3 - inferior thyroid artery

32
Q

In thyroid surgery nerves can be damaged. Which 2 of the following could be damaged leading to hoarse voice, stridor or even laryngeal obstruction?

1 - left recurrent laryngeal nerve
2 - vagus nerve
3 - superior laryngeal nerve
4 - right recurrent laryngeal

A

1 - left recurrent laryngeal nerve
4 - right recurrent laryngeal

33
Q

When removing the thyroid gland in surgery we must ensure we do not remove what?

1 - C cells
2 - parathyroid
3 - pituitary gland
4 - superior thyroid artery

A

2 - parathyroid

  • only need one to function

A. MLA Map ENT (27 decks)

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