Download C. MEN 2B

QUIZ 1 ORAL CAVITY AND SALIVARY GLAND TUMORS
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QUIZ 2 ROLE OS SURGERY IN ENDOCRINE TUMORS
Best treatment option for patients with nonfamilial
medullary carcinoma of the thyroid:
A. total lobectomy
B. thyroid lobectomy and irradiation with I131
C. total thyroidectomy
D. total thyroidectomy and irradiation with I131
Which of the following is a calcitonin secreting tumor of the
thyroid gland?
A. Papillary CA
B. Follicular CA
C. Medullary CA
D. hurthle cell CA
Cell of origin of medullary thyroid cancer:
A. thyroid follicular cells
B. parafollicular cells
C. oxyphil cells
D. parietal cells
A distressing symptoms of patients with medullary thyroid
carcinoma:
A. diarrhea
B. episodic flushing
C. hoarseness
D. dysphagia
The following are actions of PTH in calcium regulation:
A. inhibits resorption of Ca and PO4 in the bone
B. stimulates reabsorption of Ca in the kidney while
inhibiting reabsorption of PO4 and HCO3
C. stimulates absorption of Ca and PO4 in the intestine
D. inhibits reabsorption of PO4 and Ca in the kidney
Clinical features present in both MEN 2A and MEN2B
syndromes:
A. pituitary tumor
B. parathyroid hyperplasia
C. pheochromocytoma
D. marfanoid habitus
A 35 year old driver who had multiple recurrent fractures
was worked up for possible hyperparathyroidism. The
results of lab tests are as follows: serum Ca = 35 mg/dl,
PTH was elevated 10x normal. Physical exam of the neck
revealed 3 cm hard, fixed mass on the right anterior neck.
He was then adviced to undergo surgery. What could be
the possible etiology of her condition?
A. adenoma
B. hyperplasia
C. cancer
D. it would be difficult to determine at first point
Upon cervical exploration, there was a gray brown 3cm
mass near the inferior pole of the right thyroid lobe which
is adherent to the surrounding soft tissues. What is the
recommended extend of resection for this case?
A. excision of the tumor
B. lobectomy with en bloc excision of the tumor
C. total thyroidectomy with central node dissection
D. excision of the tumor with prophylactic neck dissection
Which of the following condition will present with
hypercalcemia secondary to PTHrP?
A. sarcoidosis
B. Tb
C. Multiple myeloma
D. Benign familial hypercalcemia
Part of the pre-op work up for patients suspected of having
medullary thyroid cancer include which of the following?
A. RET testing
B. 24 urine metanephrines
C. serum Ca
D. all
Characteristic cytologic feature of medullary thyroid
cancer:
A. orphan annie
B. vacuolated nucleus
C. amyloid stroma
D. ground glass
Postoperatively, a patient with locally aggressive medullary
thyroid cancer may be given:
A. interferon treatment
B. RAI
C. External beam radiation
D. Doxorubicin based chemotherapy
The
A.
B.
C.
D.
worst prognosis is seen among MTC patients with:
familial MTC
MEN 2A
MEN 2B
Sporadic MTC
35 yr old woman with chronic renal failure and undergoing
hemodialysis 2-3x a day develops tumoral calcinosis. Her
PTH is markedly elevated while her ionized Ca is normal.
The
A.
B.
C.
D.
diagnosis of the above case is:
primary hyper PTH
secondary hyper PTH
tertiary hyperPTH
parathyroid carcinoma
The
A.
B.
C.
D.
surgical mngt of Parathyroid hyperplasia:
excision of the largest gland
remove parathyroid glands
remove ½ from each parathyroid gland
total parathyroidectomy with autotransplantation
Most common cause of Cushing’s syndrome:
A. adrenal adenoma
B. pituitary adenoma
C. adrenal carcinoma
D. adreanal hyperplasia
The most impt criteria to distinguish a malignant adrenal
tumor from a benign one on studies is :
A. tumor heterogeneity
B. irregulary of margins
C. presence of adjacent lymphadenopathy
D. tumor size
A 25 year old female is complaining of headache
accompanied by diaphoresis and palpitations. Upon
obtaining a detailed family history, her father was
previously diagnosed with medullary thyroid cancer. Which
of the following endocrinopathy could she be probably be
suffering from?
A. aldosteronoma
B. pancreatic tumor probably insulinoma
C. pheochromocytoma
D. Cushing’s disease
To confirm your diagnosis, which of the following would you
request?
A. abdominal CT
B. _____
C. serum K
D. 24-hr urine metanephrine
The most common etiology of hyperparathyroidism is:
A. parathyroid hyperplasia
B. parathyroid adenoma
C. parathyroid carcinoma
D. none of the above
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QUIZ 3 BENIGN THYROID DISEASES
The major disadvantage of radioactive iodine treatment in
grave’s dse is:
A. high incidence of permanent hypothyroidism
B. shorter time required to gain control of the dse
C. avoidance of surgery
D. recurrent nerve paralysis
The
A.
B.
C.
D.
E.
most common side effect of antithyroid drug is:
hypersensitivity
agranulocytosis
lupus-like syndrome
arthralgia
aplastic anemia
A form of thyroiditis causing dense fibrous tissue in the
thyroid gland and surrounding structures with concomitant
tracheal compression is:
A. struma thyroiditis
B. subacute thyroiditis
C. de quervain thyroiditis
D. hashimoto’s thyroiditis
one of these treatment options for hyperthyroidism may
have a recurrence rate of up to 100% after the course of
treatment:
A. surgery
B. external radiation
C. antithyroid drugs
D. radioiodine treatment
most common cause of hypothyroidism:
A. hypopituitarism
B. hashimoto’s thyroiditis
C. RAI ablation
D. Thyroidectomy
E. Thyroid malignancy
Represent the most common form of functioning ectopic
thyroid tissue that achieves clinical significance:
A. lingual thyroid
B. lateral aberrant thyroid
C. thyroglossal duct cyst
D. struma ovarii
thyroiditis is best treated with:
A.
B.
C.
D.
surgery
thyoid hormones
RAI
Antihyroid drugs
A 20 w/o female in her 1st trimester develop grave’s dse.
She is best managed with:
A. antithyroid drugs
B. RAI
C. Exogenous thyroid hormones
D. Surgery
A 40 y/o female with a cystic solitary nodule in the left lobe
of the thyroid gland is best managed by:
A. aspiration
B. aspiration w/ thyroid suppression
C. thyroid suppression
D. thyroidectomy
E. RAI
When progressive enlargement of a multinodular goiter
causes symptomatic tracheal compression, the preferred
mngt in otherwise good risk patients is:
A. iodine treatment
B. thyroid hormone treatment
C. surgical resection of abnormal thyroid
D. RAI
One day after the thyroidectomy, a patient complained of
circumoral numbness and carpopedal spasm, you would
recommend:
A. opening the cervical wound
B. immediate endotracheal intubation
C. immediate tracheostomy
D. IV infusion of calcium gluconate
E. Further observation
RAI as a modality of treatment for hyperthyroidism is best
with:
A. nodular toxic goiter
B. diffuse toxic goiter
C. toxic adenoma
D. diffuse nontoxic goiter
the preferred operation for initial mngt of a thyroid nodule
that is considered for malignancy by FNAB is:
A. excision
B. partial lobectomy
C. total lobectomy and isthmusectomy
D. total thyroidectomy
a 24 y/o colleges tudent came in for consult with complaint
of easy fatiguability, palpitation,s irritability and
progressive weight loss. Her classmate called her attention
because of prominence of the eyes and her unusual
irritability. PE reveals: PR = 120 per minute, RR = 15 per
minute, BP 110/70, there is a bilateral moderate uniform
enlargement of the thyroid gland with thrill and bruit.
Heart. Lungs and abdomen were unremarkable.
Which of the ff will help confirm diagnosis?
A. RAIU
B. ESR
C. Serum T3, T4
D. TRH
The
of:
A.
B.
C.
D.
PE findings of thrill and bruit in the thyroid is indicative
nodular nature of the gland
hypervascularity
inflammation
malignancy
Which would be the most helpful in determining whether
there was really thyromegaly or not:
A. 2nd opinion from an endocrinologist
B. MRI of the neck
C. Thyroid scan
D. Serum TSH
The tachycardia, arrhythmia and cardiovascular effects of
excessive T3 and T4 levels is best treated with:
A. digitalis
B. adrenalin
C. propanolol
D. calcium channel blocker
The examination comfirmed moderate diffuse thyromegaly,
you will:
A. suggest surgery
B. just observe
C. prescribe antithyroid drugs
D. prescribe thyroxine for TSH suppression
a 45 y/o women underwent subtotal thyroidectomy for a
huge nontoxic nodular goiter. The surgery was otherwise
unremarkable except for significant intraoperative bleeding
due to the hugeness and vascularity of the mass.
the most practical approach (diagnostic and therapeutic) in
establishing the nature of the mass:
A. FNAB
B. Surgery
C. CT scan
D. Thyroid scan
Upon extubation, it was noted that the patient has shallow
respiration. Pulse oximetry reading was 85% O2 saturation.
One would:
A. reintubate and ventilate the patient
B. observe closely since oximetry reading is acceptable
C. open the incision because hematoma might be forming
D. this is normal postthyroidectomy
in the same scenaria as the above case, except that the
anesthesiologist had a difficult time intubating the patient
prior to surgery. Upon completion of the surgery and on
extubation, the patient was noted to have stridor, one
should:
A. reopen the wound to repair an injured RLN
B. perform tracheostomy
C. reopen the wound and drain an accumulating
hematoma
D. reintubate the patient and ventilate
while in the recovery room, the nurse called your attention,
that they have to change the wound dressing 6 times
because of very significant bleeding. You should:
A. request for CT/BT and PTTA
B. reexplore the wound
C. order parenteral vit K
D. order for parenteral epsilon aminocaproic acid
while monitoring the patient, she was noted to be
developing signs of hypocalcemia, this is due to:
A. injury the the blood supply and trauma to the
parathyroid glands
B. inadvertent removal of the 4 parathyroid glands
C. antiparathormone secretion of a nodular goiter
D. metabolic alkalosis commonly associated with general
anesthesia
after surgery, the final histopath report turned out ot be
hashimoto’s thyroiditis. You will:
A. reoperate for completion thyroidectomy
B. post operatively give thyroxine and monitor TSH
C. the surgery was sufficient treatment
D. post-op RAI ablation
a 16 y/o teen came to you with complaint that her friends
took notice of an anterior neck mass. You were indecisive
as to whether there is really thyromegaly. The rest of the
PE was normal.
You decided to aspirate the nodule and you got 8 ml of
brown fluid. You should:
A. immediately refer to a surgeon since problematic
bleeding will follow
B. consider that you puncture a carcinomatous nodule
C. press on site and observe
D. an expanding hematoma will surely follow