Chapter 38 - Thyroid, parathyroid, and adrenal

Which of the following findings is suggestive of a parathyroid carcinoma? A. An elevated serum calcium level greater than 14 mg/dL. B. An elevated PTH level greater than five times normal. C. A palpable mass in the neck. D. All of the above.

A. An elevated serum calcium level greater than 14 mg/dL.

Pheochromocytomas can secrete excess amounts of all of the following EXCEPT A. Dopa (L-dihydroxyphenylalanine) B. Dopamine C. Norepinephrine D. Epinephrine

A. Dopa (L-dihydroxyphenylalanine)

Intraoperative, rapid PTH assays provide guidance that all hyperfunctioning glands have been removed during parathyroidectomy. What criterion is used to indicate satisfactory resolution of the hyperparathyroidism during the procedure? A. Greater than 50% all in PTH level within 10 minutes of removal of parathyroid tissue. B. Greater than 25% all in PTH level within 30 minutes of removal of parathyroid tissue. C. Greater than 75% all in PTH level within 10 minutes of removal of parathyroid tissue. D. Greater than 90% all in PTH level within 30 minutes of removal of parathyroid tissue.

A. Greater than 50% all in PTH level within 10 minutes of removal of parathyroid tissue.

Children exposed to the Chernobyl disaster in 1986 subsequently demonstrated an increased incidence of which thyroid cancer? A. Papillary thyroid cancer (PTC) B. Follicular thyroid cancer (FTC) C. Medullary thyroid cancer (MTC) D. Anaplastic thyroid cancer (ATC)

A. Papillary thyroid cancer (PTC)

A follow-up C scan in a 60-year-old patient with previous nephrolithiasis reveals a 1.5-cm hypovascular round lesion with clear margins in the right adrenal gland. The patient is not hypertensive, hyperglycemic, or hypokalemic. Urinary catechol metabolites are within normal limits, and serum cortisol and ACTH levels are normal. Which course is advisable? A. Repeat CT scan and chemical tests annually. B. Percutaneous FNAB. C. Adrenal venous sampling or cortisol, renin, and angiotensin. D. Laparoscopic adrenalectomy.

A. Repeat CT scan and chemical tests annually.

Although injury to the RLN results in hoarseness (unilateral injury) or airway obstruction (bilateral injury), injury to the superior laryngeal nerve (SLN) results in a more subtle injury, affecting the ability to A. Speak loudly or sing high notes. B. Cough. C. Feel sensation in the anterior neck. D. Grimace.

A. Speak loudly or sing high notes.

In North America, hyperthyroidism is most often caused by A. Toxic multinodular goiter B. Diffuse toxic goiter (Graves disease) C. Thyroid cancer D. Thyroid stimulating hormone-secreting pituitary adenoma

B. Diffuse toxic goiter (Graves disease)

Which surgeon was awarded the Nobel Prize in Physiology or Medicine or his work on the "physiology, pathology, and surgery of the thyroid gland?" A. Theodore Billroth B. Emil Kocher C. John Hunter D. Harvey Cushing

B. Emil Kocher

What is the recommended course of action when f ne needle aspiration biopsy (FNAB) of a thyroid nodule is "follicular neoplasm?" A. Repeat FNAB B. Lobectomy C. Lobectomy and isthmusectomy D. Total thyroidectomy

B. Lobectomy

A 35-year-old woman undergoes an evaluation for infertility. She has gained almost 100 lb in the past year, is hypertensive, and is borderline diabetic. She also complains of easy bruising. Her serum chemistries are normal with the exception of an elevated glucose. Imaging studies reveal a unilateral adrenal mass. What is the likely diagnosis? A. Secondary hypercortisolism (Cushing disease) B. Primary hypercortisolism (Cushing syndrome) C. Hyperaldosteronism (Conn syndrome) D. Pheochromocytoma

B. Primary hypercortisolism (Cushing syndrome)

A 70-year-old woman with early dementia but otherwise good physical health has an elevated parathyroid hormone (PTH) level and a sestamibi scan which localizes a single focus of increased activity to the left lower neck. An ultrasound confirms an enlarged gland in the same area. What treatment is likely to provide the best outcome? A. Bilateral neck exploration under general anesthesia. B. Unilateral, "mini-incision" parathyroidectomy under local anesthesia. C. Minimally invasive videoscopic parathyroidectomy from a left axillary approach under general anesthesia. D. Percutaneous alcohol ablation with ultrasound guidance under local anesthesia.

B. Unilateral, "mini-incision" parathyroidectomy under local anesthesia.

What congenital anomaly arises from the formation of the thyroid gland? A. The thyroid isthmus B. The cricothyroid arch C. A thyroglossal duct cyst D. An endobronchial cyst

C. A thyroglossal duct cyst

Advantages of laparoscopic adrenalectomy compared with open adrenalectomy include all of the following EXCEPT A. Decreased incidence of wound infection B. Decreased length of hospital stay C. Decreased operative time D. Decreased narcotic analgesic use

C. Decreased operative time

A 50-year-old, healthy-appearing man undergoes evaluation of persistent hypertension. Serum chemistries reveal hypokalemia (less than 3.2 mmol/L) and imaging studies reveal a unilateral adrenal mass. What is the likely diagnosis? A. Secondary hypercortisolism (Cushing disease) B. Primary hypercortisolism (Cushing syndrome) C. Hyperaldosteronism (Conn syndrome) D. Pheochromocytoma

C. Hyperaldosteronism (Conn syndrome)

In patients who undergo bilateral adrenalectomy in treatment of Cushing disease after failed attempts at resection of an ACTH-secreting pituitary adenoma, the subsequent development of Nelson syndrome is associated with all of the following EXCEPT A. Hyperpigmentation B. Diminished visual fields C. Loss of hearing D. Headaches

C. Loss of hearing

The recommended treatment for an otherwise healthy 50-year-old man with a 2-cm PTC in the left lobe diagnosed by FNAB is A. Left lobectomy B. Left lobectomy and isthmusectomy C. Total left lobectomy and subtotal right lobectomy D. Excisional biopsy with frozen section analysis

C. Total left lobectomy and subtotal right lobectomy

An asymptomatic child with a normal physical examination is found to harbor a mutation in codon 918 of the RET tyrosine kinase receptor, compatible with MEN2B. Ultrasound of the neck is unremarkable and serum calcitonin levels are normal. What course is indicated? A. Repeat examination and ultrasound yearly B. Planned thyroidectomy in 3 to 5 years C. Total thyroidectomy D. Total thyroidectomy with bilateral neck dissection

C. Total thyroidectomy

A patient with primary hyperparathyroidism undergoes neck exploration where our small, normal appearing glands are found. What are the possible locations of an additional, supernumerary gland? A. In the thyroid gland B. In the thymus C. In the tracheoesophageal groove D. All of the above

D. All of the above

An adolescent patient with a thyroid mass undergoes FNAB which returns as MCT. What other diseases should be screened before treatment is undertaken? A. Hyperparathyroidism B. Pheochromocytoma C. Mucocutaneous ganglioneuromas D. All of the above

D. All of the above

In what location, relative to the inferior thyroid artery (ITA), is the recurrent laryngeal nerve (RLN) found? A. Medial or posterior to the ITA B. Lateral or anterior to the ITA C. Passing between the branches of the ITA D. All of the above

D. All of the above

Postoperative complications within 24 hours of thyroid surgery include A. Hypocalcemia B. Dyspnea C. Dystonia D. All of the above

D. All of the above

The arterial supply of the thyroid arises from which of the following vessels? A. The aorta B. The external carotid arteries C. The thyrocervical trunk D. All of the above

D. All of the above

Which diseases are associated with germline mutations in the RET tyrosine kinase receptor gene? A. Multiple endocrine neoplasia type 2A (MEN2A) B. Multiple endocrine neoplasia type 2B (MEN2B) C. Hirschsprung disease D. All of the above

D. All of the above

Subtotal or total thyroidectomy is preferred or the treatment of Graves disease A. When radioactive iodine therapy is contraindicated. B. When the goiter is large or airway obstruction appears imminent. C. In patients with demonstrated poor compliance with anti-thyroid medications. D. All of the above.

D. All of the above.

A patient with persistent ulcer disease is diagnosed with a gastrinoma. Serum chemistry studies indicate hypercalcemia, and an elevated PTH level is documented. What is the indicated course of treatment? A. Administration of mithramycin 25 mg/kg/day or 4 to 5 days to lower calcium levels. B. Administration of octreotide 100 mg ID to suppress gastrin secretion. C. Abdominal exploration or removal of the gastrinoma. D. Neck exploration or removal of the parathyroid adenoma.

D. Neck exploration or removal of the parathyroid adenoma.

All of the following imaging techniques are useful to localize a pheochromocytoma EXCEPT A. Computed tomography (CT) scan B. Magnetic resonance imaging (MRI) scan C. Metaiodobenzylguanidine (MIBG) scan D. Octreotide scan

D. Octreotide scan

The preoperative preparation of a patient with pheochromocytoma should include all of the following EXCEPT A. An alpha-adrenergic blocker such as phentolamine. B. A beta-adrenergic blocker such as propranolol. C. Intravenous hydration to avoid volume depletion. D. Systemic steroids to avoid adrenal insufficiency.

D. Systemic steroids to avoid adrenal insufficiency.

Thyroid hormones (T3 and T4) have regulatory roles in all of the following EXCEPTT A. The hypoxia and hypercapnia drives of the respiratory center in the brain. B. Gastrointestinal motility. C. The speed of muscle contraction and relaxation.

D. Visual acuity in low-light conditions ("night vision").