THE THYROID GLAND 1. what is the colour of the normal thyroid gland ? answer : brownish-red colour . 2. the thyroid gland is highly vascular. TRUE OR FALSE ? answer : true . 3. which of the following statements about thyroid is true ? a- thyroid is located anteriorly in the upper neck b- thyroid is located posteriorly in the upper neck c- thyroid is located anteriorly in the lower neck d- thyroid is located posteriorly in the lower neck answer : c . the thyroid is located anteriorly in the lower neck . 4. what is the vertical extension of the thyroid in relation to the vertebrae ? a- C4 to T1 b- C5 to T1 c- C6 to T1 d- C3 to T1 answer : b . fifth cervical vertebra to the first thoracic vertebra . C5 to T1. 5. thyroid is ensheathed by a fascia . what is it ? answer : pretracheal layer of the deep cervical fascia . 6. what are the number of lobes in thyroid ? answer : 2 lobes . right and left lobes connected by a narrow, median isthmus . 7. what is the weight of the thyroid ? answer : 25 g ( usually but can vary ) . 8. among men and women, who have heavier thyroids ? answer : women have slightly heavier thyroids when compared to males. 9. a woman came to the doctor with complaints of increase in the size of thyroid during menstruation . if u were the doctor there, what would u do ? answer : I would tell her that it is perfectly normal for the size of a woman’s thyroid to increase during menstruation . 10. a pregnant woman came to ur clinic with complaints of enlarged thyroid . what would you suggest ? answer : I would tell her that there is nothing to worry , because it is absolutely normal for a woman’s thyroid to enlarge during pregnancy and menstruation . 11. how will you normally estimate the size of the thyroid gland ? answer : by doing diagnostic ultrasound . 12. As I already told u women have heavier thyroids than men, hence the volume of thyroid in women is slightly more than in men. But there is a phase of life in both males and females where no significant difference between the volumes of the male and female thyroid was observed. When is that phase ? answer : from 8 months to 15 years . between these ages the volumes of both male and female thyroid show no significant difference . 13. what is the shape of the lobes of the thyroid gland ? answer : approximately conical . 14. the bases of the thyroid lobes are level with which tracheal cartilage ? answer : 4th or 5th tracheal cartilages . 15. what is the length of each thyroid lobe ? answer : 5cms long . 16. the posteromedial aspects of the thyroid lobes are attached to which structure ? answer : cricoid cartilage . 17. what is the name of the ligament which attaches the lobes of thyroid to the cricoid cartilage posteromedially ? answer : lateral thyroid ligament . 18. what is the part of the thyroid that connects the lower parts of the two lobes called ? answer : isthmus . 19. what would you suggest to a healthy patient who has no isthmus ? answer : I would suggest that it is physiologically normal for a person to be born without an isthmus and this happens occasionally . I would assure him that there is nothing to worry . 20. what is the length of the isthmus ? answer : 1.25 cms transversely and vertically . 21. the isthmus normally lies anterior to which tracheal cartilages ? answer : it usually lies anterior to second and third tracheal cartilages. ( it can lie slightly higher or slightly lower sometimes because of the variations in size and site of the thyroid gland ) 22. what is the tumor marker of the medullary carcinoma of the thyroid? answer : calcitonin . 23. what is the most common position of the thyroglossal cyst ? answer : below the hyoid bone . ( check again ). 24. what is the name of the surgery done to treat the thyroglossal cyst/fistula ? answer : sistrunk’s operation . 25. what is the hormone secreted by the thyroid that controls the calcium metabolism ? answer : calcitonin . 26. superior thyroid artery is a branch of which artery ? answer : external carotid artery . ( the branches of the external carotid artery are 1. superior thyroid artery 2.lingual artery 3.posterior auricular artery 4.facial artery 5.occipital artery 6.ascending pharyngeal artery 7.maxillary artery 8.superficial temporal artery ------ SLPFOAMS ------ SISTER LUCY’S POWDERED FACE OFTEN ATTRACTS MEDICAL STUDENTS . ) 27. which is the only medial branch of the external carotid artery ? answer : ascending pharyngeal artery . ( out of context but important .) 28. the thyroid develops from ? a- ectoderm b- mesoderm c- dorsal pharyngeal gut endoderm d- ventral pharyngeal gut endoderm answer : d . ventral pharyngeal gut endoderm . 29. the development of thyroid occurs in which week of the intrauterine life ? answer : 4th week . 30. what are the cells in the thyroid which produce the calcitonin ? answer : C cells ( also called as the parafollicular cells .) 31. what is the function of calcitonin ? answer : lowers blood calcium by inhibiting the bone resorption and inhibiting the calcium recovery from renal tubule ultrafiltrate . 32. the embryonic thyroid descends from a foramen located in the posterior part of the tongue . what is it ? answer : it is called the foramen caecum . 33. the thyroid usually reaches the front of the trachea by the end of how many months of the intrauterine life ? answer : by the end of 2nd month of intrauterine life . 34. the thyroglossal duct is originally a hollow tube running from foramen caecum to pharynx . TRUE OR FALSE ? answer : true . ( check again ) 35. thyroglossal duct tissue normally becomes solid and remains uncanalised after transit of the thyroid . TRUE OR FALSE ? answer : FALSE ( check again ) 36. the pyramidal lobe of the thyroid represents part of the thyroglossal duct . TRUE OR FALSE? answer : TRUE ( check again ) . 37. most common histological type of thyroid cancer ? answer : papillary carcinoma . 38. thyroid carcinoma with best prognosis ? answer : papillary carcinoma . 39. screening method for medullary carcinoma of thyroid ? a- serum calcitonin b- serum calcium c- serum ALP d- serum acid phosphatase answer : a . serum calcitonin . 40. the carcinoma of thyroid associated with hypocalcemia ? answer : medullary carcinoma of thyroid . ( remember it secretes calcitonin ). 41. medullary carcinoma of thyroid arises from ? a- parafollicular cells b- cells lining the acini c- capsule of thyroid d- stroma of the gland answer : a . parafollicular cells . 42. papillary carcinoma of thyroid usually presents as ? answer : single nodule + local lymph node . 43. which of the following is/are used in the management of thyroid malignancy? a- Iodine 131 b- Iodine 125 c- Technitium 99 d- Phosphorus 32 e- strontium answer is a . Iodine 131 . 44. which of the following factors contribute to the development of duodenal ulcer ? a- Iodine 131 b- Iodine 125 c- Technitium 99 d- Phosphorus 32 answer : a . iodine 131 . 45. characteristic eye sign in dysthyroid status ? a- exopthalmos b- ptosis c- optic neuropathy d- myopathy answer : a . exopthalmos . 45. hurthle cells are seen in ? a- hashimoto’s thyroiditis b- follicular cell carcinoma c- hurthle cell thyroid adenoma d- all the above answer is d . all the above . 46. the C cells of the thyroid parenchyma belongs to the APUD system of dispersed neuron-endocrine cells . what is APUD system ? answer : AMINE PRECURSOR UPTAKE AND DECARBOXYLATION SYSTEM . 47. how did the C cells get their name ? answer : C stands for Clear cells , because they have pale staining cytoplasm and hence appear clear . 48. what is arteria thyroidea ima ? answer : an artery supplying thyroid which is seen occasionally and arises from the brachiocephalic trunk or aortic arch . 49. what are the two main arteries that supply the thyroid ? answer : superior and inferior thyroid arteries . superior thyroid artery is a branch of the external carotid artery and the inferior thyroid artery is branch of the thyrocervical trunk . 50. C cells populate which part of the lateral lobe of the thyroid ? a- upper one-third of the lateral lobe of thyroid b- middle one-third of the lateral lobe of thyroid c- lower one-third of the lateral lobe of the thyroid d- distributed equally all over the lateral lobe of the thyroid answer : b . C cells populate the middle one-third of the lateral lobe of the thyroid . ( typically found scattered within thyroid follicles , inside the basal lamina but not reaching the follicle lumen .) 51. pick out the correct statements . a- the external laryngeal nerve runs close to the superior thyroid artery . b- the recurrent laryngeal nerve runs close to the inferior thyroid artery . c- the external laryngeal nerve runs close to the inferior thyroid artery . d- the recurrent laryngeal nerve runs close to the superior thyroid artery . answer : both a and b are correct . ( so the surgeon has to be very careful while ligating those arteries, while performing thyroidectomy ). 52. what are the branches of the thyrocervical trunk ? answer : 1. inferior thyroid artery 2.suprascapular artery 3.transverse cervical artery ( also called transversalis artery colli ) . 53. thyrocervical trunk arises from which artery ? answer : subclavian artery . 54. what are the active thyroid hormones secreted by the follicular epithelial cells of the thyroid ? answer: tri-iodothyronine T3 and tetra-iodothyronin T4 ( thyroxine ) . 55. treatment of medullary carcinoma of the thyroid with lymphnode metastasis? a- subtotal thyroidectomy + radioiodine b- subtotal thyroidectomy + radiotherapy c- neartotal thyroidectomy + radioiodine d- neartotal thyroidectomy + radiotherapy e- total thyroidectomy + radiotherapy answer : e . total thyroidectomy + radiotherapy . 56. what is near total thyroidectomy ? a- right lobectomy + isthmusectomy b- left lobectomy + isthmusectomy c- bilateral lobectomy with isthmusectomy d- right lobectomy + isthmusectomy + left half lobectomy e- right and left lobectomy answer : d . 57. papillary carcinoma of thyroid with bone metastasis is treated by? a- subtotal thyroidectomy + radioiodine b- subtotal thyroidectomy + radiotherapy c- near total thyroidectomy + radioiodine d- near total thyroidectomy + radiotherapy e- total thyroidectomy + chemotherapy answer : c and d . both . near total thyroidectomy with radioiodine and radiotherapy. 58. most common cause of thyroiditis is ? a- hashimoto’s thyroiditis b- reidl’s thyroiditis c- subacute thyroiditis d- viral thyroiditis answer : a . hashimoto’s thyroiditis . 59. recurrent laryngeal nerve is in close association with ? a- superior thyroid artery b- inferior thyroid artery c- middle thyroid vein d- superior thyroid vein answer : b . inferior thyroid artery . 60. thyroglossal cyst may occasionally give rise to which carcinoma ? a- papillary b- anaplastic c- medullary d- follicular answer : a . papillary carcinoma of the thyroid . 61. a post-thyroidectomy patient develops signs and symptoms of tetany. The management is ? a- I.V calcium gluconate b- Bicarbonate c- Calcitonin d- Vitamin D Answer : a . I.V calcium gluconate . 62. hypoparathyroidism following thyroid surgery occurs with in ? a- 24 hours b- 2-5 days c- 7-14 days d- 2-3 weeks Answer : b . 2-5 days . 63. what are the normal levels of calcium in our body ? answer : calcium,ionized - wholeblood – 1.1 to 1.4 mmol/litre – 4.5 to 5.6 mg/dl(meq/l) . calcium - serum - 2.2 to 2.6 mmol/litre – 9 to 10.5 mg/ dl(meq/l) . 64. a patient undergoes thyroid surgery following which he develops perioral tingling . his blood calcium is 8.9 meq/l. next step in the management is ? a- vitamin D orally b- oral calcium and vitamin D c- intravenous calcium gluconate and serial monitoring d- wait for calcium to decrease to less than 7 meq/l before taking further action answer : b . oral calcium and vitamin D . 65. a patient after undergoing thyroid surgery presents with perioral paraesthesia . serum calcium level is 7 mg/dl . what will be the best management ? a- oral vitamin D3 b- oral vitamin D3 and calcium c- I.V calcium gluconate d- Oral calcium Answer : d . oral calcium . 66. which of the following is not a complication of total thyroidectomy ? a- bleeding b- airway obstruction c- hoarseness d- hypercalcemia answer : d . hypercalcemia . 67. in post operative room after thyroid surgery , patient developed sudden respiratory distress , dressing was removed and it was found to be slightly blood stained and wound was bulging . what will be the first thing to be done ? a- tracheostomy b- cricothyroidectomy c- laryngoscopy and intubation d- remove the stitch and take the patient to O.T answer : d . remove the stitch and take the patient to the O.T . 67. a patient presents with swelling in the neck following a thyroidectomy. What is the most likely resulting complication ? a- respiratory obstruction b- recurrent laryngeal nerve palsy c- hypovolemia d- hypocalcemia answer : a . respiratory obstruction . 68. a patient presents with neck swelling and respiratory distress few hours after a thyroidectomy surgery. Next management would be ? a- open immediately b- tracheostomy c- wait and watch d- oxygen by mask answer : a . open immediately . 69. after thyroidectomy patient developed stridor within 2 hours. All are likely causes of stridor except ? a- hypocalcemia b- recurrent laryngeal nerve palsy c- laryngomalacia d- wound hematoma answer : a . hypocalcemia due to hypoparathyroidism after thyroid surgey normall results with in 2-5 days . 70. which of the following will not lead to respiratory distress after thyroid surgery? a- laryngomalacia b- bilateral recurrent laryngeal nerve palsy c- hypocalcemia d- none answer : d . none . all the 3 can lead to respiratory distress . 71. how does hypocalcemia result in respiratory distress ? answer : pending . 72. papillary carcinoma of the thyroid ( PCT ) patients are ? a- euthyroid b- hypothyroid c- hyperthyroid d- T3 thyrotoxicosis Answer : a . euthyroid . 73. medullary carcinoma of thyroid is derived from which cells ? a- follicular b- para follicular c- oxyphilic d- lymphocytes answer : para follicular cells ( also called C cells ) . 74. HURTHLE cell carcinomas are derived from which cells ? a- follicular cells b- para follicular cells c- oxyphilic cells d- lymphocytes answer : c . oxyphilic cells . 75. patients with MEN 2a also may have hirschsprung’s and lichen cutaneous amyloidosis ? TRUE OR FALSE ? answer : true . 76. the malignancy which is common on long standing goiter ? a- PCT b- MCT c- FCT d- Anaplastic Answer : c . Follicular carcinoma of the thyroid . 77. cancer common in iodine deficient areas ? a- papillary b- medullary c- anaplastic d- follicular answer : c and d . follicular and anaplastic both are common . 78. least malignant thyroid cancer ? e- papillary f- medullary g- anaplastic h- follicular answer : e . papillary . 79. commonest tumor of the thyroid ? answer : papillary carcinoma of the thyroid . 80. which of the following gene defects is associated with development of the medullary carcinoma of the thyroid ? a- RET proto oncogene b- FAP gene c- RB gene d- BRCA 1 gene Answer : a . RET proto oncogene . 81. what are the other diseases associated with the RET gene ? answer : medullary thyroid carcinoma, hirschsprung’s disease and pheochromocytoma. 82. RET proto-oncogene encodes for ? a- tyrosine kinase receptor on the cytoplasmic membrane b- protein kinase c- IP3 d- All the above Answer : a . tyrosine kinase receptor on the cytoplasmic membrane . 83. RET gene is located on which chromosome ? Answer : 10 th chromosome . 84. rearrangement of RET gene leads to ? a- PTC b- MTC c- FCT d- Lymphoma Answer : a. papillary thyroid cancer . 85. gene implicated in papillary thyroid cancer is ? a- RET b- K ras c- C myc d- APC Answer : a . RET gene . 86. point mutation of RET gene leads to ? answer : familial medullary carcinoma ( MEN 2A AND MEN 2B ). 87. RET ligand is identified as ? Answer: GDNF ( glial cell line-derived neurotropic factor ). 88. psammoma bodies are seen in all of the following conditions except ? a- serous cystadenoma of ovary b- papillary carcinoma of thyroid c- meningioma d- mucinous cystadenoma of ovary answer : d . 89. all of the following are early life threatening complications of thyroid operation except ? a- tracheomalacia and collapse of larynx b- wound hematoma with compression of the trachea c- hypocalcemia d- thyroid storm answer : c . hypocalcemia . 90. in pregnancy ? a- thiouracil is contraindicated b- surgery is contraindicated c- radioiodine is contraindicated d- none answer: c . only radioiodine is contraindicated . 91. amyloid stroma is seen in which carcinoma of thyroid? Answer : medullary carcinoma of thyroid . 92. lateral aberrant thyroid refers to ? a- congenital thyroid abnormality b- metastatic foci from primary in the thyroid c- struma ovarii d- lingual thyroid answer : b . metastatic foci from primary carcinoma in the thyroid . 93. a patient with long standing multinodular goiter develops hoarseness of voice ; also the swelling undergoes sudden increase in size. Likely diagnosis is ? answer : follicular carcinoma of thyroid . 94. a patient has pituitary tumor and pheochromocytoma and a thyroid nodule . which carcinoma is most likely to occur ? answer : medullary carcinoma of the thyroid . the condition is MEN 2a or MEN 2b. MEN 1 comprises of parathyroid , pituitary and pancreatic tumors. MEN 2a comprises of parathyroid, medullary carcinoma of thyroid and pheochromocytoma tumors. MEN 2b comprises of medullary carcinoma of thyroid, pheochromocytoma and neuromas . 95. a patient presented with headache and flushing . he has a family history of his relative having died of a thyroid tumor. The investigation that would be required for this patient will be ? a- chest x-ray b- measurement of 5-HIAA c- measurement of catecholamine d- intravenous pyelography answer : c . measurement of catecholamines . headache and flushing suggest symptoms of adrenal tumor and a history of thyroid tumor in the relative suggest the MEN syndrome type 2a or 2b . so the adrenal tumor is probably pheochromocytoma and so catecholamines have to be measured . 96. cancer that develops after irradiation ? a- PCT b- MCT c- FCT d- Anaplastic Answer : papillary carcinoma of the thyroid . 97. what is an oncogene ? answer : gene that contributes directly to tumor genesis . 98. mutated p53 gene is formed in most of ? a- anaplastic carcinomas b- PCT c- MCT d- FCT Answer : a . anaplastic carcinomas . 99. deletion of which chromosome accompanies transformation of follicular adenoma to follicular adeno carcinoma ? answer : 3p . 100. treatment of choice for medullary carcinoma of thyroid is ? a- total thyroidectomy b- partial thyroidectomy c- iodine 131 ablation d- hemithyroidectomy answer : a . total thyroidectomy .
Posted on: Fri, 07 Mar 2014 15:36:11 +0000
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