Head and Neck

A 45-year-old woman presents with a painless neck mass she noticed 3 months ago. On examination, there is a firm, non-tender nodule in the right lobe of the thyroid. Ultrasound reveals a hypoechoic solid nodule with irregular margins and microcalcifications. Fine-needle aspiration (FNA) suggests papillary thyroid carcinoma. There is no cervical lymphadenopathy. What is the most likely diagnosis based on the FNA result and ultrasound findings?

• Medullary thyroid carcinoma

• Follicular adenoma

• Papillary thyroid carcinoma

• Anaplastic thyroid carcinoma

Which of the following is the most common risk factor for papillary thyroid carcinoma?

• Chronic iodine deficiency

• Radiation exposure to the head and neck

• Family history of Graves’ disease

• Hashimoto’s thyroiditis

What is the next best step in the management of this patient?

• Observation and repeat FNA in 6 months

• Total thyroidectomy

• Radioactive iodine therapy only

• External beam radiation

Which of the following histologic features is characteristic of papillary thyroid carcinoma?

• Hurthle cell change

• Psammoma bodies and Orphan Annie eye nuclei

• Sheets of undifferentiated large cells

• Amyloid stroma

What is the usual prognosis for patients diagnosed with papillary thyroid carcinoma?

• Very poor; median survival less than 1 year

• Poor unless treated with chemotherapy

• Good, with high long-term survival rates

• Moderate, with frequent recurrence

What is the most appropriate management for a solitary category IV thyroid nodule?

• Repeat lultrasound guided FNAB

• Repeat ultrasound guided FNAB with adequacy

• Diagnostic lobectomy, isthmusectomy

• Diagnostic lobectomy, isthmusectomy, frozen section, possible total thyroidectomy

Which of the following classifies as a biochemical incomplete response?

• Negative imaging and stimulated Tg >1 ng/mL

• Negative imaging and unstimulated Tg> 5 ng/mL

• Negative imaging and unstimulated Tg>10 ng/mal

• Negative imaging and rising TgAb levels

A 62/M consulted for a stimulated Tg of 5 ng/mL. He allegedly underwent total thyroidectomy 4 weeks ago for papillary thyroid cancer. On ultrasound, there is a 1 cm focus at the mid anterior trachea. FNAB of the 1 cm focus showed papillary thyroid cancer. What is your diagnosis and plan?

• Persistent papillary thyroid cancer and re excision + RAI

• Persistent disease and RAI

• Recurrent disease and re excision + RAI

• Recurrent disease and RAI

A 58/F underwent a left total parotidectomy with facial nerve preservation for a suspected pleomorphic adenoma in the deep lobe. On histopath, there is a 3 cm focus of low grade mucoepidermoid carcinoma with close margins. What will you advise the patient?

• Surveillance

• RT and surveillance

• ChemoRT and surveillance

• Facial nerve resection, chemoRT and surveillance

A 38/F consulted for a 3 cm left lateral neck mass. On neck ultrasound, there is a 1 cm TIRADS 5 nodule in the superior aspect of the right thyroid lobe, and a 3 cm left level III lymph node. FNAB of the lymph node revealed follicular cells. What lymph node levels will you remove?

• Right level VI, left level I-V

• Right level VI, left level II-V

• Left, level I-V

• Left, level II-V