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WorksheetsHead and Neck
Total questions: 20
Worksheet time: 10mins
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
A patient with a 2 cm right thyroid lobe mass sought consult and underwent fine
needle biopsy which revealed psammoma bodies. What is the recommended
definitive treatment for this patient?
Total lobectomy right and isthmusectomy
Total lobectomy right, subtotal lobectomy left
Total Thyroidectomy
Radioactive Iodine Ablation
A 35 year old patient incidentally presented with a 1 cm thryoid mass during her
annual physical exam. She has no symptoms. There are no palpable nodes.
Biopsy was done which revealed Anaplastic Carcinoma. What is the TNM stage of
the patient?
I
II
III
IV
A 40 year old patient initially underwent fine needle biopsy which revealed
Follicular Neoplasm. He then underwent Subtotal Thyroidectomy and after a
week, the histopathology results came back reading Follicular Adenoma. What is
the recommended next step?
Advise observation and monitoring
Advise Completion Thyroidectomy
Advise Radioactive Iodine Ablation
Advise Thyroid Suppression Therapy
Which of the following can differentiate benign from malignant Follicular disease?
Fine needle biopsy
Intraoperative Gross examination
Frozen Section biopsy
Molecular Studies
This type of branchial cleft cyst are usually located in the preauricular area,
associated with the parotid gland and external auditory canal
A. First branchial cleft cyst
Second branchial cleft cyst
Third branchial cleft cyst
Fourth branchial cleft cyst
A subglottic carcinoma will usually drain into a first echelon of nodes which
includes nodes in the
I
III
V
VI
A patient came in for consult for a 3cm hard, preauricular mass. Further workups
and intra-operative findings revealed the histology to be a Squamous Cell
Carcinoma located at the superficial lobe of the parotid. What is the recommended
treatment?
Superficial Parotidectomy
Total Parotidectomy
Total Parotidectomy with selective neck dissection
Total Parotidectomy with Modified Radical neck dissectio
An adult male patient came in for a 1.5 cm firm, movable, non painful mass in the
left pre-auricular area. The recommended management for this patient would be
to perform:
CT scan of the neck area
Fine needle aspiration of the mass
Excision biopsy of the mass
Superficial Parotidectomy
A 50-year-old female with a 2cm thyroid nodule on the left was recently biopsied and the result was indeterminate lesion, she then decided to consult in another institution where BRAF mutation was identified. She claimed to have experienced palpitations and resting tremors, she is currently on anti-hyperthyroid medications. She wanted to have the mass removed. What will you advise?
Observe since there are no compressive symptom
Complete medications until euthyroid state and perform lobectomy left
Wait until the patient is euthyroid and perform total thyroidectomy
Give loading dose of propranolol and methimazole, do intraop monitoring and perform total thyroidectomy
A 35 year old woman came to the surgery clinic complaining of neck tightness with “sensation of being choked.” On examination, there is a painless, hard, “woody”, fixed anterior neck mass. What is the primary goal of surgical intervention in the treatment of the patient’s condition?
The main goal of surgery is to perform a total thyroidectomy to remove the fibrotic thyroid gland
The chief goal of operation is to remove all fibrotic tissue within the neck, followed by radiotherapy to target residual fibrotic cell
Surgery aims to decompress the trachea by wedge excision of the thyroid isthmus and to obtain a tissue diagnosis
Surgical treatment is primarily cosmetic, focusing on reducing the size of the goiter.
