Endocrine Surgery Practice Questions

Question 1

A 50-year-old woman comes to the physician because of palpitations and irritability. Over the past 4 months, she has had several episodes of heart racing and skipping beats that lasted between 30 seconds and several hours. She has also been arguing with her husband more, often about the temperature being too warm. The patient has also lost 8.8-kg (19.4-lb) over the past 4 months, despite being less strict with her diet. She has mild asthma treated with inhaled bronchodilators. Her pulse is 102/min and blood pressure is 148/98 mm Hg. On physical examination, the skin is warm and moist. A mass is palpated in the anterior neck area. On laboratory studies, thyroid stimulating hormone is undetectable and there are antibodies against the thyrotropin-receptor. Thyroid scintigraphy shows diffusely increased iodine uptake. Two weeks later, a single oral dose of radioactive iodine is administered. This patient will most likely require which of the following in the long-term?

Accepted Answer

L-thyroxine therapy

Answer

Propranolol therapy

Answer

Near-total thyroidectomy

Answer

Methimazole therapy

Answer

Estrogen replacement therapy

Question 2

A 31-year-old man comes to the physician because of worsening abdominal pain, an inability to concentrate at work, and a general lack of motivation over the past several months. He has a history of spontaneous passage of two kidney stones. His father and uncle underwent thyroidectomy before the age of 35 for thyroid cancer. Physical examination shows diffuse tenderness over the abdomen. Serum studies show:
Na+ 142 mEq/L
K+ 3.7 mEq/L
Glucose 131 mg/dL
Ca2+ 12.3 mg/dL
Albumin 4.1 g/dL
Parathyroid hormone 850 pg/mL
Further evaluation is most likely to show elevated levels of which of the following?

Accepted Answer

Urine metanephrines

Answer

Serum aldosterone to renin ratio

Answer

Serum prolactin

Answer

Urine 5-hydroxyindoleacetic acid

Answer

Midnight salivary cortisol

Question 3

A 40-year-old woman comes to the physician because of a 3-month history of a lump on her neck. The lump is mildly painful. She appears healthy. Examination shows a swelling on the left side of her neck that moves on swallowing. Cardiopulmonary examination shows no abnormalities. Her TSH is 3.6 μU/mL. Ultrasound shows a 4.0-cm (1.6-in) hypoechoic mass in the left thyroid lobe. Fine-needle aspiration of the mass shows neoplastic follicular cells. Molecular analysis of the aspirate shows a mutation in the RAS gene. Which of the following is the most appropriate next step in management?

Accepted Answer

Thyroid lobectomy

Answer

Radioiodine therapy

Answer

External beam radiation

Answer

Total thyroidectomy

Answer

Watchful waiting

Question 4

Immediately after undergoing a right total knee replacement, a 69-year-old woman has severe abdominal pain, non-bloody emesis, and confusion. She has a history of Hashimoto thyroiditis that is well-controlled with levothyroxine and hyperlipidemia that is controlled by diet. She underwent bunion removal surgery from her right foot 10 years ago. Her temperature is 39°C (102.2°F), pulse is 120/min, and blood pressure is 60/30 mm Hg. Abdominal examination shows a diffusely tender abdomen with normal bowel sounds. She is confused and oriented to person but not place or time. Laboratory studies are pending. Which of the following is the most appropriate next step in the management of this patient?

Accepted Answer

Intravenous isotonic saline infusion

Answer

High-dose hydrocortisone

Answer

Exploratory laparotomy

Answer

CT angiogram of the abdomen

Answer

Noncontrast CT of the head

Question 5

A 20-year-old woman visits the clinic for her annual physical examination. She does not have any complaints during this visit. The past medical history is insignificant. She follows a healthy lifestyle with a balanced diet and moderate exercise schedule. She does not smoke or drink alcohol. She does not take any medications currently. The family history is significant for her grandfather and uncle who had their parathyroid glands removed. The vital signs include: blood pressure:122/88 mm Hg, pulse 88/min, respirations 17/min, and temperature 36.7°C (98.0°F). The physical exam is within normal limits. The lab test results are as follows:
Blood Urea Nitrogen 12 mg/dL
Serum Creatinine 1.1 mg/dL
Serum Glucose (Random) 88 mg/dL
Serum chloride 107 mmol/L
Serum potassium 4.5 mEq/L
Serum sodium 140 mEq/L
Serum calcium 14.5 mg/dL
Serum albumin 4.4 gm/dL
Parathyroid Hormone (PTH) 70 pg/mL (Normal: 10-65 pg/mL)
24-Hr urinary calcium 85 mg/day (Normal: 100–300 mg/day)
Which of the following is the next best step in the management of this patient?

Accepted Answer

No treatment is necessary

Answer

Start IV fluids to keep her hydrated

Answer

Start her on pamidronate

Answer

Give glucocorticoids

Answer

Parathyroidectomy

Question 6

A 43-year-old male with a history of thyroid cancer status post total thyroidectomy presents to his primary care physician after repeated bouts of headaches. His headaches are preceded by periods of anxiety, palpitations, and sweating. The patient says he is unable to pinpoint any precipitating factors and instead says the events occur without warning. Of note, the patient's father and uncle also have a history of thyroid cancer. On exam his vitals are: T 36.8 HR 87, BP 135/93, RR 14, and O2 Sat 100% on room air. The patient's TSH is within normal limits, and he reports taking his levothyroxine as prescribed. What is the next best step in diagnosing this patient's chief complaint?

Accepted Answer

Plasma fractionated metanephrines

Answer

24-hour urine free cortisol

Answer

Plasma aldosterone/renin ratio

Answer

Abdominal CT scan with and without IV contrast

Answer

High dose dexamethasone suppression test

Question 7

A 75-year-old man is referred for thyroidectomy for treatment of thyroid nodules. A portion of the thyroid gland is resected, and the neck is closed with sutures. After awakening from anesthesia, the patient complains of ‘hoarseness’. His vital signs are normal and his incisional pain is minimal. The surgeon realizes he most likely damaged the recurrent laryngeal nerve. Which of the following should the surgeon tell the patient?

Accepted Answer

"We made a mistake during the operation that may have harmed you."

Answer

"A mistake occurred during the operation, but there was no harm to you."

Answer

"The case took longer than we thought it would, but everything went well."

Answer

"A mistake occurred because this hospital has poor operating room protocols."

Answer

"The operation was successful and no complications occurred."

Question 8

A 27-year-old-man is brought to the emergency department 30 minutes after being involved in a motorcycle accident. He lost control at high speed and was thrown forward onto the handlebars. On arrival, he is alert and responsive. He has abdominal pain and superficial lacerations on his left arm. Vital signs are within normal limits. Examination shows a tender, erythematous area over his epigastrium. The abdomen is soft and non-distended. A CT scan of the abdomen shows no abnormalities. Treatment with analgesics is begun, the lacerations are cleaned and dressed, and the patient is discharged home after 2 hours of observation. Four days later, the patient returns to the emergency department with gradually worsening upper abdominal pain, fever, poor appetite, and vomiting. His pulse is 91/min and blood pressure is 135/82 mm Hg. Which of the following is the most likely diagnosis?

Accepted Answer

Pancreatic ductal injury

Answer

Abdominal compartment syndrome

Answer

Aortic dissection

Answer

Splenic rupture

Answer

Diaphragmatic rupture

Question 9

A 62-year-old man comes to the physician for a follow-up examination after having been diagnosed with stage II adenocarcinoma of the left lower lung lobe without evidence of distant metastases 1 week ago following an evaluation for a chronic cough. He has hypertension and type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for the past 40 years. His current medications include metformin, sitagliptin, and enalapril. He is 177 cm (5 ft 10 in) tall and weighs 65 kg (143 lb); BMI is 20.7 kg/m2. He appears lethargic. Vital signs are within normal limits. Pulse oximetry shows an oxygen saturation of 98%. Examination shows inspiratory wheezing at the left lung base. The remainder of the examination shows no abnormalities. A complete blood count and serum concentrations of electrolytes, creatinine, glucose, and liver enzymes are within the reference range. Spirometry shows an FEV1 of 1.6 L. The diffusing lung capacity for carbon monoxide (DLCO) is 66% of predicted. Which of the following is the most appropriate next step in the management of this patient?

Accepted Answer

Schedule lobectomy

Answer

Administer cisplatin and vinorelbine

Answer

Schedule a wedge resection

Answer

Administer cisplatin and etoposide

Answer

Radiation therapy

Question 10

An obese 52-year-old man is brought to the emergency department because of increasing shortness of breath for the past 8 hours. Two months ago, he noticed a mass on the right side of his neck and was diagnosed with laryngeal cancer. He has smoked two packs of cigarettes daily for 27 years. He drinks two pints of rum daily. He appears ill. He is oriented to person, place, and time. His temperature is 37°C (98.6°F), pulse is 111/min, respirations are 34/min, and blood pressure is 140/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 89%. Examination shows a 9-cm, tender, firm subglottic mass on the right side of the neck. Cervical lymphadenopathy is present. His breathing is labored and he has audible inspiratory stridor but is able to answer questions. The lungs are clear to auscultation. Arterial blood gas analysis on room air shows:
pH 7.36
PCO2 45 mm Hg
PO2 74 mm Hg
HCO3- 25 mEq/L
He has no advanced directive. Which of the following is the most appropriate next step in management?

Accepted Answer

Cricothyroidotomy

Answer

Comfort care measures

Answer

Tracheostomy

Answer

Intramuscular epinephrine

Answer

Tracheal stenting

Endocrine Surgery

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Adrenalectomy approaches

Endocrine surgery complications

Hyperparathyroidism surgical management

Minimally invasive endocrine procedures

Multiple endocrine neoplasia syndromes

Parathyroidectomy procedures

Pheochromocytoma resection

Postoperative hypocalcemia management

Radioguided parathyroidectomy

Recurrent laryngeal nerve protection

Thyroid cancer management

Thyroid nodule evaluation

Thyroidectomy indications and techniques

Practice Questions

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Master Endocrine Surgery