Endocrine Surgery Practice Questions

Q: Which of the following is NOT a feature of medullary carcinoma of the thyroid?

Constipation occurs. **Explanation:** Medullary Carcinoma of Thyroid (MCT) is a neuroendocrine tumor derived from the **parafollicular C-cells** of the thyroid. These cells are responsible for the secretion of **Calcitonin**. **Why Option D is the correct answer:** MCT is associated with **diarrhea**, not constipation. The tumor secretes high levels of Calcitonin, prostaglandins, and serotonin, which increase intestinal motility and lead to secretory diarrhea. This is a classic paraneoplastic feature of the disease. **Analysis of other options:** * **Option A:** MCT originates from the **ultimobranchial body** (parafollicular C-cells), which are neural crest in origin. This distinguishes it from papillary and follicular cancers, which arise from follicular cells. * **Option B:** A hallmark histological feature of MCT is the presence of **amyloid stroma**. This amyloid is formed by the deposition of pro-calcitonin molecules and stains positive with **Congo Red** (showing apple-green birefringence). * **Option C:** Approximately **20-25%** of MCT cases are familial, occurring as part of **MEN 2A, MEN 2B**, or Familial MCT (FMCT). These are associated with the **RET proto-oncogene** mutation. **High-Yield Clinical Pearls for NEET-PG:** * **Tumor Marker:** Calcitonin (used for diagnosis and monitoring recurrence) and CEA. * **Genetics:** All patients with MCT must be screened for **RET mutations** and **Pheochromocytoma** (before thyroid surgery). * **Staining:** Positive for Calcitonin, Chromogranin, and Synaptophysin. * **Spread:** MCT spreads via both lymphatic and hematogenous routes. * **Treatment:** Total thyroidectomy with central compartment neck dissection is the standard of care. It is **not** sensitive to Radioiodine (I-131) therapy.

Q: A patient with multinodular goiter developed pain and difficulty in breathing. Which of the following types of thyroid carcinoma is most likely to cause this complication?

Anaplastic carcinoma. **Explanation:** The clinical presentation of a long-standing multinodular goiter (MNG) suddenly developing **pain, rapid enlargement, and obstructive symptoms** (dyspnea, dysphagia, or hoarseness) is a classic hallmark of **Anaplastic Thyroid Carcinoma (ATC)**. **1. Why Anaplastic Carcinoma is correct:** ATC is one of the most aggressive solid tumors in humans. It often arises from a pre-existing differentiated thyroid cancer or a long-standing MNG in elderly patients. Its hallmark is **rapid local invasion** into surrounding structures like the trachea (causing breathing difficulty), esophagus (dysphagia), and recurrent laryngeal nerve (hoarseness). The rapid growth stretches the thyroid capsule, leading to significant pain. **2. Why the other options are incorrect:** * **Papillary Carcinoma (B):** The most common thyroid cancer; it is typically slow-growing, painless, and spreads via lymphatics. It rarely causes acute respiratory distress unless in very advanced, neglected stages. * **Follicular Carcinoma (C):** Usually presents as a solitary "cold" nodule. It spreads hematogenously (to bones and lungs) and rarely causes acute local pressure symptoms or pain. * **Medullary Carcinoma (A):** Arises from parafollicular C-cells. While it can be aggressive, it does not typically show the explosive growth or acute painful presentation characteristic of ATC. **Clinical Pearls for NEET-PG:** * **Age Group:** ATC typically affects the elderly (6th–7th decade). * **Diagnosis:** Often requires **Core Needle Biopsy** or Incisional Biopsy because FNAC may only show necrosis or be inconclusive. * **Histology:** Shows spindle cells, giant cells, and pleomorphic cells. * **Prognosis:** Extremely poor; treatment is often palliative (tracheostomy for airway) as most cases are unresectable at presentation.

Q: What is the stage of an adrenocortical carcinoma measuring 6cm without invasion of surrounding structures?

Stage II Adrenocortical carcinoma. The staging of Adrenocortical Carcinoma (ACC) primarily follows the **ENSAT (European Network for the Study of Adrenal Tumors)** classification, which is the gold standard for NEET-PG. ### **Explanation of the Correct Answer** **Stage II** is defined as a tumor measuring **>5 cm** in its greatest dimension, which is confined to the adrenal gland (no invasion of surrounding fat or organs) and has no lymph node or distant metastasis (T2 N0 M0). Since the question specifies a **6 cm** tumor without invasion, it fits the criteria for Stage II. ### **Analysis of Incorrect Options** * **Stage I:** This stage is reserved for tumors measuring **≤5 cm** that are confined to the adrenal gland (T1 N0 M0). * **Stage III:** This stage involves local invasion into surrounding adipose tissue, adjacent organs (like the kidney or liver), or the presence of positive regional lymph nodes (T3/T4 or N1). * **Stage IV:** This stage is characterized by the presence of distant metastasis (M1), regardless of the tumor size or local invasion. ### **High-Yield Clinical Pearls for NEET-PG** * **ENSAT vs. AJCC:** ENSAT is preferred over AJCC because it better correlates with prognosis, particularly in distinguishing Stage III and IV. * **Imaging:** CT scan showing high unenhanced attenuation (>10 HU) and slow contrast washout is suspicious for ACC. * **Biopsy Contraindication:** Never perform a fine-needle aspiration (FNA) if ACC is suspected, as it carries a high risk of **capsular track seeding**. * **Treatment:** Radical surgical resection (R0) is the only curative treatment. **Mitotane** is the standard adjuvant therapy for high-risk patients.

Question 1

A 26-year-old woman presents with a palpable thyroid nodule. Needle biopsy demonstrates amyloid in the stroma of the lesion. A cervical lymph node is palpable on the same side as the lesion. What is the preferred treatment?

Accepted Answer

Total thyroidectomy and modified neck dissection on the side of the enlarged lymph node.

Answer

Removal of the involved node, the isthmus, and the enlarged lymph node.

Answer

Removal of the involved lobe, the isthmus, a portion of the opposite lobe, and the enlarged lymph node.

Answer

Total thyroidectomy and irradiation of the cervical lymph nodes.

Question 2

A patient presents with a small solitary nodule in the right lobe of the thyroid. FNAC shows follicular adenoma. What is the best surgical management?

Accepted Answer

Right hemithyroidectomy

Answer

Enucleation

Answer

Subtotal thyroidectomy

Answer

Near-total thyroidectomy

Question 3

Postoperative hypoparathyroidism-related hypocalcemia usually presents within what timeframe?

Accepted Answer

48 hours

Answer

10 days

Answer

10 weeks

Answer

6 months

Question 4

A patient develops sudden respiratory distress in the postoperative room after thyroid surgery. The dressing is removed and found to be slightly blood-stained with a bulging wound. What is the first action to be taken?

Accepted Answer

Remove the stitch and take the patient to the operating theatre

Answer

Tracheostomy

Answer

Cricothyroidotomy

Answer

Laryngoscopy and intubation

Question 5

Which of the following are indications for surgery in a case of thyroid swelling?

Accepted Answer

Cosmetic, pressure symptoms, and swelling with symptoms

Answer

Cosmetic, pressure symptoms, and myxedema

Answer

Cosmetic, pressure symptoms, pain, and swelling with symptoms

Answer

All are indications for surgery

Question 6

Which of the following is NOT a feature of medullary carcinoma of the thyroid?

Accepted Answer

Constipation occurs

Answer

Arises from parafollicular cells

Answer

Amyloid infiltrate is present on histology

Answer

10-25% of cases are familial

Question 7

A patient with multinodular goiter developed pain and difficulty in breathing. Which of the following types of thyroid carcinoma is most likely to cause this complication?

Accepted Answer

Anaplastic carcinoma

Answer

Medullary carcinoma

Answer

Papillary carcinoma

Answer

Follicular carcinoma

Question 8

What is the approximate amount of thyroid tissue typically left on each side after a subtotal thyroidectomy?

Accepted Answer

4 grams on each side

Answer

4 grams on one side

Answer

6 grams on one side

Answer

6 grams on each side

Question 9

What is the stage of an adrenocortical carcinoma measuring 6cm without invasion of surrounding structures?

Accepted Answer

Stage II Adrenocortical carcinoma

Answer

Stage I Adrenocortical carcinoma

Answer

Stage III Adrenocortical carcinoma

Answer

Stage IV Adrenocortical carcinoma

Question 10

Which of the following statements about a solitary thyroid nodule are TRUE?

Accepted Answer

1, 2, and 3 are false, while 4 and 5 are true.

Answer

1, 2, and 3 are true, while 4 and 5 are false.

Answer

1, 3, and 5 are true, while 2 and 4 are false.

Answer

None of the statements are true.

Endocrine Surgery — MCQs

Endocrine Surgery — MCQs

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