Endocrine Surgery Practice Questions

Q: Identify the instrument in the image:

Kocher dissector. ***Kocher dissector*** - The image displays a **Kocher dissector**, characterized by its **spatula-like tip with longitudinal grooves** and a flattened, often grooved handle. - This instrument is designed for **blunt dissection**, pushing and separating tissues rather than cutting, which aligns with its appearance. *Gillies forceps* - **Gillies forceps** are typically **toothed dissecting forceps**, used for grasping delicate tissues, and do not resemble the flat, spatula-like instrument shown. - They feature fine teeth at the tips for secure grip, which is absent in the image. *Spencer Wells forceps* - **Spencer Wells forceps** are **hemostatic forceps** used for clamping blood vessels, featuring a locking mechanism and serrated jaws. - Their appearance is distinct from the instrument pictured, which lacks rings and a ratchet mechanism. *Desjardin choledocholithotomy forceps* - **Desjardin choledocholithotomy forceps** are specialized instruments with a spoon-like or cup-shaped jaw used for **removing stones from the common bile duct**. - Their design is clearly different from the blunt dissector depicted in the image. *MacDonald dissector* - **MacDonald dissector** is a periosteal elevator with a curved, sharp edge used primarily in **orthopedic and neurosurgical procedures**. - Unlike the Kocher dissector's blunt spatula tip, the MacDonald has a more curved profile and sharper working end.

Q: Identify the instrument in the image:

Joll retractor. ***Joll retractor*** - The image displays a **Joll retractor**, which is a self-retaining retractor used commonly in **thyroid and parathyroid surgeries**. - Its design typically includes a frame with adjustable blades or hooks that help maintain exposure of the surgical site. *Langenbeck retractor* - A **Langenbeck retractor** is a handheld, single-ended retractor with an L-shaped blade, used for **superficial soft tissue retraction**. - It does not have the self-retaining mechanism or the complex frame shown in the image. *Morris retractor* - The **Morris retractor** is another type of handheld retractor, often used in **deep surgical fields**. - It is also a single-ended instrument with a curved or angled blade, unlike the self-retaining instrument pictured. *Dyball retractor* - The **Dyball retractor** is a specialized retractor, often used in **neck surgery** for deeper dissection. - While used in similar surgical areas to the Joll retractor, its design is distinct and does not match the instrument in the image. *Green retractor* - The **Green retractor** (also called thyroid retractor) is a double-ended handheld retractor commonly used in **thyroid surgery**. - It has a simple blade design and lacks the self-retaining frame mechanism characteristic of the Joll retractor.

Q: A 25-year-old patient presents with a neck swelling which moves with deglutition as shown below. Your diagnosis is?

Thyroglossal cyst. ***Thyroglossal cyst*** - A **thyroglossal duct cyst** is a common congenital neck mass that typically presents in the midline of the neck. - The classic characteristic feature is its **movement with deglutition** (swallowing) and often with protrusion of the tongue, due to its attachment to the hyoid bone and remnants of the thyroglossal duct. *Brachial cyst* - **Branchial cleft cysts** are usually located laterally in the neck, anterior to the sternocleidomastoid muscle, and do not typically move with deglutition. - They are remnants of the branchial arches failing to involute completely. *Cystic hygroma* - A **cystic hygroma** is a type of lymphangioma, commonly found in the posterior triangle of the neck or axilla. - It is typically a soft, compressible, and ill-defined mass that does not move with deglutition. *Cervical lymphadenopathy* - **Cervical lymphadenopathy** involves enlarged lymph nodes, which can be firm or tender depending on the cause (e.g., infection, malignancy). - While they are common in the neck, they are generally not mobile with deglutition unless they are very superficial and freely movable, but they do not typically have the same characteristic movement as a thyroglossal cyst. *Dermoid cyst* - A **dermoid cyst** is another congenital midline neck mass that can present in the submental region. - Unlike thyroglossal cysts, dermoid cysts do not move with deglutition or tongue protrusion as they are not attached to the hyoid bone. - They are typically non-tender, doughy masses that may contain hair, sebum, and skin elements.

Q: Which is correct about tumor found in the triangle location shown below?

Associated with MEN1. ***Associated with MEN1*** - The triangle shown in the image represents the **Gastrinoma Triangle**, a common location for gastrin-producing tumors (gastrinomas) to occur. - Approximately 20-30% of gastrinomas are associated with **Multiple Endocrine Neoplasia type 1 (MEN1)** syndrome, which involves tumors of the parathyroid glands, pituitary gland, and pancreas. *Most common site is stomach* - The most common primary site for gastrinomas is the **duodenum** (50-70%), followed by the pancreas (20-40%). - Gastrinomas found in the stomach are rare and usually associated with MEN1, but the duodenum is the predominant site overall. *Best test for diagnosis is pentagastrin test* - The **pentagastrin stimulation test** is used to assess maximal acid output but it is not specific for diagnosing gastrinomas. - The **secretin stimulation test** is the most sensitive and specific provocative test for gastrinoma, as secretin normally inhibits gastrin release from G cells but paradoxically stimulates it in gastrinomas. *Metastasis to adjacent gut* - Gastrinomas are malignant neuroendocrine tumors that commonly **metastasize to regional lymph nodes** and the **liver**. - While they can invade locally, metastasis typically involves distant sites rather than just the adjacent gut wall. *Primary treatment is medical with proton pump inhibitors* - While **proton pump inhibitors (PPIs)** are essential for managing acid hypersecretion symptoms, they are not the primary definitive treatment. - **Surgical resection** is the primary treatment for localized, sporadic gastrinomas when feasible, offering potential cure. - PPIs serve as adjunctive medical therapy to control symptoms but do not address the underlying tumor.

Question 1

Identify the instrument in the image:

Accepted Answer

Kocher dissector

Answer

Gillies forceps

Answer

Spencer Wells forceps

Answer

Desjardin choledocholithotomy forceps

Answer

MacDonald dissector

Question 2

Identify the instrument in the image:

Accepted Answer

Joll retractor

Answer

Langenbeck retractor

Answer

Morris retractor

Answer

Dyball retractor

Answer

Green retractor

Question 3

A 51-year-old woman presents with complaints of nervousness and weight loss. She reveals that she has been feeling her heart racing often. On examination, she has a fine tremor, and a large mass in the front of her neck that moves when she swallows. What is the definite treatment of choice for this condition?

Accepted Answer

Total thyroidectomy

Answer

Subtotal thyroidectomy

Answer

Propranolol

Answer

${ }^{131} \mathrm{I}$ radioablation

Answer

Antithyroid drugs (Methimazole)

Question 4

A 25-year-old patient presents with a neck swelling which moves with deglutition as shown below. Your diagnosis is?

Accepted Answer

Thyroglossal cyst

Answer

Brachial cyst

Answer

Cystic hygroma

Answer

Cervical lymphadenopathy

Answer

Dermoid cyst

Question 5

Which is correct about tumor found in the triangle location shown below?

Accepted Answer

Associated with MEN1

Answer

Most common site is stomach

Answer

Best test for diagnosis is pentagastrin test

Answer

Metastasis to adjacent gut

Answer

Primary treatment is medical with proton pump inhibitors

Endocrine Surgery — MCQs

Endocrine Surgery — MCQs

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