Judgments
Breast-Endocrine-Surgery.docx
Judgement of 51 pages for the course usmle at usmle (Breast-Endocrine-S)
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Theme: Familial endocrine diseaseA MEN1 syndrome
B MEN2 syndrome
C Phaeochromocytoma
D Papillary carcinoma of thyroid
E Hyperparathyroidism
F Diabetes
For each of the statements below select the most likely answer from the list
above. Each option may be used once, more than once or not at all
Scenario 1
Incorrect
Autosomal dominant condition with high penetrance
A Correct answer
Scenario 2
Incorrect
Autosomal dominant condition involving mutations of the RET proto-oncogene
B Correct answer
Scenario 3
Incorrect
Presents with tumours of anterior pituitary, parathyroids and pancreatic islets
A Correct answer
Scenario 4
Incorrect
The most common presenting abnormality in MEN1 syndrome
,E Correct answer
Theme: Treatment options for Thyroid disease
A Subtotal thyroidectomy
B Hemithyroidectomy
C Total thyroidectomy
D Radio-iodine treatment
E Nucleation
Select the options above the most appropriate treatment for the patients below.
Each option may be used once, more than once or not at all.
Scenario 1
Incorrect
A 25-year-old woman with Graves’ disease who is thyrotoxic. Medical treatment has failed to
control her symptoms and is hoping to start a family in the next few years.
B Your answer
A Correct answer
Scenario 2
Correct
A 55-year-old woman presents with a swelling in her thyroid. Investigation shows it to be a
lymphoma.
C Correct answer
Scenario 3
Incorrect
,A 45-year-old man presents with a lump in the right lobe of the thyroid. Fine needle aspiration
reveals it to be follicular in nature.
E Your answer
B Correct answer
Theme: Thyroid disease
A Medullary thyroid carcinoma (MTC)
B Anaplastic carcinoma
C Follicular carcinoma
D Lymphoma
E Follicular adenoma
F Papillary carcinoma
For each patient described below, select the most likely single diagnosis from the
list of options above. Each option may be used once, more than once or not at all.
Scenario 1
Incorrect
A 13-year-old girl presents to the surgical outpatient department with a neck swelling. Clinical
examination shows a 2.8 cm solid lump in the left thyroid lobe and two enlarged cervical lymph
nodes lateral to the thyroid mass. Ultrasonography confirms the solid nature of the thyroid
nodule. Fine needle aspiration (FNA) biopsy of the thyroid nodule reveals malignant cells with
vesicular appearance of nuclei. The nodule is cold on radio-isotope scanning.
F Correct answer
The presence of regional lymphadenopathy, the age of the patient and the characteristic vesicular
appearance of the nuclei support the diagnosis of papillary carcinoma. The surgical treatment
consists of total thyroidectomy and removal of enlarged lymph nodes.
Scenario 2
Incorrect
, A 60-year-old man presents to the outpatients with rapidly enlarged thyroid swelling and
hoarseness. Clinical examination shows a 2.8cm solid lump in the left thyroid lobe and two
enlarged cervical lymph nodes lateral to the thyroid mass. Ultrasonography confirms the solid
nature of the thyroid nodule. FNA biopsy of the thyroid nodule reveals malignant cells with
vesicular appearance of nuclei. The nodule is cold on radio-isotope scanning.
B Correct answer
The presence of regional lymphadenopathy, the age of the patient and the characteristic vesicular
appearance of the nuclei support the diagnosis of anaplastic carcinoma. The surgical treatment is
palliative.
Theme: Radial nerve injury
A Compression at the elbow
B Fracture of the mid-humerus
C Axillary compression
D Laceration at the wrist
For each of the scenarios below describe the level of injury. Pick the most
appropriate option from the above list. Each option may be used once only, more
than once or not at all.
In low radial nerve lesions, ie those due to fractures or dislocations at the elbow,
the posterior interosseus nerve may be injured and the patient is unable to
perform finger extension with weakness of thumb abduction and extension.
In high lesions with fractures of the humerus or due to prolonged tourniquet
pressure, there is weakness of the radial extensors of the wrist and numbness
over the anatomical snuffbox.
In very high lesions, the radial nerve may be compressed in the axilla, eg crutch
palsy.
Scenario 1
Incorrect
A 25-year-old man presenting with weakness of the wrist and hand with paralysis of the triceps
muscle and an absent triceps reflex.
A Your answer
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