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Self-Assessment Questions

General Surgery

Endocrine Surgery: Review Questions

Ravi J. Chokshi, MD

Dr. Chokshi is a fourth year surgical resident, St. Francis Medical Center-Seton Hall University, Trenton, NJ.


Choose the single best answer for each question.



Figure 1

Questions 1 and 2 refer to the following case.
A 45-year-old woman with no significant past medical history presents with a firm 3-cm mass in the right thyroid lobe with no clinical evidence of nodal involvement. A fine-needle aspiration (FNA) is performed and histologic examination confirms a diagnosis of papillary cancer.

1. How should this patient be treated?

  1. Enucleation
  2. Lobectomy and isthmusectomy
  3. Radioiodine ablation
  4. Total thyroidectomy
  5. Total thyroidectomy with bilateral modified radical neck dissection (MRND)
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2. Following surgery, pathologic examination of the thyroid tissue reveals a well-circumscribed 3-cm papillary cancer with negative margins. A lymph node found in the specimen is positive for papillary cancer. What is the next step in this patient’s management?

  1. External beam radiation therapy
  2. Radioiodine ablation
  3. Reexploration and ipsilateral MRND
  4. Reexploration and ipsilateral radical neck dissection
  5. No other intervention is needed at this time
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Questions 3 and 4 refer to the following case.
A 60-year-old man with a past medical history of primary hyperparathyroidism presents to the emergency department with nausea, vomiting, constipation, confusion, polyuria, and generalized weakness. The patient is immediately placed on a monitor, intravenous (IV) access is obtained, and a Foley catheter is inserted. Initial laboratory testing reveals a serum calcium level of 16 mg/dL.

3. What is the next step in this patient’s management?

  1. Aggressive IV fluid resuscitation followed by a loop diuretic
  2. Bisphosphonates and calcitonin
  3. Neck exploration and removal of the enlarged gland
  4. Neck exploration and removal of 3.5 parathyroid glands with autotransplantation
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4. Ultrasonography and a sestamibi scan are performed, and a large left inferior lobe gland is identified (Figure 1 and Figure 2). How should this patient be treated?

  1. Remove the enlarged gland
  2. Remove 3.5 glands with autotransplantation
  3. Identify all 4 glands and remove only the enlarged gland
  4. Identify all 4 glands, remove the enlarged gland, analyze the specimen intraoperatively using frozen section analysis, and measure parathyroid hormone (PTH) levels intraoperatively
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Figure 2

5. A 45-year-old man is brought into the emergency department after being struck by a motor vehicle. A computed tomography (CT) scan of the abdomen and pelvis is negative for any traumatic injury but demonstrates a 7.0-cm left adrenal mass. There is no evidence of metastatic disease. What is the most appropriate treatment for this patient?

  1. Chemotherapy and radiation
  2. Follow-up only if symptomatic
  3. FNA of the mass
  4. Observation with serial CT scans
  5. Surgical resection
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6. A 32-year-old man presents to his primary care physician with generalized weakness. On physical examination, the patient is hypertensive and has significant truncal obesity. At 1-week follow-up, laboratory testing reveals increased plasma adrenocorticotropic hormone and serum cortisol levels. The patient undergoes a low- and high-dose dexamethasone test; the high-dose dexamethasone test reveals decreased urinary cortisol levels. CT scan of the brain demonstrates a pituitary mass. How should this patient be treated?

  1. Bilateral adrenalectomy
  2. Chemotherapy
  3. Long-term high-dose steroids for suppression
  4. Transphenoidal resection of pituitary adenoma
  5. Unilateral adrenalectomy
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7. A 47-year-old woman presents to her primary care physician with palpitations and is sweating profusely. On physical examination, the patient has a heart rate of 110 bpm and appears diaphoretic. The remainder of the physical examination is unremarkable. A fingerstick glucose test shows a glucose level of 45 mg/dL. The patient is given a glass of orange juice and some crackers, and her glucose level returns to normal. A CT scan of the abdomen and pelvis reveals a 1-cm mass in the tail of the pancreas. What is the treatment of choice?

  1. Distal pancreatectomy
  2. Enucleation
  3. Observation
  4. Whipple procedure
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