1. A 32-year-old woman has had a lump in her neck for 6 months. She has a 1.

2-cm solitary left thyroid

nodule. Fine-needle aspiration cytology of the mass is consistent with a low-grade papillary
malignancy. Which of the following is the most appropriate next step in management?

a. Thyroid scan
b. I131 therapy
c. Propylthiouracil therapy
d. Thyroxine therapy
e. Left thyroid lobectomy

2. Which of the following ultrasound findings is LEAST suggestive of a thyroid malignancy?

a. Micro-calcifications
b. Complete halo around a cystic thyroid nodule
c. Ipsilateral cervical lymph nodes with rounded bulging shape, replaced fatty hilum & irregular margins
d. Intrinsic hypervascularity of thyroid nodule
e. Solid hypoechoic thyroid nodule with irregular margins

3. A 30-year-old male presents to the head & neck surgery clinic with a solitary thyroid nodule. He denies
any symptoms but recalls a history of having radiotherapy as a child over 20 years ago as treatment for
keloids. His docket also reveals that he received radiotherapy for thymic hyperplasia. His thyroid
function tests are within normal limits. Ultrasound guided fine needle biopsy on two separate occasions
suggest that the nodule is benign. Your next step in the management of this patient should be

a. Thyroidectomy
b. Reassurance
c. Core needle biopsy
d. Computed tomography
e. Follow-up in 6 months with an interval ultrasound
A 25-year-old woman is referred to the outpatient ENT, head & neck surgery department after her GP
noted a thyroid nodule. The mass is painless and has been steadily growing for 3 months. She has no
compressive or constitutional symptoms and there is no previous history of radiation exposure. She is
otherwise doing well and expresses no major concerns about cosmesis. TSH, T3 &T4 are within normal
range. Ultrasound of the neck reveals multiple thyroid nodules of varying sizes interspersed throughout the
thyroid gland. There is no retrosternal extent.

4. Which of the following statements about her management would be the MOST accurate?

a. Thyroid surgery should be considered in this patient even if her biopsy results are benign
b. The presence of multiple nodules on ultrasound excludes the possibility of her having a malignancy
c. Thyroid nodules should be selected for biopsy solely based on size
d. Interval growth of her thyroid nodule is a specific predictor of malignancy
e. Any hypoechogenic nodule with irregular margins and central hypervascularity should be biopsied
regardless of size
5. 31-year-old woman who is 11 weeks pregnant presents with tachycardia, tremors and palpitations. She has strong
family history of autoimmune thyroid disease and goitre. Her thyroid function test results are as shown below:

Free T4 32.8 pmol/L (9-23)

Free T3 11.2 pmol/L (3.5-6.5)
TSH < 0.01 mU/L (0.35-5.5)
What is the best therapeutic option in her case?
1)Carbimazole
2)Lugols iodine
3) Propanolol
4)Propylthiouracil
5)Radioiodine

6.
7. A 32 year old female undergoes a radio-iodine uptake scan and this is reported to show 'generalised
reduced uptake of 123I tracer throughout thethyroid'. In which of the following would this result be
expected?
8. 1) DeQuervain
2)Graves
3)Multi-nodular toxic goitre
4)Thyroid nodule with papillary thyroid cancer
5)Type 1 amiodarone induced thyrotoxicosis type 1