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|QuestionAuthor=[[User:Gonzalo Romero|Gonzalo A. Romero, M.D.]] [mailto:gromero@wikidoc.org] | |QuestionAuthor=[[User:Gonzalo Romero|Gonzalo A. Romero, M.D.]] [mailto:gromero@wikidoc.org] | ||
|ExamType=USMLE Step 2 CK | |ExamType=USMLE Step 2 CK | ||
|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|Prompt=1. A 45-year-old female comes to the physician due to a 6-month history of difficulty swallowing. She is very worried because her condition is getting worse. At first, she thought it was a cold. Review of systems is significant for dyspnea and stridor. Upon examination her vitals are within normal limits, her neck is supple without JVD and her thyroid has a hard consistency and non-mobile. Her TSH and free T3 and T4 are within normal limits. A fine needle aspiration is performed on it shows dense collagenous replacement of the thyroid gland with chronic inflammation. Which of the following complications is this patient most likely to develop? | |Prompt=1. A 45-year-old female comes to the physician due to a 6-month history of difficulty swallowing. She is very worried because her condition is getting worse. At first, she thought it was a cold. Review of systems is significant for dyspnea and stridor. Upon examination her vitals are within normal limits, her neck is supple without JVD and her thyroid has a hard consistency and non-mobile. Her TSH and free T3 and T4 are within normal limits. A fine needle aspiration is performed on it shows dense collagenous replacement of the thyroid gland with chronic inflammation. Which of the following complications is this patient most likely to develop? | ||
|Explanation=This patient is presenting with symptoms and signs of [[Riedel's thyroiditis]], a chronic inflammatory disease of the [[thyroid]], which causes [[fibrosis]]. The fibrosis can extend to adjacent structures causing dysphagia, dyspnea, dysphonia and hoarseness (due to the laryngeal nerve involvement), [[hypoparathyroidism]]. 30% of patients present with [[hypothyroidism]], but most patients are euthyroid. | |||
|Explanation=This patient is presenting with symptoms and signs of Riedel thyroiditis, a chronic inflammatory disease of the thyroid, which causes fibrosis. The fibrosis can extend to adjacent structures causing dysphagia, dyspnea, dysphonia and hoarseness (due to the laryngeal nerve involvement), hypoparathyroidism. 30% of patients present with hypothyroidism, but most patients are euthyroid. | |||
<font color="Green">'''Correct.'''</font> | <font color="Green">'''Correct.'''</font> | ||
# Riedel thyroiditis can cause mediastinal and retroperitoneal fibrosis | # Riedel thyroiditis can cause mediastinal and retroperitoneal fibrosis | ||
| Line 29: | Line 18: | ||
'''References:''' | '''References:''' | ||
|AnswerA=Papillary carcinoma of the thyroid | |AnswerA=Papillary carcinoma of the thyroid | ||
|AnswerAExp=<font color="red">'''Incorrect.'''</font> Papillary carcinoma of the thyroid is the most common type of thyroid cancer 75 to 85% of cases of all thyroid cancers. Microscopically is seen as with the characteristic Orphan Anney eye nuclear inclusions (nuclei with uniform staining) and psammoma bodies (which are laminated concentric calcifications). | |AnswerAExp=<font color="red">'''Incorrect.'''</font> [[Thyroid cance|Papillary carcinoma of the thyroid]] is the most common type of thyroid cancer 75 to 85% of cases of all thyroid cancers. Microscopically is seen as with the characteristic Orphan Anney eye nuclear inclusions (nuclei with uniform staining) and [[psammoma body|psammoma bodies]] (which are laminated concentric calcifications). | ||
|AnswerB=Retroperitoneal fibrosis | |AnswerB=Retroperitoneal fibrosis | ||
|AnswerBExp=Riedel thyroiditis can involve mediastinal and retroperitoneal fibrosis. | |AnswerBExp=Riedel thyroiditis can involve mediastinal and retroperitoneal fibrosis. | ||
|AnswerC=Thyroid storm | |AnswerC=Thyroid storm | ||
|AnswerCExp=<font color="red">'''Incorrect.'''</font> Thyroid storm is defined as a sudden elevation of the thyroid hormones. Riedel thyroiditis is not associated with thyroid storm. Contrary, it is associated with hypothyroidism. | |AnswerCExp=<font color="red">'''Incorrect.'''</font> [[Thyroid storm]] is defined as a sudden elevation of the thyroid hormones. Riedel thyroiditis is not associated with thyroid storm. Contrary, it is associated with hypothyroidism. | ||
|AnswerD=Pneumonia | |AnswerD=Pneumonia | ||
|AnswerDExp=<font color="red">'''Incorrect.'''</font> | |AnswerDExp=<font color="red">'''Incorrect.'''</font> Although mediastinal fibrosis could potentially lead to peribronchial fibrosis, riedel thyroiditis is not commonly associated with [[pneumonia]]. | ||
|AnswerE=Thyroid lymphoma | |AnswerE=Thyroid lymphoma | ||
|AnswerEExp=<font color="red">'''Incorrect.'''</font>Thyroid lymphoma is a rare complication of Hashimoto thyroiditis. | |AnswerEExp=<font color="red">'''Incorrect.'''</font>[[Thyroid lymphoma]] is a rare complication of [[Hashimoto thyroiditis]]. | ||
|RightAnswer=B | |RightAnswer=B | ||
|WBRKeyword=Riedel thyroiditis | |WBRKeyword=Riedel thyroiditis | ||
|Approved=No | |Approved=No | ||
}} | }} | ||
Revision as of 19:37, 25 September 2013
| Author | [[PageAuthor::Gonzalo A. Romero, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | |
| Sub Category | SubCategory::Endocrine |
| Prompt | [[Prompt::1. A 45-year-old female comes to the physician due to a 6-month history of difficulty swallowing. She is very worried because her condition is getting worse. At first, she thought it was a cold. Review of systems is significant for dyspnea and stridor. Upon examination her vitals are within normal limits, her neck is supple without JVD and her thyroid has a hard consistency and non-mobile. Her TSH and free T3 and T4 are within normal limits. A fine needle aspiration is performed on it shows dense collagenous replacement of the thyroid gland with chronic inflammation. Which of the following complications is this patient most likely to develop?]] |
| Answer A | AnswerA::Papillary carcinoma of the thyroid |
| Answer A Explanation | [[AnswerAExp::Incorrect. Papillary carcinoma of the thyroid is the most common type of thyroid cancer 75 to 85% of cases of all thyroid cancers. Microscopically is seen as with the characteristic Orphan Anney eye nuclear inclusions (nuclei with uniform staining) and psammoma bodies (which are laminated concentric calcifications).]] |
| Answer B | AnswerB::Retroperitoneal fibrosis |
| Answer B Explanation | AnswerBExp::Riedel thyroiditis can involve mediastinal and retroperitoneal fibrosis. |
| Answer C | AnswerC::Thyroid storm |
| Answer C Explanation | [[AnswerCExp::Incorrect. Thyroid storm is defined as a sudden elevation of the thyroid hormones. Riedel thyroiditis is not associated with thyroid storm. Contrary, it is associated with hypothyroidism.]] |
| Answer D | AnswerD::Pneumonia |
| Answer D Explanation | [[AnswerDExp::Incorrect. Although mediastinal fibrosis could potentially lead to peribronchial fibrosis, riedel thyroiditis is not commonly associated with pneumonia.]] |
| Answer E | AnswerE::Thyroid lymphoma |
| Answer E Explanation | [[AnswerEExp::Incorrect.Thyroid lymphoma is a rare complication of Hashimoto thyroiditis.]] |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::This patient is presenting with symptoms and signs of Riedel's thyroiditis, a chronic inflammatory disease of the thyroid, which causes fibrosis. The fibrosis can extend to adjacent structures causing dysphagia, dyspnea, dysphonia and hoarseness (due to the laryngeal nerve involvement), hypoparathyroidism. 30% of patients present with hypothyroidism, but most patients are euthyroid.
Correct.
References: |
| Approved | Approved::No |
| Keyword | WBRKeyword::Riedel thyroiditis |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |