WBR0069
| Author | PageAuthor::Mahmoud Sakr, M.D. |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Endocrine |
| Prompt | [[Prompt::33 y/o African American woman presents with malaise, constipation and intolerance to cold weather. Physical examination reveals an enlarged thyroid gland that’s soft, diffuse, nodular and mobile. Her TSH is elevated and her T3 and T4 are decreased. Anti thyroglobulin antibodies are positive. The patient was referred to an endocrinologist for a fine needle aspiration. Which of the following cells will be predominant on her biopsy results?]] |
| Answer A | AnswerA::Multinucleate giant cells |
| Answer A Explanation | AnswerAExp::This would be related to de Quervain's thyroiditis or giant cell thyroiditis. |
| Answer B | AnswerB::Lymphocytes |
| Answer B Explanation | AnswerBExp::This is the correct answer as mentioned above. Actually, another used name for Hashimoto's is chronic lymphocytic thyroiditis |
| Answer C | AnswerC::Neutrophils |
| Answer C Explanation | AnswerCExp::Neutrophils are Found in subacute granulomatous thyroiditis, not Hashimoto's. |
| Answer D | AnswerD::Parafollicular C cells |
| Answer D Explanation | AnswerDExp::This would be correct if the suspected diagnosis is medullary thyroid cancer. |
| Answer E | AnswerE::Eosinophils |
| Answer E Explanation | AnswerEExp::There has been reports that eosinophils can be detected on tissue biopsies of Hashimoto's. However, this is still under investigation. The predominant cells are always lymphocytes in hashimoto's. |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::The correct answer is B.
This patient has Hashimoto’s thyroiditis. The biopsy in Hashimoto’s shows lymphocytic infiltration unlike subacute granulomatous thyroiditis that has multinucleate giant cells and neutrophils. Parafollicular C cells are present in medullary thyroid cancer, which is not the case here. |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |