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Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5775_Библиотеки_им_академика_М_И_Перельмана

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A.Multinodulargoiter;follow-upultrasoundin1year. B.Multiplecolloidcyststhroughoutthethyroid;nofurtherfollow-upindicated. C.  Diffuse sclerosing variant of papillary thyroid carcinoma; biopsy followed by total
thyroidectomyandcervicallymphnodedissection.
D. Diffuse metastaticdisease to the thyroid; furtherimagingof the chest,abdomen, andpelvis
withCTisrecommendedtoidentifyaprimarymalignancy.
E.Chroniclymphocyticthyroiditis;thyroid function testsandsupplementationwithSynthroidif
indicated.
8b.Whichofthesonographicfeatureslistedbelowismostlikelytobeassociatedwithabenignthyroid
nodule?
A.Spiculatedorlobulatednodulemargin B.Microcalcifications C.Taller-than-wideshape D.Extensionbeyondthethyroidcapsule E.Spongiformcomposition
9a.Amiddle-agedmalewithhyperparathyroidismunderwentultrasoundandtechnetium-99msestamibi
scan.Whatisthemostlikelycauseofthissonographicabnormality?
A.Renalfailure B.Parathyroidcarcinoma
C.Parathyromatosis D.Thyroidcarcinoma
9b.  After parathyroidectomy, what is the most common cause of persistent or recurrent
hyperparathyroidism?
A.Missedparathyroidtissueinnormalpositionduringprevioussurgery B.Regrowthofresectedtumor C.Recurrentparathyroidcancer D.Hyperfunctioningectopicparathyroidtissue
10a.Afterarecentupperrespiratorytractinfection,amiddle-agedwomanpresents withanteriorneck
pain,weightloss,lidlag,andsinustachycardiatoherphysicianwhoordersathyroidultrasound(Figs.1 and2). Threeweekslater,theneck painspreads, andarepeatultrasound(shownhere)wasperformed (Fig.3).Whatisthemostlikelydiagnosis?
A.DeQuervainthyroiditis B.Gravesdisease C.Thyroidcancer D.Thyroidlymphoma
10b.  What would an iodine-123 thyroid scan be expected to show in the early phase of subacute
thyroiditis?
A.Decreasedthyroiduptakeofradioactiveiodine B.Increasedthyroiduptakeofradioactiveiodine C.Normalthyroiduptakeofradioactiveiodine
11.  A patient with thyromegaly and hyperparathyroidism is undergoing ultrasound. Images initially
obtained with a high-frequency 15 MHz transducer only show the superficial aspect of a vague hypoechoicnodule deep tothe rightmidpolewith poor colorDopplerflow.Whatcouldthe ultrasound technologist do to improve both depth penetration and color Doppler sensitivity of the potential parathyroidadenoma?
A.Switchtoalower-frequencytransducer. B.Increasethewallfilter. C.Turnonspatialcompounding. D.IncreasecolorDopplergain.
12.Athyroidnoduleshownherewasdetectedinayoungwomanbeingevaluatedforapalpablethyroid
nodule.Whatistheabnormalityandtheclinicalsignificanceofthefindingshownbythearrow?
A.Tissuevibrationthatoccursinstiffnodulesbecauseofadjacentturbulenthigh-velocityflowin
thecarotidarteryinpatientswithhigh-gradecarotidarterystenosis
B.  Refractive edge shadowing that occurs at the junction of tissues with different sound-
propagatingspeedsincreasingthelikelihoodthatanoduleismalignant
C.Acousticstreamingattheedgeofthenodulecausedbytissueheatingfromhigh-energysound
waves
D.Capsular washoutinthyroid nodulesaftermicrobubbleinfusion, whichhasbeenassociated
withanincreasedriskofmalignancy
13.Theultrasoundtechnologistisconcernedaboutanabnormalityonthethyroidimagesheobtainedina
youngpatientwhosustainedblunttraumatotheneck.Afterreviewingtheimageprovided,themostlikely causeforthisabnormalityandthebestcourseofactionarewhichofthefollowing?
A. Malfunction ofa transducercrystalhasoccurred, andadditionalimagesshouldbeobtained
afterthesonographerreplacesthetransducer.
B.Thefindingissuspiciousforathyroidhematoma,andaneckCTshouldberecommendedfor
furtherevaluation.
C.Anartifactcalledfocalzonebandingispresent,andrepeatimagescanbeobtainedafter the
numberoffocalzonesisreduced.
D.  Theappearanceis due to poor transducer contactwith the skin, and repeat images can be
obtainedaftermoresonographicgelisapplied.
14.A65-year-old malepresentingwith aneckmassandleftclavicularpainhadthe followingimages
obtained.Whichofthesonographicfindingsshownbelowisthemostimportant?
A.Theirregularmarginofthethyroidnodule B.Thelesionintheclavicle
C.Thesizeofthethyroidnodule D.Thesolidandhypoechoicnoduleconsistency
15.  In the Just Culture Model proposed by David Marx, the response to an error or near miss is
determinedbythecauseoftheerrorandnottheseverityoftheevent.Inthisenvironment,at-riskbehavior ismanagedthrough:
A.Remedialaction B.Consolement C.Creatingincentivesforbetterchoices D.Punitivemeans
16.A37-year-oldfemalepresentswithapainlesspalpablenoduleanteriortotherightear.Whatisthe
mostlikelydiagnosis?
A.Warthintumor B.Adenoidcysticcarcinoma C.Mucoepidermoidcarcinoma D.Pleomorphicadenoma
17. Whichoftheparameters listedontheultrasounddisplayshown indicatestheriskoftissueheating
duringthisultrasoundstudy?
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