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Q1: Thyroid nodule workup (2 min)
"A 45-year-old woman has a 2 cm thyroid nodule. Walk me through your approach."
- TSH first (suppressed = hyperfunctioning = usually benign)
- Ultrasound with TI-RADS scoring
- FNA if TI-RADS warrants (Bethesda system I-VI)
- Bethesda IV = follicular neoplasm = diagnostic lobectomy (can't distinguish adenoma from carcinoma on FNA)
Q2: Four histological types (2 min)
"Papillary, follicular, medullary, anaplastic — one key point each"
- Papillary (80%): BRAF, psammoma bodies, lymphatic spread, excellent prognosis
- Follicular (10-15%): haematogenous spread (bone/lung), diagnosed on vascular/capsular invasion
- Medullary (2-4%): C cells, calcitonin, RET/MEN2, screen for pheo before surgery
- Anaplastic (1-2%): undifferentiated, rapidly fatal, all stage IV in AJCC 8th
Q3: Post-thyroidectomy complications (3 min)
"Patient develops perioral tingling day 1 post-total thyroidectomy. What's happening?"
- Hypocalcaemia from parathyroid injury (check corrected calcium)
- IV calcium gluconate for symptomatic, then oral calcium + calcitriol
- Also check for RLN injury (hoarseness), haematoma (airway)
Q4: MEN2 (2 min)
"A 30-year-old with medullary thyroid carcinoma. What else must you screen for?"
- Pheochromocytoma (plasma metanephrines) — before surgery!
- Hyperparathyroidism (serum calcium/PTH)
- RET mutation = prophylactic thyroidectomy (MEN2B by age 1, MEN2A by age 5)