This document contains 25 multiple choice questions about the thyroid gland. The questions cover topics like the arterial supply of the thyroid, signs of a toxic thyroid, management of hyperthyroidism in pregnancy, treatments for Graves' disease, complications of thyroidectomy, and causes of thyrotoxicosis. The questions are part of a thyroid MCQ revision for a surgical resident by Dr. Mohamed Elmatary and Omar Ayman.

1. THYROID MCQ REVISION 1
Undersupervision of: Dr. Mohamed Elmatary
By: Omar Ayman

2. 1) Which of the following is not true about the arterial supply of the
thyroid?
a) The superior thyroid arises from the external carotid.
b) The inferior thyroid arises from the subclavian artery.
c) The middle thyroid arises from the external carotid.
d) The thyroida ima arises from the aortic arch.

3. 2) To know if a thyroid nodule is fixed to the trachea or not, one must:
a) Ask the patient to swallow.
b) Move the swelling cranio – caudally.
c) Move the swelling sideways.
d) Ask the patient to protrude his/her tongue.

4. 3) Dilated veins over the thyroid indicate that the thyroid is:
a) Toxic.
b) Large simple nodular goiter.
c) Has a retrosternal extension.
d) Inflammatory goiter.
e) None of the above

5. 4) The main presentation of a patient with secondary toxic goiter is:
a) True exophthalmos.
b) Pretibial myxedema.
c) Palpitation and arrhythmias
d) Weight loss despite of good appetite

6. 5) All of the following can be a treatment of primary toxic goiter,
except:
a) Radio-active iodine.
b) Hemi-thyroidectomy.
c) Anti-thyroid drugs.
d) Beta blockers

7. 6) Hoarseness of voice denotes:
a) Compression of the superior laryngeal nerve.
b) Infiltration of the recurrent laryngeal nerve.
c) Infiltration of the superior laryngeal nerve.
d) Tracheal compression.

8. 7) At first trimester pregnant lady came to you with clinical picture of
hyperthyroidism. On examination, the gland was smooth and the TSH
was very low. The best management in this case would be:
a) Anti-thyroid drugs
b) Radio-iodine
c) Subtotal thyroidectomy
d) External irradiation

9. 8) Among following statements about retro sternal goiter, the false
one is that it:
a) Usually arises in aberrant intrathoracic thyroid tissue.
b) Is particularly common in males.
c) May present with symptoms of mediastinal compression (syndrome).
d) Is often associated with palpable enlargement of the thyroid.
e) Is best removed through a cervical incision.

10. 9) Medical treatment of thyrotoxicosis is least useful in:
a) Cases with true exophthalmos.
b) Pregnant females.
c) Secondary thyrotoxicosis.
d) Uncomplicated thyrocardiac patient
e) Post-operative recurrence.

11. 10) The following statements about treatment of thyrotoxicosis by
radioactive iodine are true except that it:
a) Is contraindicated in patients below the age of 25.
b) Is particularly useful in elderly and thyrocardiac patients.
c) Produces its beneficial effects within a few days.
d) May be followed by myxedema.
e) Carries the risk of late occurrence of thyroid cancer

12. 11) Regarding autoimmune thyroiditis (Hashimoto) select the right
statement:
a) due to viral infection
b) The pathology may extend outside the thyroid capsule
c) Almost always leads to hypothyroidism
d) Subtotal thyroidectomy is the treatment of choice

13. 12) In physiological goiter, the following statements are true except
that it:
a) Affects females more often than males.
b) Presents as fullness of the neck (Venus neck)
c) Characterized by uniform smooth enlargement with fleshy or firm
consistency.
d) May be associated with toxic or pressure symptoms.
e) Usually resolves spontaneously

14. 13) Which of these eye signs will occur only in cases of Graves' and
not in cases of Plummer’s disease?
a) Dalrymple sign (Rim of sclera)
b) Stellwag sign (staring look)
c) Von Graefe's sign (lid Lag)
d) Mobius sign (lack of convergence

15. 14) The untrue statement about thyroglossal cyst is that it:
a) Results from an unobliterated portion of the thyroglossal duct.
b) Usually lies below the hyoid bone in or close to the middle line.
c) Moves upwards during protrusion of the tongue.
d) It is lined by transitional epithelium.
e) It is filled with mucoid fluid rich in cholesterol crystals

16. 15) Concerning thyroglossal fistula, the false statement among
following is that it:
a) Usually follows suppuration in a thyroglossal cyst.
b) Mostly open above the hyoid.
c) Has a tortuous track intimately related to the hyoid bone
d) Is liable to recurrent attacks of inflammation.
e) Should be treated by Sistrunk's operation

17. 16) Regarding thyroglossal cyst which of the following is true?
a) Thyroglossal duct reaches to the base of tongue.
b) Commonly presents in old age.
c) Does not move on protrusion of the tongue.
d) Treatment by aspiration.
e) Secondary infection is rare

18. 17) thyroid all is correct, except:
a) De Quervain thyroiditis is mostly due to viral infection.
b) Thyroglossal fistula is always acquired.
c) Hashimoto's thyroiditis is autoimmune.
d) Hashimoto's thyroiditis does not lead to hypothyroidism.
e) Recurrent laryngeal nerve can be injured during thyroidectomy

19. 18) You are a surgical resident and were called to see a patient who
underwent thyroidectomy 6 hours ago. On arrival she had severe
difficulty in breathing and huge hematoma at the surgical site. The
best management is:
a) Call the senior surgeon
b) Oxygen at rate of 3L / min
c) Open the wound in bed
d) Schedule the patient for next operative bed

20. 19) Carbimazole in the treatment of Graves' disease is continued till:
a) The pulse reaches 80 bpm
b) The TSH reaches<5m
c) The free T4 <26pmol/L
d) A period of 12 -18 months after the euthyroid state have been reached

21. 20) Thyroid antibodies are elevated in this form of thyroiditis?
a) Subacute (De Quervain)
b) Autoimmune (Hashimoto's)
c) Riedel's
d) Acute(bacterial)

22. 21) Treatment of diffuse hyperplastic (physiological) goiter is:
a) Lugol's iodine
b) L-thyroxin
c) Inderal
d) Subtotal thyroidectomy

23. 22) Which one of the following is the least common cause of
hyperthyroidism?
a) Graves' disease
b) Secondary toxic goiter
c) Toxic nodule
d) TSH secreting adenoma of the pituitary

24. 23) Which of the following IS NOT a possible complication of
thyroidectomy?
a) Laryngeal edema.
b) Hyper- calcaemia.
c) Hypothyroidism.
d) Haematoma.
e) Superior laryngeal nerve palsy

25. 24) All of following are recognized clinical features of Horner's
syndrome Except:
a) Ptosis.
b) Enophthalmos.
c) Meiosis.
d) Unilateral anhydrosis.
e) Severe headache.

26. 25) Which of the following IS NOT A CAUSE of thyrotoxicosis?
a) Neonatal thyrotoxicosis.
b) Thyroid cyst.
c) De- Quervain's thyroiditis.
d) Grave's disease.
e) Eltroxin over dosage