Thyroid Sonography

Reading for this module should include the section on Thyroid Ultrasonography in Thyroid Disease Manager, or alternative sources. These could include chapters in Endocrinology, Edition III, comparable chapters in Endocrinology Edition IV (when released), or appropriate chapters in “The Thyroid”. Please note that many questions have more than one correct answer among the multiple possible responses offered.

Anticipated study and testing time for this module is 2 hours. After reading the material, print out his page, complete the test, fill in required personal information, and send the page with payment to

Center for Continuing Medical Education, 950 E 61^st St., University of Chicago, Chicago, IL 60637., with payment of $45. After satisfactory completion of the examination, a certificate will be returned by mail.

1. Sonography depicts the internal structure of the thyroid gland and the regional anatomy and pathology:
	A. Without using ionizing radiation
	B. Iodine containing contrast medium improves the image
	C. High frequency sound waves in the megahertz range are used
	D. Gadolinium administration improves the image
	E. A+C

2. Thyroid sonography:
	A. Does not cause damage to thyroid tissue
	B. Does not require discontinuation of any medication
	C. Swallowing must be avoided
	D. A+B
	E. A+B+C

3. Sonography of the neck shows that:
	A. The thyroid gland is slightly more echo-dense than the adjacent structures and has a homogenous ground glass appearance
	B. The esophagus may be demonstrated behind the medial part of the left thyroid lobe, especially if it is distended
	C. The air-filled trachea does not transmit the ultrasound
	D. The parathyroid glands are observed only when they are enlarged and are less dense ultrasonically than thyroid tissue
	E. A+B+C+D

4. Thyroid sonography:
	A. Plays little or no useful role in the management of patients who have a palpable thyroid which is otherwise totally normal to palpation
	B. Is cost effective when there is a palpable thyroid nodule
	C. Is necessary to supplement or confirm a physical examination
	D. Differentiates adenoma and carcinoma with a reliability of approximately 60%
	E. A+B+C

5. In a patient with a goiter sonography may be used to:
	A. Answer a specific clinical question about the anatomy of a goiter
	B. Essentially exclude cancer when there is a dominant palpable nodule and the gland is multinodular
	C. Diagnose as cancer a tender or hard spot when the echo pattern is solid and distinct from the rest of the goiter
	D. Differentiate Graves’ and Hashimoto’s diseases when Doppler examination shows hypervascularity
	E. A + B

6. Sonographic characteristics of a thyroid nodule that are associated with a higher than average risk of cancer are:
	A. A hyperdense echo pattern
	B. A “halo”
	C. Microcalcifications
	D. A specific vascular pattern on Doppler examination
	E. An irregular margin

7. Which statement (s) about micronodules is (are) true?
	A. Non-palpable nodules increase with age to involve approximately 50% of older adults especially women
	B. Sonography may show that a solitary nodule on palpation really is a clinically palpable nodule in a gland that is subclinically multinodular
	C. Elevated thyroglobulin in the presence of micronodules suggests cancer
	D. A+B
	E. A+B+C

8. Concerning ultrasound-guided needle aspiration biopsy:
	A. The risks include bleeding and infection
	B. It is most useful for nodules that are approximately 0.5 cm. in diameter
	C. It improves accuracy for small nodules or those with cystic degeneration
	D. A+B+C
	E. A+C

9. Regarding the patient with thyroid cancer:
	A. After thyroidectomy for cancer, nodules and adenopathy that are detected by sonography are more likely to represent cancer when the concentration of thyroglobulin is elevated
	B. Sonography may detect cancer even before it has grown sufficiently large to be palpable
	C. In patients in whom thyroid carcinoma has been diagnosed as the result of metastases to bone, lung or cervical nodes, sonography can detect an occult thyroid primary tumor even when the thyroid gland is normal to palpation
	D. A
	E. A+B+C

10. Sonography reliably differentiates:
	A. An enlarged lymph node and a parathyroid adenoma
	B. Thyroid adenoma and carcinoma
	C. Hashimoto’s disease and lymphoma
	D. Cyst and blood vessel
	E. Toxic autonomous nodule and non toxic nodule

Answer Sheet
Enter "True" or "False" in the appropriate boxes.
	A (True/False)	B (True/False)	C (True/False)	D (True/False)	E (True/False)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Was there a topic not covered you would have liked to have had presented? Please specify.

Do you believe the presentations contained pharmaceutical industry bias? Yes __ No __ Comments:

I certify that I spent three hours in preparation and examination for this module-

CME QUESTIONS -THYROID SONOGRAPHY BACK Prepared by Manfred Blum, M.D.

CME QUESTIONS -THYROID SONOGRAPHY BACK
Prepared by Manfred Blum, M.D.