sfk
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A 53-year-old woman comes to the physician because of a "lump" in her neck. She says that her masseuse noticed it 1 month ago. There is no associated pain, pressure, or hoarseness. She feels fine and has no other complaints. She has no history of radiation exposure. Examination reveals a palpable thyroid nodule that is approximately 3 cm. Which of the following is the most appropriate next step in diagnosis?
A; Needle biopsy
B FNA
C Neck US
D Surgical excision
E Thyroxine replacement
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| peter90036
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most apropriate next step in a thyroid nodule is
T4, TSH
depending on that, RAIU
but
eventually all ends up with doing FNA (except functional "hot" nodule)
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| doc_clotaire
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B FNA
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| 7ooDa
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Neck U/S to determine whether cystic or solid.
If cystic ==> Needle aspiration and fluid analysis
If solid ==> FNAB ( needle biopsy )
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| Justice
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doc_clotaire wrote:B FNA
Kind of have hard time to understand difference between A and B options... Not sure is A exists clinically...
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| sfk
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The correct answer is C.
An ultrasound is the first step in the evaluation of a palpable thyroid nodule. An ultrasound is a noninvasive technique that can determine if the nodule is cystic or solid, the exact size of the lesion, and whether there are any additional masses. If the nodule is cystic, a fine needle aspiration (FNA; choice B) is performed. If the cyst disappears and the cytology is benign, no additional treatment is necessary. If the cyst remains, further evaluation is necessary. If the nodule is solid and < 3 cm, an FNA is performed. If the cytology is benign, thyroid hormone replacement (choice E) is given to suppress growth. If the nodule is solid and > 3 cm., a needle biopsy (choice A) is performed. If the pathology is indeterminate or malignant, surgical resection (choice D) is the treatment. If the nodule is benign, thyroid hormone is given.
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| Justice
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I am sure this is incorrect answer from whatever source it is...
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| peter90036
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holy s#!T guidelines changed 2006
AACE/AME Guidelines
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS
AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI
MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE
DIAGNOSIS AND MANAGEMENT OF THYROID NODULES
http://www.aace.com/pub/pdf/guidelines/thyroid_no...
some quick cut-outs:
High-resolution US is the most sensitive test available to detect thyroid lesions
This study, however, should not be performed on an otherwise normal thyroid gland nor used as a substitute for a physical examination
US should not be performed as a screening test in the general population unless well-known risk factors have been recognized.
In all patients with palpable thyroid nodules or MNG, US should be performed...
alot more information is in the guidelines PDF
... too bad most question banks, review books, First Aids, arent up to date ...
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| sfk
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Justice, This is a qbank question!!
Peter, Where did u get all that info from!! So is US the right answer now???
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| mildus
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I would also say US as the first option (differentiate between cystic and solid)
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| patpelletier
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History tells she feels fine, no signs or symptoms of hypo or hyperfunction, so next step is FNA.
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