Pathology EMQ template.

Name: Ajay Gandhi

Candidate number: 3271

Theme: Endocrine disease

OPTION LIST

A	Anaplastic thyroid tumour	I	Primary hypothyroidism
B	Atrophic hypothyroidism	J	Medullary thyroid tumour
C	De Quervain’s	K	Sick Euthyroid
D	Follicular thyroid tumour	L
E	Graves disease	M
F	Hashimoto’s Thyroiditis	N
G	Iatrogenic Hypothyroidism	O
H	Papillary thyroid tumour	P

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A poorly controlled 30 year old T1 diabetic has had a prolonged stay in hospital with ketoacidosis. She has been unwell for some time now. As a new F1 you feel it is necessary to perform every blood test under the sun for her everyday. One day, thyroid function tests reveal a normal TSH, but her T3 and T4 are a little low. Your registrar reassures you.

2. A previously healthy 35 year old choir singer comes to your clinic. He was soprano but is now an alto. Your thorough neck examination demonstrates a nodule. Thyroid function tests returned as normal, but an ultrasound guided fine needle aspiration demonstrates a worryingly dangerous cancer. Unfortunately you must counsel him for palliative care.

3. A 50 year old female patient has been complaining of tiredness, weight gain and depression. She has a raised TSH and low thyroid hormone. But her goitre raises your suspicions. You later find she has a thyroid lymphoma and Askanazy cells on biopsy.

4. A 38 year old female returns for her follow up after irradiation of the neck for a tumour. You find a new nodule on her thyroid gland which you have excised as soon as possible. Her prognosis remains good. Thyroid function is normal.

5. A 70 year old man is on amiodorone for atrial fibrillation. His hair is coarse and he feels cold and tired even in the summer. Thyroid function tests reveal a raised TSH and a low T4 and T3. His symptoms are improved with a different anti-arrhythmic.

ANSWERS

1. K

2. A

3. F

4. H

5. G