30-year-old woman has had a painless lump in her neck

Discussion in 'USMLE STEP 2 CS' started by Shel., May 31, 2008.

  1. Shel.

    Shel. Guest

    A previously healthy 30-year-old woman has had a painless lump in her neck for 2 days. Her mother was treated for a thyroid tumor at the age of 35 years. Her 28-year-old sister has an increased serum calcitonin level but no thyroid mass. Examination shows a palpable thyroid nodule. Her serum calcitonin level is increased. Which of the following diagnoses should be excluded prior to surgical treatment of the thyroid gland?

    A) Adrenocortical carcinoma
    B) Lung carcinoma
    C) Ovarian carcinoma
    D) Parathyroid carcinoma
    E) Pheochromocytoma
  2. Guest

    Guest Guest

    men II syndrome a/b
    they both have medullary carcinoma of thyroid (which is explained by the increased calcitonin) and pheochromocytoma
  3. Guest

    Guest Guest

    Type 2A MEN is defined by medullary thyroid carcinoma (MTC), pheochromocytoma (about 50% of cases), and hyperparathyroidism caused by parathyroid gland hyperplasia (about 20% of cases).

    hyperplasia not carcinoma....
  4. Guest

    Guest Guest

    The presence of thyroid nodule and elevated calcitonin level as well as the family history of thyroid tumour in mother makes the diagnosis of medullary carcinoma most likely. Thyroidectomy is almost decided. Now the question is on ruling out some other malignancy. Second cancers are known to exist in the same patient. Lung cancers are known to secrete PTH or PTH like peptides, with resultant hypercalcemia. Hypercalcemia is a known secretagogue for calcitonin.

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