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SB82 Endocrine Surg

SB82 Endocrine Surg - Loosely taken from Fiser's ABSITE Review

QuestionAnswer
The thyroid develops from these embryological structures _____________ First and third pharyngeal pouches
TSH is released from the __________________ Anterior pituitary gland
TRF and TSH release are controlled by T3 and T4 through this mechanism _________________ Negative feedback loop
The first branch off the external carotid artery is the ________________ Superior thyroid artery
The inferior thyroid artery is a branch off this structure ______________ Thyrocervical trunk
Which artery supplies the superior and inferior parathyroids? __________ Inferior thyroid artery
The thyroid ima artery originates from the _______ or the ___________ Aorta, innominate
The Ima artery supplies this part of the thyroid _____________ Isthmus
The superior and middle thyroid veins drain into the ______________ Internal jugular
The inferior thyroid vein drains into the _____________ Innominate vein
Non-recurrent laryngeal nerve is more common on the __________ (right/left) side Right
Non-recurrent laryngeal nerve occurs in ______ percent of the population 2-3%
The superior laryngeal nerve supplies the _________ muscle Cricothyroid
Injury to the superior laryngeal nerve causes what deficits? Loss of vocal projection and easy fatiguability
This nerve supplies motor to all muscles of the larynx except the cricothyroid muscle _______________ Recurrent laryngeal nerve
The recurrent laryngeal nerve runs posterior to the thyroid lobes in the ______________ Tracheoesophageal groove
The recurrent laryngeal nerve tracks with this structure __________ Inferior thyroid artery
The left RLN loops around this structure __________ Aorta
The right RLN loops around this structure ________ Right subclavian artery
Which RLN tends to not be recurrent? _________ (right/left) Right
The posterior medial suspensory ligament of the thyroid is known as the ligament of ______ Berry
Plasma T4:T3 ratio is _______ 15:1
Most T3 is converted in the periphery by T4 to T3 conversion by ____________ Peroxidases
The most sensitive indicator of thyroid gland function is measurement of ______ TSH
The most lateral, posterior extensions of thyroid tissue are known as the tubercles of __________ Zuckerkandl
If you rotate the tubercles of Zuckerkandl medially, you will see these structures ______________ Recurrent laryngeal nerves
The parafollicular C cells produce this substance _________________ Calcitonin
This test measures free T3 _____________ Resin T3 uptake
With thyroxine treatment, TSH levels should decrease by this percentage __________ Fifty
This is a major long-term side effect of thyroxine treatment ____________ Osteoporosis
This symptom can be seen with post-operative hematoma after thyroidectomy _______ Postthyroidectomy stridor
This condition is most common after surgery in patients with Graves disease ____________ Thyroid storm
Thyroid storm can be precipitated by these situations _____________ Anxiety, excessive palpation of the thyroid gland, adrenergic stimulants
Treatments for thyroid storm (7) Beta blockers, KI, fluids, cooling blankets, glucose, oxygen, PTU
This effect is seen with patients who receive high doses of KI with thyroid storm, causing inhibition of TSH action on the thyroid, decreasing organic coupling of iodide __________ Wolff Chaikoff
An asymptomatic thyroid nodule, when treated with thyroxine, should regress in this time frame __________ Six months
An FNA showing follicular cells has malignancy risk of what percentage? __________ 5-10%
An FNA shows colloidal tissue. What is the malignancy risk? _________ <1%
Treatment of colloidal nodule _________ Thyroxine
If FNA of an asymptomatic thyroid nodule is indeterminant, obtain a ______ study Radionuclide
Initially after diagnosis of a hot thyroid nodule, treat with ____________ Thyroxine for six months
If a hot nodule does not resolve with thyroxine treatment after 6 months, treat with ________ Lobectomy
Cold thyroid nodule are _________ (more/less) likely to be malignant than hot nodules More
This percentage of thyroid nodules are benign ____________ Eighty-five percent
The most frequent cause of goiter is _____________ Iodine deficiency
Diagnosis of diffuse enlargement without evidence of functional abnormality ______ Nontoxic colloid goiter
A pyramidal lobe occurs in what percentage of patients? _________ Ten percent
The pyramidal lobe of the thyroid, when present, extends from the isthmus toward the _______ Thymus
A lingual thyroid is thyroid tissue that persists in the area of the _____________ at the base of the tongue Foramen cecum
Malignancy risk of lingual thyroid tissue is ___________ percent Two percent
Lingual thyroid tissue is the only thyroid tissue in _________ percent of the patients who have it Seventy percent
Classic sign of thyroglossal duct cyst ____________ Moves upward when swallowing
Problems with thyroglossal duct cyst Susceptible to infection and may be premalignant
During resection of thyroglossal duct cyst, this needs to be removed as well ___________ (all or the midportion) Hyoid bone
Side effects of PTU ____________ Aplastic anemia
During pregnancy, the best time to perform thyroidectomy is the _______ trimester Second
Most common cause of hyperthyroidism (80%) _____________ Graves disease
Cause of Graves disease __________ IgG Abs
Large goiter can cause __________ syndrome Cervical compression
Graves disease has _______ percent recurrence with thioamide treatment Seventy
Graves disease has _______ percent recurrence with radioactive iodine treatment Ten percent
Graves disease has _______ percent recurrence with subtotal thyroidectomy Ten percent
Which artery supplies the superior portion of the adrenal gland? ______________ Inferior phrenic
Which artery supplies the middle portion of the adrenal gland? ___________ Branches from the aorta
Which artery supplies the inferior portion of the adrenal gland? ___________ Renal
Which adrenal vein goes directly to the venal cava? _______________ Right
What percentage of adrenal incidentalomas are metastases or primary tumors? _____________ Five
Surgery for adrenal incidentaloma is indicated under what conditions? Non-homogeneous, greater than 4 cm, functional, or enlarging
Follow up CT scans for adrenal incidentalomas should be set up for what frequency? Every 3 months for one year, then yearly
What is the most common primary site to metastasize to the adrenal gland? __________ Lung
What are the most common cancers to metastasize to the adrenal gland? Lung, breast, melanoma, renal
What embryologic cell layer does the adrenal gland arise from? __________ Mesoderm
The adrenal medulla receives innervation from which nerves? ______________ Splanchnic
Lymphatics drain from the adrenals to what locations? Subdiaphragmatic and renal
Aldosterone causes absorption of what ion? __________ Sodium
Aldosterone causes release of what substances? Potassium, hydrogen ions, and ammonia
If excess androgens / estrogens are secreted by the adrenal glands, this is almost always due to what? _________ Cancer
What is the most common form of congenital adrenal hyperplasia? 21-Hydroxylase deficiency
Which form of CAH is salt-WASTING? _______________ 21-hydroxylase deficiency
What is the most common cause of Conn’s syndrome? __________ Adrenal adenoma
Which form of hyperaldosteronism has high renin? __________ Secondary
What disease is caused by a renin-secreting tumor? ___________ Bartters syndrome
What is the first test to diagnose primary hyperaldosteronism? ______________ Urine aldosterone after salt load
What electrolyte abnormalities will you see with Conn’s syndrome? Hypokalemia, hypernatremia, increased urine K
What acid-base disorder is seen with Conn’s syndrome? _____________ Metabolic alkalosis
What is the aldosterone:renin ratio seen in Conn’s syndrome? __________ Greater than 20
If bilateral adrenalectomy is performed to cure Conn’s syndrome, what medication should the patient receive post-operatively? _______________ Fludrocortisone
What are the symptoms of acute adrenal insufficiency? Hypotension, fever, lethargy, abdominal pain, hypoglycemia, altered mental status, nausea, vomiting, hyperkalemia
Treatment of Addison’s disease _____________ Dexamethasone and IV fluids
Most common cause of Cushing’s syndrome ______________ Iatrogenic
First test for Cushing’s syndrome ______________ 24-hr urine cortisol
Second test for Cushing’s syndrome ______________ Low-dose dexamethasone suppression test
Third test for Cushing’s syndrome ______________ Serum ACTH
Fourth test for Cushing’s syndrome ______________ High-dose dexamethasone suppression test
Fifth test for Cushing’s syndrome ______________ CRH test
Test to localize adrenal tumors ___________ NP-59 scintography
Most common non-iatrogenic cause of Cushing’s syndrome ______________ Pituitary adenoma
What tests can be used to localize the microadenomas that cause Cushing’s disease? ______________ MRI or petrosal sampling
Most pituitary adenomas are removed using what approach? _____________ Transsphenoidal
Ectopic ACTH production is usually due to what? ___________ Small cell lung cancer
What is the treatment for symptomatic adrenal hyperplasia? _____________ Bilateral adrenalectomy
What medications can be given to inhibit steroid formation in treating Cushing’s syndrome? ______________ Ketoconazole, metyrapone
What medication is used to treat metastatic adrenal disease? _____________ Mitotane
Adrenocortical carcinoma has what type of distribution? _____________ Bimodal
What percentage of adrenocortical carcinomas are functional? ___________ Fifty
Children with adrenocortical carcinoma often present with what sign? _____________ Virilization
Treatment for initial adrenocortical carcinoma ___________ Radical adrenalectomy
Treatment for metastatic adrenocortical carcinoma ______________ Mitotane
What percent 5-yr survival is seen with adrenocortical carcinoma? ____________ Twenty
What is the rate-limiting enzyme in catecholamine production? ____________ Tyrosine hydroxylase
What enzyme converts norepinephrine to epinephrine? ___________ PNMT
In what location(s) is epinephrine produced? ____________ Adrenal medulla only
In what location does extra-adrenal catecholamine producing tissue exist? _________ Organ of Zuckerkandl
What cell type makes up pheochromocytoma? ______________ Chromaffin
The ten percent rule of pheochromocytomas includes: _________ Bilateral, children, extra-adrenal, familial, malignant
Pheochromocytomas occur more commonly on which side? _________ Right
What diagnostic test can help localize a pheochromocytoma? ________ MIBG scan
What is the most sensitive test for pheochromocytoma? ____________ VMA
What is the response of a pheochromocytoma to a clonidine suppression test? Catecholamines stay high
Preoperative treatment in preparation for resection of a pheochromocytoma must have what medication? ______________ Phenoxybenzamine
Failure to induce alpha blockade prior to resecting a pheochromocytoma may cause what devastating problem? ______________ Hypertensive crisis
What must you do first before resecting an adrenal pheochromocytoma? Ligate adrenal veins to avoid spilling catecholamines into the bloodstream
What medication inhibits tyrosine hydroxylase? _______________ Metyrosine
The superior parathyroids are located WHERE in relation to the recurrent laryngeal nerves? ______________ Lateral
The superior parathyroids are located WHERE in relation to the inferior thyroid artery? ______________ superior
The inferior parathyroids are located WHERE in relation to the recurrent laryngeal nerves? ______________ Medial
The inferior parathyroids are located WHERE in relation to the inferior thyroid artery? ______________ Inferior
What is the most common ectopic site of parathyroid glands? ________________ Thymus
What percentage of people have all 4 parathyroid glands? ____________ Ninety
What is the blood supply to the superior parathyroids? To the inferior parathyroids? ________________ Inferior thyroid artery
What is the main function of parathyroid hormone? _____________ Increase serum calcium
What type of cells secrete PTH? _____________ Oxyphil
In what location within the kidney does PTH act to increase renal calcium reabsorption? ______________ Distal convoluted tubule
How does vitamin D increase intestinal absorption of calcium? ______________ Increases calcium binding protein
What other molecule does vitamin D help absorb? ______________ Phosphate
What is the function of calcitonin? _____________ Decrease serum calcium
Where is calcitonin produced? _____________ Parafollicular C cells of thyroid
What is the most common cause of hypoparathyroidism? _____________ Previous thyroid surgery
What oncogene increases risk of parathyroid adenomas? _____________ PRAD-1
What acid base abnormality does hyperparathyroidism cause? __________ Hyperchloremic metabolic acidosis
Condition in which brown bone lesions form from PTH-induced calcium resorption seen in hyperparathyroidism ____________ Osteitis fibrosa cystica
Indications for surgery for hyperparathyroidism Symptomatic disease or asymptomatic disease with calcium > 13, decreased creatinine clearance, kidney stones, or severe osteoporosis
In what percentage of patients is hyperparathyroidism caused by a single adenoma? ___________ Eighty
What is the treatment for parathyroid adenocarcinoma? Radical parathyroidectomy with ipsilateral thyroidectomy
A pregnant patient must have resection for hyperparathyroidism during the 2nd trimester to prevent what condition? __________ Stillbirth
What is the half life of PTH? __________ Ten minutes
What should be seen on intraoperative parathyroid levels with successful parathyroidectomy? Decrease in PTH to less than half of the pre-op value.
At reoperation for a missing parathyroid gland, the most common location to find it is where? _______________ Normal anatomic position
What is the most common cause of persistent hyperparathyroidism after parathyroidectomy? _______________ Missed adenoma
What will a Technetium-99 scan NOT pick up? ________________ Four-gland hyperplasia
Secondary hyperparathyroidism is seen in patients with what condition? ________________ Renal failure
What is the pathophysiology of secondary hyperparathyroidism? Increased PTH production in response to low serum calcium
What are the indications for surgery in secondary hyperparathyroidism? Bone pain, fractures, or pruritis
What is the most common location for metastases of parathyroid adenocarcinoma? _________ Lung
What is the percentage recurrence rate of parathyroid cancer? ______________ Fifty
This abnormality is caused by a defect in the PTH receptor in the distal convoluted tubule causing resorption of calcium _____________ Familial hypercalcemic hypocalciuria
Created by: StudyBug82 on 2011-12-05



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