SB82 Endocrine Surg - Loosely taken from Fiser's ABSITE Review
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| The thyroid develops from these embryological structures _____________ | First and third pharyngeal pouches
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| TSH is released from the __________________ | Anterior pituitary gland
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| TRF and TSH release are controlled by T3 and T4 through this mechanism _________________ | Negative feedback loop
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| The first branch off the external carotid artery is the ________________ | Superior thyroid artery
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| The inferior thyroid artery is a branch off this structure ______________ | Thyrocervical trunk
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| Which artery supplies the superior and inferior parathyroids? __________ | Inferior thyroid artery
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| The thyroid ima artery originates from the _______ or the ___________ | Aorta, innominate
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| The Ima artery supplies this part of the thyroid _____________ | Isthmus
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| The superior and middle thyroid veins drain into the ______________ | Internal jugular
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| The inferior thyroid vein drains into the _____________ | Innominate vein
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| Non-recurrent laryngeal nerve is more common on the __________ (right/left) side | Right
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| Non-recurrent laryngeal nerve occurs in ______ percent of the population | 2-3%
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| The superior laryngeal nerve supplies the _________ muscle | Cricothyroid
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| Injury to the superior laryngeal nerve causes what deficits? | Loss of vocal projection and easy fatiguability
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| This nerve supplies motor to all muscles of the larynx except the cricothyroid muscle _______________ | Recurrent laryngeal nerve
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| The recurrent laryngeal nerve runs posterior to the thyroid lobes in the ______________ | Tracheoesophageal groove
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| The recurrent laryngeal nerve tracks with this structure __________ | Inferior thyroid artery
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| The left RLN loops around this structure __________ | Aorta
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| The right RLN loops around this structure ________ | Right subclavian artery
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| Which RLN tends to not be recurrent? _________ (right/left) | Right
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| The posterior medial suspensory ligament of the thyroid is known as the ligament of ______ | Berry
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| Plasma T4:T3 ratio is _______ | 15:1
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| Most T3 is converted in the periphery by T4 to T3 conversion by ____________ | Peroxidases
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| The most sensitive indicator of thyroid gland function is measurement of ______ | TSH
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| The most lateral, posterior extensions of thyroid tissue are known as the tubercles of __________ | Zuckerkandl
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| If you rotate the tubercles of Zuckerkandl medially, you will see these structures ______________ | Recurrent laryngeal nerves
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| The parafollicular C cells produce this substance _________________ | Calcitonin
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| This test measures free T3 _____________ | Resin T3 uptake
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| With thyroxine treatment, TSH levels should decrease by this percentage __________ | Fifty
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| This is a major long-term side effect of thyroxine treatment ____________ | Osteoporosis
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| This symptom can be seen with post-operative hematoma after thyroidectomy _______ | Postthyroidectomy stridor
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| This condition is most common after surgery in patients with Graves disease ____________ | Thyroid storm
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| Thyroid storm can be precipitated by these situations _____________ | Anxiety, excessive palpation of the thyroid gland, adrenergic stimulants
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| Treatments for thyroid storm (7) | Beta blockers, KI, fluids, cooling blankets, glucose, oxygen, PTU
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| 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
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| An asymptomatic thyroid nodule, when treated with thyroxine, should regress in this time frame __________ | Six months
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| An FNA showing follicular cells has malignancy risk of what percentage? __________ | 5-10%
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| An FNA shows colloidal tissue. What is the malignancy risk? _________ | <1%
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| Treatment of colloidal nodule _________ | Thyroxine
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| If FNA of an asymptomatic thyroid nodule is indeterminant, obtain a ______ study | Radionuclide
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| Initially after diagnosis of a hot thyroid nodule, treat with ____________ | Thyroxine for six months
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| If a hot nodule does not resolve with thyroxine treatment after 6 months, treat with ________ | Lobectomy
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| Cold thyroid nodule are _________ (more/less) likely to be malignant than hot nodules | More
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| This percentage of thyroid nodules are benign ____________ | Eighty-five percent
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| The most frequent cause of goiter is _____________ | Iodine deficiency
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| Diagnosis of diffuse enlargement without evidence of functional abnormality ______ | Nontoxic colloid goiter
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| A pyramidal lobe occurs in what percentage of patients? _________ | Ten percent
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| The pyramidal lobe of the thyroid, when present, extends from the isthmus toward the _______ | Thymus
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| A lingual thyroid is thyroid tissue that persists in the area of the _____________ at the base of the tongue | Foramen cecum
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| Malignancy risk of lingual thyroid tissue is ___________ percent | Two percent
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| Lingual thyroid tissue is the only thyroid tissue in _________ percent of the patients who have it | Seventy
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| Classic sign of thyroglossal duct cyst ____________ | Moves upward when swallowing
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| Problems with thyroglossal duct cyst | Susceptible to infection and may be premalignant
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| During resection of thyroglossal duct cyst, this needs to be removed as well ___________ (all or the midportion) | Hyoid bone
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| One of the side effects of PTU ____________ | Aplastic anemia
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| During pregnancy, the best time to perform thyroidectomy is the _______ trimester | Second
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| Most common cause of hyperthyroidism (80%) _____________ | Graves disease
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| Cause of Graves disease __________ | IgG Abs
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| Large goiter can cause __________ syndrome | Cervical compression
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| Graves disease has _______ percent recurrence with thioamide treatment | Seventy
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| Graves disease has _______ percent recurrence with radioactive iodine treatment | Ten percent
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| Graves disease has _______ percent recurrence with subtotal thyroidectomy | Ten percent
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| Which artery supplies the superior portion of the adrenal gland? ______________ | Inferior phrenic
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| Which artery or arteries supply the middle portion of the adrenal gland? ___________ | Branches from the aorta
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| Which artery supplies the inferior portion of the adrenal gland? ___________ | Renal
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| Which adrenal vein goes directly to the venal cava? _______________ | Right
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| What percentage of adrenal incidentalomas are metastases or primary tumors? _____________ | Five
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| Surgery for adrenal incidentaloma is indicated under what conditions? | Non-homogeneous, greater than 4 cm, functional, or enlarging
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| Follow up CT scans for adrenal incidentalomas should be set up for what frequency? | Every 3 months for one year, then yearly
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| What is the most common primary site to metastasize to the adrenal gland? __________ | Lung
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| What are the most common cancers to metastasize to the adrenal gland (4)? | Lung, breast, melanoma, renal
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| What embryologic cell layer does the adrenal gland arise from? __________ | Mesoderm
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| The adrenal medulla receives innervation from which nerves? ______________ | Splanchnic
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| Lymphatics drain from the adrenals to what locations? | Subdiaphragmatic and renal
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| Aldosterone causes absorption of what ion? __________ | Sodium
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| Aldosterone causes release of what substances (3)? | Potassium, hydrogen ions, and ammonia
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| If excess androgens / estrogens are secreted by the adrenal glands, this is almost always due to what? _________ | Cancer
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| What is the most common form of congenital adrenal hyperplasia? | 21-Hydroxylase deficiency
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| Which form of CAH is salt-WASTING? _______________ | 21-hydroxylase deficiency
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| What is the most common cause of Conn’s syndrome? __________ | Adrenal adenoma
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| Which form of hyperaldosteronism has high renin? __________ | Secondary
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| What disease is caused by a renin-secreting tumor? ___________ | Bartters syndrome
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| What is the first test to diagnose primary hyperaldosteronism? ______________ | Urine aldosterone after salt load
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| What electrolyte abnormalities will you see with Conn’s syndrome? | Hypokalemia, hypernatremia, increased urine K
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| What acid-base disorder is seen with Conn’s syndrome? _____________ | Metabolic alkalosis
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| What is the aldosterone:renin ratio seen in Conn’s syndrome? __________ | Greater than 20
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| If bilateral adrenalectomy is performed to cure Conn’s syndrome, what medication should the patient receive post-operatively? _______________ | Fludrocortisone
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| What are the symptoms of acute adrenal insufficiency? | Hypotension, fever, lethargy, abdominal pain, hypoglycemia, altered mental status, nausea, vomiting, hyperkalemia
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| Treatment of Addison’s disease _____________ | Dexamethasone and IV fluids
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| Most common cause of Cushing’s syndrome ______________ | Iatrogenic
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| First test for Cushing’s syndrome ______________ | 24-hr urine cortisol
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| Second test for Cushing’s syndrome ______________ | Low-dose dexamethasone suppression test
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| Third test for Cushing’s syndrome ______________ | Serum ACTH
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| Fourth test for Cushing’s syndrome ______________ | High-dose dexamethasone suppression test
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| Fifth test for Cushing’s syndrome ______________ | CRH test
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| Test to localize adrenal tumors ___________ | NP-59 scintography
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| Most common non-iatrogenic cause of Cushing’s syndrome ______________ | Pituitary adenoma
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| What tests can be used to localize the pituitary microadenomas that cause Cushing’s disease (2)? ______________ | MRI or petrosal sampling
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| Most pituitary adenomas are removed using what approach? _____________ | Transsphenoidal
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| Ectopic ACTH production is usually due to what pathology? ___________ | Small cell lung cancer
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| What is the treatment for symptomatic adrenal hyperplasia? _____________ | Bilateral adrenalectomy
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| What medications can be given to inhibit steroid formation in treating Cushing’s syndrome? ______________ | Ketoconazole, metyrapone
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| What medication is used to treat metastatic adrenal disease? _____________ | Mitotane
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| Adrenocortical carcinoma has what type of distribution? _____________ | Bimodal
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| What percentage of adrenocortical carcinomas are functional? ___________ | Fifty
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| Children with adrenocortical carcinoma often present with what sign? _____________ | Virilization
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| Treatment for initial adrenocortical carcinoma ___________ | Radical adrenalectomy
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| Treatment for metastatic adrenocortical carcinoma ______________ | Mitotane
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| What percent 5-yr survival is seen with adrenocortical carcinoma? ____________ | Twenty
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| What is the rate-limiting enzyme in catecholamine production? ____________ | Tyrosine hydroxylase
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| What enzyme converts norepinephrine to epinephrine? ___________ | PNMT
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| In what location(s) is epinephrine produced? ____________ | Adrenal medulla only
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| In what location does extra-adrenal catecholamine producing tissue exist? _________ | Organ of Zuckerkandl
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| What cell type makes up pheochromocytoma? ______________ | Chromaffin
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| The ten percent rule of pheochromocytomas includes: _________ | Bilateral, children, extra-adrenal, familial, malignant
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| Pheochromocytomas occur more commonly on which side? _________ | Right
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| What diagnostic test can help localize a pheochromocytoma? ________ | MIBG scan
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| What is the most sensitive test for pheochromocytoma? ____________ | VMA
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| What is the response of a pheochromocytoma to a clonidine suppression test? | Catecholamines stay high
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| Preoperative treatment in preparation for resection of a pheochromocytoma must have what medication? ______________ | Phenoxybenzamine
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| Failure to induce alpha blockade prior to resecting a pheochromocytoma may cause what devastating problem? ______________ | Hypertensive crisis
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| What must you do surgically first before resecting an adrenal pheochromocytoma to prevent spilling catecholamines? | Ligate adrenal veins
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| What medication inhibits tyrosine hydroxylase? _______________ | Metyrosine
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| The superior parathyroids are located WHERE in relation to the recurrent laryngeal nerves? ______________ | Lateral
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| The superior parathyroids are located WHERE in relation to the inferior thyroid artery? ______________ | superior
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| The inferior parathyroids are located WHERE in relation to the recurrent laryngeal nerves? ______________ | Medial
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| The inferior parathyroids are located WHERE in relation to the inferior thyroid artery? ______________ | Inferior
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| What is the most common ectopic site of parathyroid glands? ________________ | Thymus
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| What percentage of people have all 4 parathyroid glands? ____________ | Ninety
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| What is the blood supply to the superior parathyroids? To the inferior parathyroids? ________________ | Inferior thyroid artery
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| What is the main function of parathyroid hormone? _____________ | Increase serum calcium
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| What type of cells secrete PTH? _____________ | Oxyphil
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| In what location within the kidney does PTH act to increase renal calcium reabsorption? ______________ | Distal convoluted tubule
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| Vitamin D causes an increase in this substance, which increases intestinal absorption of calcium ______________ | Increases calcium binding protein
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| What other molecule does vitamin D help absorb? ______________ | Phosphate
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| What is the function of calcitonin? _____________ | Decrease serum calcium
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| Where is calcitonin produced (location and cell type)? _____________ | Parafollicular C cells of thyroid
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| What is the most common cause of hypoparathyroidism? _____________ | Previous thyroid surgery
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| What oncogene increases risk of parathyroid adenomas? _____________ | PRAD-1
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| What acid base abnormality does hyperparathyroidism cause? __________ | Hyperchloremic metabolic acidosis
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| Condition in which brown bone lesions form from PTH-induced calcium resorption seen in hyperparathyroidism ____________ | Osteitis fibrosa cystica
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| Indications for surgery for hyperparathyroidism (5) | Symptomatic disease or asymptomatic disease with calcium > 13, decreased creatinine clearance, kidney stones, or severe osteoporosis
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| In what percentage of patients is hyperparathyroidism caused by a single adenoma? ___________ | Eighty
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| What is the treatment for parathyroid adenocarcinoma? | Radical parathyroidectomy with ipsilateral thyroidectomy
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| A pregnant patient must have resection for hyperparathyroidism during the 2nd trimester to prevent what condition? __________ | Stillbirth
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| What is the half life of PTH? __________ | Ten minutes
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| What should be seen on intraoperative parathyroid levels with successful parathyroidectomy? | Decrease in PTH to less than half of the pre-operative value
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| At reoperation for a missing parathyroid gland, the most common location to find it is where? _______________ | Normal anatomic position
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| What is the most common cause of persistent hyperparathyroidism after parathyroidectomy? _______________ | Missed adenoma
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| What will a Technetium-99 scan NOT pick up? ________________ | Four-gland hyperplasia
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| Secondary hyperparathyroidism is seen in patients with what condition? ________________ | Renal failure
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| What is the pathophysiology of secondary hyperparathyroidism? | Increased PTH production in response to low serum calcium
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| What are the indications for surgery in secondary hyperparathyroidism (3)? | Bone pain, fractures, or pruritis
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| What is the most common location for metastases of parathyroid adenocarcinoma? _________ | Lung
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| What is the percentage recurrence rate of parathyroid cancer? ______________ | Fifty
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| This abnormality is caused by a defect in the PTH receptor in the distal convoluted tubule causing resorption of calcium _____________ | Familial hypercalcemic hypocalciuria
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