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SB82 Endocrine Surg
SB82 Endocrine Surg - Loosely taken from Fiser's ABSITE Review
| Question | Answer |
|---|---|
| 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 |
| 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 |
| One of the 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 or arteries supply 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 (4)? | 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 (3)? | 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 pituitary microadenomas that cause Cushing’s disease (2)? ______________ | MRI or petrosal sampling |
| Most pituitary adenomas are removed using what approach? _____________ | Transsphenoidal |
| Ectopic ACTH production is usually due to what pathology? ___________ | 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 surgically first before resecting an adrenal pheochromocytoma to prevent spilling catecholamines? | Ligate adrenal veins |
| 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 |
| Vitamin D causes an increase in this substance, which increases 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 (location and cell type)? _____________ | 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 (5) | 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-operative 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 (3)? | 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 |
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