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Endocrinology Fellowship > ATA 2014 > Flashcards

ATA 2014 Flashcards

0
Q

How long should a patient with Grave’s disease be treated with methimazole?

A

12 - 24 months.

Stop if TSH is normal at that time.

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1
Q

Which is bigger: TR alpha or TR beta?

A

TR beta

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2
Q

What percentage of people are ‘cured’ of hyperthyroidism with radioactive iodine therapy?

A

80%

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3
Q

Pre-operative potassium iodide should be given to Grave’s disease patients

True or false?

A

True

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4
Q

Does maternal TSH cross the placenta?

A

No

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5
Q

Does maternal T4 cross the placenta?

A

Yes - in low amounts.

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6
Q

Gestational thyrotoxicosis is secondary to elevation of which hormone?

A

Beta hcg.

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7
Q

How much PTU is 10 mg of methimazole equivalent to?

A

100 - 150 mg

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8
Q

Which crosses the placenta more: T3 or T4?

A

T4

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9
Q

Is levothyroxine alone or combination thyroid hormone therapy preferable in pregnancy?

A

Levothyroxine alone.

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10
Q

Approximately how much maternal T4 crosses the placenta?

A

About one third of T4.

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11
Q

What’s the starting dose of levothyroxine in infants?

A

10 - 15 mcg/kg/day

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12
Q

What percentage of the world birth population undergo newborn hypothyroidism screening?

A

30%

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13
Q

Should you biopsy a thyroid nodule that is less than 1 cm?

A

No.

Not even if looks suspicious

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14
Q

Should you do a lateral neck dissection without doing a biopsy of the lymph nodes?

A

No.

If you can’t - then at least do a neck ultrasound to look at the lymph nodes.

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15
Q

If you see suspicious lymph nodes which imaging studies should you do?

A

Neck ultrasound for surgical planning.

Lymph node survey

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16
Q

If a differentiated thyroid cancer / highly suspicious nodule is less than 1 cm in an old patient - can it be followed?

A

Yes - in selective cases.

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17
Q

If a thyroid mass (biopsy proven cancer) is fixed to structures in the neck should the vocal cords be looked at prior to surgery?

A

Yes

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18
Q

Patients with differentiated thyroid cancer > 1 cm and < 4 cm with no extra thyroidal extension and no lymph nodes - which surgery would to do?

A

Lobectomy/hemithyroidectomy

Near-total/total thyroidectomy

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19
Q

What are the approximate doses of radioactive iodine for:

  • Remnant ablation
  • Adjuvant treatment
  • Treatment of distant metastasis
A
  • Remnant ablation (30 mCi)
  • Adjuvant therapy (30 - 100 mCi depending on risk)
  • Treatment of distant metastasis (100 mCi or more)
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20
Q

Generally do surgeons use pharmacological DVT prophylaxis perioperatively for thyroidectomies?

A

No - bleeding risk (life threatening neck hematoma) too great.

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21
Q

Which germline mutation is associated with medullary thyroid cancer?

A

RET mutation.

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22
Q

Once you have reached 600 mCi of radioactive iodine what’s the likelihood that you will be able to cure the patient with radioactive iodine?

A

Very low likelihood.

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23
Q

What’s one the most commonly reported mutations reported in differentiated thyroid cancer?

A

BRAF

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24
Q

What iodide transporter - other than pendrin - causes iodide efflux from thyroid cells?

A

Anoctamin 1

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25
Q

What gene mutation is present in medullary thyroid cancer?

A

RET gene mutation

26
Q

75% or more of MEN 2B are typically de novo disease.

True or false.

A

True

27
Q

What levels are followed in MEN 2 in patients with medically thyroid cancer?

A

Calcitonin

28
Q

Calcitonin less than 30 - 60 pg/mg in children with medullary thyroid cancer suggest no lymph nodes involved.

True or false?

A

True

29
Q

What’s better for medically thyroid cancer: ultrasound or calcitonin?

A

Calcitonin

30
Q

What disease will you think of if you see hypertrophic ganglia (after surgery)?

A

MEN 2B

31
Q

What should you check before taking medullary thyroid cancer patient to the OR?

A

Plasma metanephrines

32
Q

Which is better for looking for metastasis in medullary thyroid cancer:
CT or PET?

A

CT

33
Q

Can pheochromocytomas present as cystic masses?

A

Yes

34
Q

What happens to the size of nerves in MEN 2B?

A

Enlargement.

35
Q

What is the median survival in medically thyroid cancer with distant metastasis?

A

3 years

36
Q

Is the calcitonin doubling time a good prognostic factor for medullary thyroid cancer?

A

Yes

37
Q

What type of CT should you do in neuroendocrine tumors?

A

Triple phase CT

38
Q

What are the three major pathways that are targets of chemotherapy in medullary thyroid cancer?

A

RET
RAF
VEGFR

39
Q

Have any of the treatment options for metastatic medullary thyroid cancer shown a survival benefit?

A

No

40
Q

Does Afirma have a greater positive predictive value or negative predictive value?

A

Negative predictive value.

41
Q

Should you biopsy an FDG positive nodule found on PET scanning?

A

Yes

Unless it’s very small

42
Q

If you have a small thyroid nodule (less than 1 cm) but an enlarged lymph node in the neck - then do you biopsy the thyroid nodule?

A

Yes - in addition to the lymph node.

43
Q

Is an intrathyroidal parathyroid carcinoma a neural crest tumor?

A

Yes

44
Q

Which acts on the cardiac myocyte:

T3 or T4?

A

T3

45
Q

What vascular pattern do parathyroid glands have on ultrasound?

A

Polar vascular pattern

46
Q

Which BRAF mutation is most strongly (more than 80%) associated with thyroid cancer?

A

V600E

47
Q

Is BRAF mutation a prognostic marker for mortality?

A

No

48
Q

When should the presence or absence of BRAF mutation be a factor in selection of patients with metastatic thyroid cancer for chemotherapy?

A

When considering tyrosine kinase drugs that inhibit BRAF pathway.

49
Q

VEGF pathway is specific for angiogenesis.

True or false?

A

True

50
Q

Does anti-VEGFR therapy improve or worsen survival?

A

Either no effect or slightly worsened.

51
Q

PDGFR expression promotes nodal metastasis in papillary thyroid cancer.

True or false?

A

True

52
Q

What determines prognosis in differentiated thyroid carcinoma?

A

Histology

53
Q

What dose of radioactive iodine for remnant ablation in differentiated thyroid cancer?

A

30 mCi.

54
Q

What does pregnancy do to antibody levels?

A

Typically it decreases them.

55
Q

What happens to the creatinine in hyperthyroidism?

A

It is falsely lowered.

56
Q

Should you give diuretics to patients with very uncontrolled hyperthyroidism?

A

Not usually - may cause blood pressure to drop.

57
Q

What is the daily requirement for iodine intake?

A

150 mcg/day

58
Q

How long should you wait before doing a repeat biopsy if indicated non-urgently?

A

6 months

59
Q

What three structures are removed in a radical neck dissection?

A
  • Sternocleidomastoid
  • Accessory nerve
  • Jugular vein
60
Q

In diffuse uptake of radioactive iodine in an uptake scan done for thyroid cancer should you give higher dose or lower dose of radioactive iodine for treatment?

A

Lower

61
Q

What do the following findings on thyroid ultrasound indicate:

  • Vascularity (increased or decreased)
  • Halo (presence or absence)
A

They don’t indicate whether a nodule is benign or malignant anymore.

62
Q

How long does calcitonin take to fall to very low levels after surgery for medullary thyroid cancer?

A

About 6 weeks.

63
Q

How long does it take for CEA to fall to very low levels in medullary thyroid carcinoma after surgical resection?

A

2 - 3 months.

Endocrinology Fellowship (30 decks)

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