Endocrine

Question 1

Refractory HTN and muscle cramping with elevated Aldo: renin level > 30. Whats the dx? what are the biochemical abnormalities?

Answer 1

Primary Hyperaldosteronism
Hypernatremia
Hypoklamia

Question 2

34 F with thyroid nodule found by PCP, no LAD. FNA with Hurthle cells. Mgmt?

Answer 2

Partial thyroidectomy as it could be cancer

Question 3

s/p renal transplant with bone pain, renal stones, weight gain. what is the cause?

Answer 3

Tertiary hyperparathyroidism (causing hypercalemia) long standing secondary hyperparathyroidism leading to hyperplasia of the parathyroid glands

Question 4

incidental adrenal mass w/u

Answer 4

H and P!!
Is it functional or malignant?
R/o phew, hypercortism, hyperaldosteronism

Question 5

Type of thyroid cancer that requires central compartment dissection?

Answer 5

MTC > 1cm or <1cm bilobar dz requires central neck dissection regardless of the clinical node usstat

Question 6

45 F with refractory hyperthyroidism gets a cellulitis and goes to ER with tachycardia, fever, diaphoresis and confusion. whats the dx? and tx?

Answer 6

Thyroid storm; dexamethason

Question 7

63 M withincidental neck mass with no risk factors. whats the most likley dx and how to confirm?

Answer 7

Lingual thyroid

Radioiodine uptake scan

Question 8

what characterizes Conn syndrome? and how does thew treatment w unilateral v b/l dz change?

Answer 8

refractory HTN< with hyperaldosteronism, low renin, low potassium

Bilateral» unilateral
Bilateral tx medical mgmt
Unilateral is lap adrenalectomy

Question 9

What is the vasculature of the adrenal gland and what is the most important step during dissection?

Answer 9

Artery = branches of the inferior phrenic artery, aorta and renal artery
Each gland drains into single drain.
the RIGHT adrenal vein enters directly into IVC directly – this is a CRITiCAL STEP in dissection

Question 10

Tests for adrenal incidentaloma

Answer 10

Dex suppression test, 24 hour urine collection for catecholamines, metanephrines and VMA

Question 11

MC place for hiding parathyroid gland?

Answer 11

thyrothymic ligament

Question 12

FNA of asx thyroid nodule shows follicular neoplasm. what is the mgmt?

Answer 12

thyroid lobectomy?

Question 13

s/p total thyroid after the patient can’t elevate her pitch of phonation. what nerve?

Answer 13

EXTERNAL branch of the superior laryngeal nerve

bc the external branch innervates the cricothyroid muscle

Question 14

25 F with fam h/o VH: and presence of multiple cerebellar hemangioblastomas. What next in management?

Answer 14

24 hour VMA and metanephrines bc VHL pts shouod be screened for CNS and retinal hemangioma, RCC and pheos

Question 15

Primary cancer that mets to the adrenal gland

Answer 15

Lung

Question 16

situation where emergent trach is presrred over cricothyroidotomy

Answer 16

unvaccinated child with acute epiglottis because the cricothyroid ligament in kids <5 is very small making it difficult

Question 17

s/p modified radical mastectomy with difficulty arm extension and internal rotation, What structured injured?

Answer 17

Thoracodorsal nerve

Question 18

presence of of LEFT non-RLN indicates what other anomalies?

Answer 18

1. Right Aortic ARch
2. Lef tSubclavian comes off a weird place on the arch
3. aligamentum arteriosum displaced to the right

Question 19

RIGHT non RLN association

Answer 19

Arteria lusoria abherrent right subclavian artery where the R SCA originates from DESCENDING aorta

Question 20

Inceidental adrenaloma with > 4cm irregular mass w peripheral enhacement with central necrosis, next step?

Answer 20

Total adrenalectomy as high chance that it’s cancer.

Must r/o pheo because

Question 21

33 F total thyrod for 2.3 cm mass. final path with Papillary and 1 node. whats next?

Answer 21

routine follow up and possible RAI

Question 22

70 F with 5 cm cyctic mass i nthe tail. what are the next diagnostic steps?

Answer 22

1. MRI/MRCP or CT pancreas to characterize lesion
2. If the mass is > 1.5 cm, main duct is dilated, or theres a solif component,
   EUS-FNA

Question 23

Diarrhea, flushing, CT with tail of panc mass. NE tumor suspected. Common features?

Answer 23

VIPoma

watery diarrhea, hypokalemia, hypochlrhydria

Question 24

left recurrent laryngeal ___ toinferior thyroid artery

Answer 24

POSTERIOR

Question 25

nerve most likley to be injured in thyroidectomy?

Answer 25

external branch of superior laryngeal nerve