Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ORAL BOARDS > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Whipple’s triad

A 
Insulinoma
Includes:
Fasting hypoglycemia
Symptoms of hypoglycemia
Relief with sugar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

C peptide levels in insulinoma

A

High

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When to enucleate vs resect in insulinoma

A

If <2 cm can enucleate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Insulinoma seen in which MEN?

A

Type 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MEN 1

A

Pancreas
Pituitary
Parathyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MC pancreas tumor in MEN1

A

Gastrinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MC pancreas neuroendocrine tumor

A

Insulinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Check for pheo - lab

A

urine metanephrines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MEN 2A

A

Parathyroid
Medullary thyroid CA
Pheo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Preop prep for pheo

A

Alpha blockade with phenoxybenzamine
Adequate hydration
If pressures still uncontrolled, beta blocker added

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

R adrenal v drains into

A

IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

L adrenal v drains into

A

L renal v

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MEN 2B

A

Mucosal neuromas
Marfanoid
Medullary thyroid CA
Pheo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Apple green birefringent in medullary thyroid

A

Amyloid deposits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recs for thyroidectomy in MEN 2A

A

5 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Gene for MEN 2

A

RET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Gene for MEN 1

A

Menin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Every medullary thyroid CA should be screened for

A

Pheo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Rule of 10s for pheo

A

10% bilateral, malignant, extra-adrenal, pediatric, asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Thyroglossal cyst tx

A

Sistrunk procedure

Surgical excision of cyst and resection of central portion of hyoid bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Thyroglossal cyst PE

A

Swallowing does not move it
Protrusion of tongue does
Midline mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Thyroglossal cyst infected - tx

A

I&D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When to resect thyroglossal cyst in baby

A

1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Branchial cleft cysts are located where?

A

Lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which neck mass moves with swallowing

A

Thyroid mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Gastrinoma triangle

A

the confluence of the cystic and common bile duct superiorly, the second and third portions of the duodenum inferiorly, and the neck and body of the pancreas medially, both dorsally and ventrally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

CT is negative for gastrinoma - what next?

A

EUS

Then octreotide scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

D2 gastrinoma 2 cm in size

A

Enucleate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Gastrinoma closely approximated to pancreas parenchyma

A

Antimesenteric duodenotomy and excise from lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Long term recs for gastrinoma

A

PPI - taper off
Re-EGD and ensure clearance of ulcers
Annual eval first 5 years with serial CT scans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

<1 cm thyroid CA

A

lobectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

> 4 cm thyroid CA

A

thyroidectomy

33
Q

Margin goals in GIST

A

Negative

34
Q

Adjuvant imatinib recs

A 
High mitotic rate
>5 cm
Positive margins 
High grade
Recurrence
35
Q

Recurrent GIST recs - resectable

A 
Endoscopy +/- EUS
Restage - CT C/A/P
Discuss at MDC
Re-resect 
Adjuvant imatinib
36
Q

Medullary thyroid CA - OR

A

total thyroidectomy + CND + ipsilateral neck dissection

37
Q

F/u for medullary thyroid CA

A

Serial calcitonin

38
Q

Adrenal incidentaloma - biochemical workup

A

CBC, CMP, 1 mg low dose dexamethasone suppression cortisol test, ACTH, renin, DHEA-sulfate, aldosterone, plasma metanephrines

39
Q

Incidental pancreatic mass - hyperdense on arterial phase

A

GI neuroendocrine tumor

40
Q

Pancreatic mass in young pt - rule out?

A

MEN syndromes
Pancreatic adenoCA
Functional vs non functional neuroendocrine tumors

41
Q

Metastatic disease in neuroendocrine tumors test

A

Dotatate PET scan

42
Q

Asymptomatic neuroendocrine tumor - resection?

A

If small can observe up to 1 cm
Resect if >2 cm
Can always re-image short interval

43
Q

How can you biopsy GIST

A

EUS with FNA

44
Q

History taking in adrenal incidentaloma

A

Symptoms of hormone excess!
Cortisol excess - HTN, hyperglycemia, weight gain, muscle weakness
Pheo - palpitations, HTN, anxiety
Aldosteronemia - hypoK, HTN diff to control

45
Q

Low dose dexamethasone suppression test

A 
1 mg dexa 10 pm
Cortisol check following AM
Normal: suppression to <1.8 
Result >5 is positive
Indeterminate --> confirmatory test as late night salivary cortisol vs 24 hr urine collection
46
Q

DHEA sulfate can be elevated in

A

adrenocortical carcinoma

47
Q

Adrenal mass concerning for malignancy - imaging

A

> 10 hounsfield units on non con - mets, primary adrenal tumors, or pheo
4 cm should have higher suspicion

48
Q

Indeterminate adrenal mass on CT

A

Can get PET or do adrenalectomy

49
Q

Non functional small adrenal adenoma - followup?

A

Repeat biochemical workup and imaging in 1 year (to be safe)

50
Q

Lap left adrenalectomy

A

Ports along costal margin, lateral decubitus position
Assess for mets if CA
Incise lateral attachments to spleen and begin mobilizing spleen and pancreas medially to develop avascular plane
ID left renal vein and trace medially until adrenal v encountered - ligate and divide between clips
Mobilize off kidney and away from diaphragm
Place in endocatch
Ensure hemostasis prior to closure

51
Q

Meds that may cause hypercalcium, hyperPTH, or interefere with PTH assays

A

HCTZ, Lithium, Biotin

52
Q

Low vitamin D, normal Ca, mildly elevated PTH

A

PTH activation of 1 alpha hydroxylase

Correct vitamin d levels and recheck PTH

53
Q

Asymptomatic primary hyperparathyroidism - indications for surgery

A 
Ca >1 mg above upper normal
Dexa t score <2.5 or vertebral fx by imaging
Cr clearance <60
Kidney stones
24 urine Ca >400
Age <50
Neurocognitive/neuropsych sx
54
Q

Can’t find inferior parathyroid - where to look?

A

Thymus

55
Q

Parathyroidectomy - OR

A 
Large bore IV access
Intubate with ETT with RLN monitoring
Draw baseline PTH 
Collar incision, subplatysmal flap
Midline raphe to retract strap mm and gain access to thyroid gland
Retract thyroid medially to develop plane between thyroid and prevertebral fascia 
Find and ligate middle thyroid v
Begin looking for parathyroid gland
56
Q

4 gland parathyroid exploration - OR

A

Begin by ID superior PTH on ipsilateral side - send small frozen to confirm parathyroid, mark with clip
Inf and superior PTH on contralateral side, confirm with frozen, place clips
Don’t excise until found all 3
If any abnormal, resect that one only
If all appeared normal, subtotal parathyroidectomy leaving 1/2 of para as remnant

57
Q

RA iodine in Grave’s disease - when to avoid?

A

Ocular Graves

58
Q

Prep for OR for Graves

A

Repeat thyroid function tests 2 weeks prior to ensure normal free T3
Lugols iodine solution for 1 week prior to OR to decrease vascularity of thyroid gland

59
Q

OR - thyroidectomy

A

Collar incision, subplatysmal flap
Midline raphe to retract strap mm and gain access to thyroid gland
Retract thyroid medially to develop plane between thyroid and prevertebral fascia
Find and ligate middle thyroid v
Upper and lower poles of thyroid, taking vessels with energy device
Preserve parathyroids on vascular pedicle
ID RLN in TE groove
Complete thyroid mobilization by taking ligament of Berry
Contralateral side
Check hemostasis, viability of para glands and autotransplant any that appear compromised

60
Q

Concern for intra op RLN injury

A

Paralyzed from traction or accidentally transected
Complete exposure and check if intact
If transected, perform primary anastomosis of nerve w/o tension and call neurosurg or plastics to help with repair
Terminate procedure and plan to rescope pt
Completion thyroidectomy once nerve recovers

61
Q

Total thyroid in papillary CA - indications

A 
>4 cm
Evidence of extrathyroidal extension on US or intraop
Metastatic LN ID pre op
Contralateral nodules 
Need for adjuvant radioiodine therapy
62
Q

Advantages of thyroid lobectomy in papillary CA

A

Decrease QOL impact
Equivalent survival
No need for thyroid supps

63
Q

Concerning LN with dx of thyroid CA

A

FNA prior to OR

Send to cytology and thyroglobulin aspirate washout (elev –> diagnostic for mets)

64
Q

Thyroid nodule workup - first step

A

Thyroid US + TSH level

65
Q

FNA not recommended for thyroid nodules under what size

A

1 cm

66
Q

Features to look for on thyroid nodule US

A 
Size
Irregular borders
Microcalcs
Hypoechogenicity
Peripheral vascularity
Taller greater than wide
67
Q

Steps of FNA

A

Use US to locate nodule
Anesthetize the skin
Under US guidance, multiple passes using 25 gauge needle
Cytopathology on site to confirm sample adequacy

68
Q

Bethesda classification

A

II - benign, interval US
III 15%
IV 40%
V and VI - malignancy

69
Q

Indeterminate thyroid nodule - next steps?

A

Repeat FNA with molecular testing vs diagnostic lobectomy

If negative molecular testing, <5% chance of malignancy

70
Q

When would you ever biopsy an adrenal mass

A

Pt that has hx of CA and wanting to r/o mets

71
Q

Open left adrenalectomy

A

Subcostal laparotomy
Mobilize splenic flexure and spleen and tail of pancreas medially
En bloc excision of left adrenal mass and surrounding RP adipose tissue
If inv of upper pole of kidney, nephrectomy also performed
AVOID RUPTURE OF CAPSULE
Any suspicious LN removed

72
Q

Addisonian crisis s/p adrenalectomy - tx

A

IV hydrocortisone post op
Transition to PO steroids at discharge
Taper slowly over 6-12 months

73
Q

How is adrenal venous sampling performed

A

Cannulation of R and L adrenal vv along with systemic aldosterone levels in IVC
Comparison between levels may show unilateral hypersecretion –> candidate for adrenalectomy even if no mass on imaging

74
Q

Lap right adrenalectomy

A

LLD
Mobilize R lobe of liver by dividing posterior peritoneal attachments of the triangular ligament and the coronary ligament to expose bare area of liver
Dissect RP posterior to R lobe of liver to expose IVC and continue along lateral and anterior aspects until ID R adrenal v, then clip and divide
Mobilize R adrenal gland away from RP adipose tissue, diaphragm, and posterior musculature using an energy device
Ligate fatty attachments of adrenal gland to upper pole of kidney, avoiding renal hilar vessels
Place in endocatch
Confirm hemostasis
Close incisions

75
Q

Avulsion of R adrenal vein - next steps

A

Alert anesthesia
Maintain pressure with lap instruments
Retract R lobe of liver medially, remove packs
Suture ligate hole with figure of 8 or clamp orifice of adrenal vein with vascular clamp followed by closure of venotomy
Confirm hemostasis
Assess for narrowing of IVC
can use allis clamp

76
Q

Concern for Cushing Syndrome - labs

A 
BMP
Glucose
ACTH
Cortisol 
Dexamethasone suppression test
77
Q

Causes of hypercortisolism

A

Exog steroids
ACTH dependent - pituitary, ectopic
Adrenal source

78
Q

Hypercortisolism - medical mgmt

A

Metyrapone
Mifepristone
Ketoconazole

ORAL BOARDS (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions