Endocrine

Question 1

Highest sensitivity for detecting pancreatic tumors

Answer 1

Intra-operative US

Question 2

Pancreatic exocrine function showing normal total volume and enzyme secretion but decreased bicarb

Answer 2

Chronic pancreatitis

Question 3

Whipple’s Triad

Answer 3

Hypoglycemia symptoms
Associated low measured glucose
Relief after increase in glucose

Question 4

Insulinoma; medical management prior to sx

Answer 4

Frequent high carb meals and diazoxide

Question 5

Gastrinoma triangle

Answer 5

Cystic duct, junction of 2nd/3rd part of duodenum, junction neck/body pancreas

Question 6

Main duct IPMN in head of pancreas; tx

Answer 6

Whipple

Question 7

Galactorrhea and refractory peptic ulcer disease and hypomagnesemia; dx

Answer 7

MEN; Pancreatic tumors(most common gastrinoma), pituitary adenomas, parathyroid hyperplasia

Question 8

Young, healthy with hypercalcemia, normal neck exam and normal PTH; next step in workup and likely dx

Answer 8

Urine calcium, Familial hypercalcemic hypocalciuria

Question 9

Needed to confirm removal of all hyper functioning parathyroid glands

Answer 9

PTH drop of 50% compared to highest pre-excision value

Question 10

Parathyroid carcinoma tx

Answer 10

Parathyroidectomy and en bloc hemithyroidectomy (mod rad neck if pos nodes)

Question 11

Hyperparathyroidism, high calcium/PTH, low phosphate

Answer 11

Primary hyperparathyroidism

Question 12

Parathyroidism, low calcium, high PTH and phosphate

Answer 12

Secondary hyperparathyroidism

Question 13

Parathyroidism, high calcium and phosphate, VERY high PTH

Answer 13

Tertiary hyperparathyroidism

Question 14

Very high calcium and palpable neck mass; dx

Answer 14

Parathyroid carcinoma

Question 15

Most commonly injured nerve during thyroidectomy

Answer 15

Superior laryngeal laryngeal nerve

Question 16

Child with MEN2A and MEN2B; tx

Answer 16

Prophylactic total thyroidectomy with bilateral central neck dissection by age 5 and age 1

Question 17

Partial thyroidectomy for papillary thyroid Ca 0.7cm; net step

Answer 17

Thyroid hormone and surveillance US

Question 18

Well-differentiated thyroid cancer in pregnancy; tx

Answer 18

Thyroidectomy post-partum

Question 19

Poorly differentiated thyroid cancer in pregnancy; tx

Answer 19

Thyroidectomy in 2nd trimester

Question 20

Absolute contraindications to radioactive iodine

Answer 20

Pregnancy and breastfeeding

Question 21

Solitary encapsulated thyroid mass spreads through local extension and hematogenous dissemination

Answer 21

Follicular carcinoma

Question 22

Indication for total thyroidectomy in follicular carcinoma

Answer 22

> 4cm, extra thyroidal extension, mets

Question 23

Medullary thyroid cancer; tx

Answer 23

Total thyroidectomy with bilateral level VI LND

Question 24

Germline mutation leading to medullary thyroid cancer in MENII

Answer 24

RET proto-oncogene

Question 25

Most common side effect of radioactive iodine

Answer 25

Hypothyroidism

Question 26

Catecholamines of adrenal medulla are derived from what

Answer 26

Tyrosine

Question 27

Enzyme Tyrosine to DOPA

Answer 27

Tyrosine hydroxylase

Question 28

Enzyme DOPA to Dopamine

Answer 28

Dopa decarboxylase

Question 29

Dopamine to NOE

Answer 29

Dopamine hydroxylase

Question 30

NE to Epi

Answer 30

PNMT

Question 31

Phenylehtanolamine-N-methyltransferase; where from

Answer 31

Adrenal medulla organ of Zuckerkandl near aortic bifurcation

Question 32

Best screening test for pheochromocytoma

Answer 32

Plasma free metanephrines

Question 33

Chemo for adrenocortical carcinomas

Answer 33

Mitotane

Question 34

Most common primary tumor to metastasize to adrenals

Answer 34

Lung

Question 35

First-line test for suspected adrenal insufficiency

Answer 35

Early morning serum cortisol

Question 36

Deficiency in 21-hydroxylase in the adrenal gland

Answer 36

Congenital adrenal hyperplasia, ambiguous genitalia and salt wasting

Question 37

Deficiency in 11beta-hydroxylase

Answer 37

CAH, less likely symptomatic than 21-hydroxylase

Question 38

Glucosylceramidase deficiency

Answer 38

Gaucher disease

Question 39

Hexosaminidase A deficiency

Answer 39

Tay-Sachs disease

Question 40

Elevated Cortisol, Low ACTH

Answer 40

Adrenocortical adenoma

Question 41

Elevated Cortisol and High ACTH; next step

Answer 41

Pituitary or ectopic source, Pituitary MRI and high-dose dexamethasone test

Question 42

Plasma aldo to renin ratio >25, muscle pain, fatigue, polyuria; dx and metabolic

Answer 42

Conn syndrome, hyperaldo, hypokalemia, hypernatremia and metabolic alkalosis

Question 43

Hypercortiolism, ACTH low and cortisol high with low dose dexamethasone test; next step

Answer 43

CT to identify adrenal source for Cushings

Question 44

Hypercortiolism, ACTH high with low dose dexamethasone test; next step and then what

Answer 44

High dose test, if suppressed Pituitary MRI, if unchanged search for ectopic source

Question 45

Pheo classic triad and rule of 10s

Answer 45

Headache, palpitations, diaphoresis Bilateral 10%, familial 10%, extra-adrenal 10%, malignant 10%

Question 46

Most common cause of Cushing's

Answer 46

Exogenous administration of steroids

Question 47

Most common cause of endogenous Cushing's syndrome

Answer 47

Adrenocorticotropic hormone-secreting pituitary adenoma

Question 48

Pituitary adenoma; tx

Answer 48

Dopamine agonist (Cabergoline)

Question 49

How to distinguish between unilateral and bilateral adrenal hyperplasia

Answer 49

Adrenal venous sampling

Question 50

Functional adrenal mass; tx

Answer 50

Lap adrenalectomy

Question 51

Adrenal mass workup

Answer 51

Adrenal CT protocol Determine if functional with BMP, Aldo, renin, serum and urine metanephrines Adrenal vein sampling if needed to localize

Question 52

Arterial supply and venous drainage of adrenals

Answer 52

Arteries - superior(inf phrenic), middle(aorta), inferior(renal) Right - IVC Left - Renal vein

Question 53

Lowest risk of recurrence for tx of hyperthyroidism due to toxic adenoma or multi nodular goiter

Answer 53

Thyroid lobectomy

Question 54

Incidentaloma, HTN, Hypokalemia, increased aldo:renin, inability to suppress with sodium load; dx and initial tx

Answer 54

Conn Syndrome (prim hyperaldo), spironolactone preop

Question 55

Hypoglycemia, confusion, diaphoresis; Neuroendocrine tumor

Answer 55

Insulinoma

Question 56

Abdominal pain, diarrhea, recurrent peptic ulcer; Neuroendocrine tumor

Answer 56

Gastrinoma

Question 57

Diabetes, necrotizing migratory erythema, thrombosis; Neuroendocrine tumor

Answer 57

Glucagonoma

Question 58

Watery diarrhea, hypokalemia, hypochlorydia, NAG met acidosis; Neuroendocrine tumor

Answer 58

VIPoma

Question 59

Cholelithiasis, steatorrhea, diabetes; Neuroendocrine tumor

Answer 59

Somatistatinoma