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*Surgery > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what parathyroid glands are more likely to not be in their normal anatomic position

A

inferior parathyroid glands (follow the thymus around)

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2
Q

artery for the parathyroid

A

superior thyroid artery

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3
Q

Increases calcium absorption in the gastrointestinal tract

A

Vitamin D

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4
Q

Stimulates osteoclasts, renal calcium reabsorption, phosphate excretion, and synthesis of D3
Inhibits osteoblasts

A

Parathyroid hormone

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5
Q

Antagonizes PTH

A

Calcitonin

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6
Q

what secrete calcitonin

A

Secreted by the C Cells of the THYROID

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7
Q

most inpatient cases of hypercalcemia are due to what?

A

malignancy

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8
Q

what is the most common cause of hypercalcemia in the outpatient

A

hyperparathyroidism

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9
Q

Triggers for hyperparathyroidism

A 
family hx
MEN syndrome
HTN
peptic ulcer
Vit D def
early osteoporosis
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10
Q

Presentation of hyperparathyroidism

A 
nephrolithiasis
renal failure
bone pain
osteopenia, osteoporosis 
polyuria
constipation
depression
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11
Q

endocrine disorders are more common in who?

A

women (3:1) in periamenopausal time period

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12
Q

a fibormyalgia patient may actually have what?

A

hyperparathyroidism

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13
Q

a calcium level over what is a hypercalcemia crisis?

A

> 14.5

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14
Q

symptoms of a hypercalcemic crisis

A 
anorexia, weakness
vomiting, dehydration
acute pancreatitis
polyuria/ polydypsia
nephrocalcinosis
coma
constipation
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15
Q

a patient w/ acute onset pancreatitis w/o gallbladder or liver problems probably is having what?

A

hypercalcemic crisis

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16
Q

tx for hypercalcemic crisis

A 
volume resuscitation/ rehydration
loop diuretic (lasix)
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17
Q

drugs to tx hypercalcemic crisis that inhibit bone resorption

A

bisphosphonates
calcintonin
mithramycin

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18
Q

what is C/I w/ hyperparathyroidism and hypercalcemia

A

HCTZ

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19
Q

phosphorous level in hyperparathyroidism

A

low

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20
Q

work up for hyperparathyroidism

A

Serum calcium and phosphorus
Intact parathyroid hormone (PTH)
Vitamin D levels
24 hour urinary calcium excretion

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21
Q

common cause of secondary hyperparathyroidism

A

Vitamin D deficiency- just need this replaced and pTH should go back to normal

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22
Q

most common cause of hyperparathyroidism

A

benign tumor of a single gland

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23
Q

what is a genetic condition that causes hyperparatyroidism

A

familal hypocalciuric hypercalcemia (FHH)

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24
Q

lead expensive and invasive way to localize parathyroid tumor

A

Ultra sound

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25
Q

Single best test for locating abnormal parathyroid glands

A

Sestamibi scintigraphy (Dual Tracer- 2 radio-isotopes)
first- iodine
second- Tech 99 (thyroid and abnormal parathyroid)

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26
Q

when should you do a CT scan for parathyroid

A

re-operation

or can’t find it on previous studies

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27
Q

how will a parathryoid tumor look like on US?

A

hypoechoic (black ball)

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28
Q

indications for surgery w/ hyperparathyroid- serum caclium > than what?

A

11.5 mg/dL

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29
Q

indications for surgery w/ hyperparathyroid with creatinine clearance

A

CrCl <30%

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30
Q

a 24 hour urinary calcium above what incidactes need for parathyroid surgery

A

> 400 mg/dL

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31
Q

bone mass reduced less than ____ SD below normal is an indication for parathyroid surgery

A

2

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32
Q

a PTH level over what is abnormal

A

75

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33
Q

what is when all the parathyroid glands are affected

A

parathyroid hyperplasia

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34
Q

tx for parathyroid hyperplasia

A

3.5 gland parathyroidectomy

4 gland parathyroidectomy w/ autograft

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35
Q

sxs of hypocalcemia

A

muscle twitching on face/ forearm

muscle twitching on face and fingertips

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36
Q

meds that can cause hyperparathyroidism

A

lithium therapy
rickets
renal failure

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37
Q

what is teritary hyperparathyroidism

A

persistent hypercalcemia after renal transplant

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38
Q

Truly a Rare Phenomenon (4g)
Very high serum calcium and PTH (quick onset)
Recurrence of resected adenoma

A

parathyroid carcinoma

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39
Q

surgery for parathyroid cancer

A

Parathyroidectomy, ipsilateral thyroid lobectomy and central compartment dissection.

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40
Q

postoperative treatment w/ parathyoidism removal

A

treat w/ calcium if <8 (IV)
Vitamin D3 (Rocaltrol)
HCTZ (want Ca reabsorption)
PHOSLO (Lower phosphorous)

41
Q

if both recurrent laryngeal nerves are severed what does a patient need

A

need a tracheotomy

42
Q

general term for thyroid swelling

A

goiter

43
Q

inflammation of the thyroid usually from viral or autoimmune condition

A

thyroiditis

44
Q

present with Heat intolerance, weight loss, tremulousness, palpitations, restlessness, emotional instability, atrial fibrillation, insomnia

A

hyperthyroidism

45
Q

Precipitating events for thyroid storm

A

Fever, hypotension, CHF

46
Q

Caused by autoantibiodies that recognize the TSH receptor

A

Graves Dz

47
Q

what will a thyroid scan w/ Graves Disease show?

A

diffuse uptake w/o nodularity

48
Q

big ADR w/ Metimazole

A

agranulocytosis (need a CBC check after every illness)

liver damage

49
Q

drug for graves that interferes with thyroid hormone synthesis and peripheral conversion of T4 to T3

A

PTU

50
Q

definitive treatment for graves Dz

A

radioactive iodine ablation (RAI)

51
Q

contraindicaitons for radioactive iodine ablation

A

pregnancy

suspicion of thyroid malignancy

52
Q

if a person has hyperthyroid toxicity and needs to be hospitalized what can you do?

A

plasmapharesis

iodine

53
Q

can someone w/ eye disease have radioactive iodine?

A

No, will worsen and can cause them to be blind

54
Q

Palpable nodules

Normal T3 and T4 are common, but TSH is decreased

A

toxic multinodular goiter (Plummer’s disease)

55
Q

tx for toxic multinodular goiter

A

total thyroidectomy

radioactive iodine ablation (RAI)

56
Q

Hyperthyroid symptoms

Thyroid scan shows hot nodule with suppression of the rest of the gland

A

toxic nodule

57
Q

definitive tx for toxic nodule

A

Thyroid lobectomy

Radioactive iodine ablation (RAI)

58
Q

Symptoms are cold intolerance, weight gain, constipation, dry skin, brittle hair, difficulty concentrating, and fatigue

A

hypothyroidism

59
Q

Occurs in middle aged women
Antimicrosomal and antithyroglobulin antibodies
Surgery rarely indicated

A

Hashimotos

60
Q

what will a thyroid be like w/ hasimotos

A

can be big

2 phases- gland will fight diseae (get big and angry) then eventually become atrophic

61
Q

Associated with thyroid tenderness for 2 - 4 months

A

subacute thyroiditis

62
Q

treatment for subacute thyroiditis

A

NSAIDs/ thyroid replacement

63
Q

thyroid nodules that are candidates for FNA

A

1 cm or bigger

64
Q

most common type of thyroid cancer

A

papillary

65
Q

what type of thyroid cancer will take up radioactive iodine

A

well-differentiated carcinoma

66
Q

why do you do lymph node dissection w/ thyroidectomy for thyroid cancer

A

want to know if the patient need radioactive iodine

67
Q

how does a follicular thyroid cancer metastasize?

A

blood

68
Q

any evidence of thyroid cells in a lymph node indicates what?

A

proof of metastasis

69
Q

if there is presence of metastasis of thyroid cancer to lymph nodes in the neck what needs to be done?

A

radical neck dissection

70
Q

thyroid cancer follow up (Post surgery)

A

routine US
whole body scans
measure thyroglobulin levels

71
Q

tx for medullary thyroid cancer

A

total thyroidectomy w/ central compartment lymph node dissection
No RAI

72
Q

do you operate for a anaplastic thyroid cancer usually?

A

No, usually just do a trach and give meds (radiotherapy and doxorubicin)

73
Q

Most commonly present in childhood or adolescence as a midline swelling or dimple of the thyroid that moves with protrusion of the tongue.
always midline

A

thyroglossal duct cysts

74
Q

treatment for thyroglossal duct cysts

A

surgical excision
Sinstrunk procedure always involves removing central 1/3rd of the hyoid bone
tx infection before surgery

75
Q

what does the glomerulosa release?

A

mineralcorticoids

76
Q

what does the fasiculata release?

A

glucocorticoids

77
Q

what does the reitcularis release?

A

sex steroids

78
Q

what part of the adrenal secretes epi/ norepi?

A

medulla

79
Q

what is the test of choice for pheochromocytoma?

A

MRI

80
Q

a non-functional lesion will be removed at what size?

A

> 5cm

can be >3cm- depends on patient

81
Q

Presents w/
Hypertension
Hypokalemia
More common in women

A

Hyperaldosteronism

82
Q

Rule of 10s w/ pheochromocytoma

A

10% familial
10% malignant
10% B/L
10% extradrenal (paraganglioma)

83
Q

what hormone does the adrenal gland convert? (how to differentiate pheochromocytoma from paraganglioma)

A

norepi to epi

84
Q

work-up for hyperaldosternoism

A

stop all diuretic and antihypertensive meds for 4 weeks
plasma aldosterone/ renin
saline infusion test (should suppress aldosteron)
CT scan

85
Q

a plasma aldosterone to renin level of what indicates hyperaldosteronism

A

more than 30

86
Q

tx for hyperaldosteronism

A

Laparoscopic adrenalectomy

Open adrenalectomy

87
Q

what is pathognomonic for cushings

A

axillary striae

88
Q

workup for Cushing’s

A

ACTH dependent vs. independent
24 hour urinary free cortisol
low dose dexamethasone supression test
localization- CT/MRI

89
Q

cushing symptoms due to a pituitary problem is called what?

A

Cushing’s Disease

90
Q

should you send a patient w/ an adrenal mass for biopsy w/o ruling out pheo?

A

Never

91
Q

workup for pheo

A

24 hour metanephrines, vanillymandelic acid, and fractionated catecholamines
Plasma levels of metanephrine and normetanephrine
CT
MIBG
MRI - test of choice

92
Q

tx for pheo

A

alpha blockade - phenoxybenzmine (maximize before starting beta blockers)
volume replation
beta blockade
laparosopic adrenalectomy

93
Q

Tx for malignant pheochromocytoma

A

surgical excision

chemo

94
Q

Most patients present with endocrinopathy - usually Cushing’s syndrome
Metastasis occurs to liver, lung, bone, and brain
Local invasion is common

A

adrenocortical carcinoma

95
Q

what is used to tx adrenocortical carcinoma metastasis

A

mitotane (adrenergic blocker)

96
Q

how will a pheo look on MRI

A

bright

97
Q

present w/ fever, hyponatremia/ hyperkalemia and have no response to fluids or pressors

A

adrenal insufficiency

98
Q

Diagnosis for adrenal insufficiency

A

ACTH stimulation test

99
Q

Tx for adrenal insufficiency (stress dose)

A

100 mg hydrocortisone IV Q8 hours (stress dose)

volume resuscitation

*Surgery (5 decks)

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