ENDOCRINE

Question 1

Symptoms of hypercalcemia

Answer 1

Symptoms of hypercalcemia

Stones
Bones
Moans
Groans
Psychiatric overtones

Question 2

Post papillary thyroid cancer resection management

Answer 2

Levothyroxin 75 µg to suppress TSH

Thyrogen (synthetic TSH) given the night before the 131 scan

I 131 scan to wipe out the remainder of thyroid tissue

Monitor thyroglobulin

Question 3

Work up for suspectedThyroid metastasis to the lung

Answer 3

Only need iodine 131 to diagnose

Do not need tissue..
Management of thyroid metastasis to the long Meniscectomy these due okay

Thyroid – okay

They do not do as good as in order:

Colon – best
Sarcoma – pretty good
Reno – pretty good

Rare:
Breast rare indicaiton
Melanoma rare indication

Question 4

Sources of ectopic ACTH

Answer 4

Small cell
Carcinoid!
Adrenal cancer
Adrenal hyperplasia

Question 5

Pertinent history for adrenal incidentaloma

Answer 5

Lung cancer
Ovarian cancer
Melanoma

Question 6

Appearance of pheochromocytoma on CT scan

Answer 6

And MRI Heterogenous on CT scan

Mass signal intensity compared to liver signal intensity greater than three for pheochromocytoma on MRI

Question 7

Functional labs needed to evaluate adrenal incedentaloma

Answer 7

24 hour urine:
Plaza metanephrines
Catecholamines
VMA
Cortisol
17 hydroxy keto steroids

Electrolytes:
If a low potassium - hyper aldosteronism

Aldosterone

Hyperglycemia / cortisol access

ACTH

Dexamethasone suppression test
(1 mg dex - cortisol should be less than three – five in the morning)

Question 8

Work up for Cushing’s syndrome

Answer 8

Ectopic ACTH:
Small cell
Carcinoid
Adrenal hyperplasia
Adrenal cancer

If increased cortisol level

Dexamethasone does not suppress = ectopic

Dexamethasone doesn’t suppress

And if it low dose decks does suppress:

Question 9

First step in diagnosing Cushing’s syndrome

Answer 9

Salivary cortisol level

(alternative 24 hour urine cortisol)

Dexamethasone can also be given to see if there is a failure to suppress cortisol when using this exogenous source of Cortizone

If Cortizone is up:

Measure ACTH to see if it is ACTH independent or dependent

Normal or high ACTH means cortisol source is coming from either:

Pituitary
Ectopic
(small cell, carcinoid)

Low ACTH:
Adrenal source

Question 10

Aldosteronoma lab findings

Answer 10

Aldosterone level
(can also be increased with renal hypertension)

LOW Aldosterone to renin

High Chloride to phos greatter than 33

Question 11

Preoperative treatment for myasthenia gravis

Answer 11

Plasmapheresis

before thymectomy

Question 12

Node dissection for medullary thyroid cancer

Answer 12

Central neck (includes 2 but not 1)

Question 13

What neck node level is the cranial nerve 11 found in?

Answer 13

Level V

Runs with the sternocleidomastoid - supplies trapezium - wing scapula

Question 14

Differential diagnosis of hypercalcemia

Answer 14

Metastatic disease
(phosphorus will also be increased)

Hyperparathyroidism

Squamous cell carcinoma of the lung and other sites (PTH like hormone)

Renal

familial hypercalcemia hypocalciuria

Question 15

Where is the ulcer found with ZE syndrome

Answer 15

Duodenum – third or fourth portion

Question 16

Electrolyte finding seen with hyperparathyroidism

Answer 16

Patients with PHPT also often have a low or low-normal blood phosphorus level, a high chloride-phosphorus ratio (> 33) and a high blood chloride level.