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General Surgery > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How may patients with PTC have microscopic nodal disease at presentation?

A

80%. Does NOT require prophylactic compartment surgery.

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2
Q

Frequency medullary thyroid cancer

A

5-10% of primary thyroid malignancies

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3
Q

Frequency Hurthle cell cancer

A

3-4% of primary thyroid malignancies

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4
Q

Frequency anaplastic thyroid cancer

A

1-2% of primary thyroid malignancies

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5
Q

In what animal was the parathyroid first identified?

A

Rhinoceros

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6
Q

Definition of Bethesda III and risk of malignancy

A

Atypical follicular lesion of uncertain significance, 5-15%

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7
Q

Size cutoff for adrenal incidentalomas prior to resection

A

4cm

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8
Q

Gene associated with medullary thyroid cancer

A

RET

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9
Q

Percentage of thyroid nodules found to be malignant

A

5%

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10
Q

How many patients with PTC have macronodular nodal disease at presentation?

A

35%

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11
Q

Position of inferior parathyroid gland in relation to RLN and inferior thyroid artery

A

Anterior to RLN, 1cm inferior to inferior thyroid artery

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12
Q

Sensitivity of sestamibi and concordant neck ultrasound in localizing single parathyroid adenoma

A

94-99%

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13
Q

Frequency papillary thyroid cancer

A

80% of primary thyroid malignancies

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14
Q

Definition of Bethesda IV and risk of malignancy

A

Follicular lesion or follicular neoplasm, 15-30%

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15
Q

Definition of Bethesda VI and risk of malignancy

A

Malignant, 97-99%

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16
Q

When should prophylactic thyroidectomy be done in patients with MEN 2B?

A

Within first year of life

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17
Q

Von Graefe’s sign

A

Lagging of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter (Graves’ disease)

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18
Q

10y survival PTC

A

90%

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19
Q

Management: Bethesda III

A

Repeat FNA

Atypical follicular lesion of uncertain significance

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20
Q

Management: Bethesda VI

A

Total thyroidectomy

Malignant

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21
Q

Globus sensation

A

Sensation of having a lump in the throat

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22
Q

Definition of Bethesda V and risk of malignancy

A

Suspicious for malignancy, 60-75%

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23
Q

Management: Bethesda II

A

Follow clinically

Benign

24
Q

In a population of patients with thyroid nodules, are men or women more likely to harbor malignancy?

A

Men

25
Q

Equation to correct calcium for hypoalbuminemia

A

Corrected calcium = serum calcium + 0.8(4 - albumin)

Add 80% of the albumin deficit to the serum calcium

26
Q

Definition of Bethesda II and risk of malignancy

A

Benign, 0-3%

27
Q

In patients with primary hyperparathyroidism, what proportion have a solitary adenoma>

A

80-85%

28
Q

Frequency follicular thyroid cancer

A

11% of primary thyroid malignancies

29
Q

Tubercle of Zuckerkandl

A

Posterolateral pyramidal extension of the thyroid

Marker for location of superior parathyroid gland at ToZ and ligament of Berry

30
Q

Sensitivity of sestamibi scan alone in localizing single parathyroid adenoma

A

80-90%

31
Q

Trismus

A

Tonic contraction of the muscles of mastication (lockjaw)

32
Q

What is the only thyroid cancer that is not female predominant?

A

Medullary thyroid cancer

33
Q

Position of superior parathyroid gland in relation to RLN and inferior thyroid artery

A

Posterior to RLN, superior to inferior thyroid artery

34
Q

Indications for central neck dissection (5)

A 
(Path) Medullary thyroid cancer
(Rads) Imaging suspicious of central lymphadenopathy
(PE) Fixed or firm thyroid mass
(PE) Palpable lymphadenopathy
(PE) RLN paresis or paralysis
35
Q

Definition of Bethesda I and risk of malignancy

A

Nondiagnostic, 1-4%

36
Q

Management: Bethesda V

A

Surgical lobectomy or total thyroidectomy

Suspicious for malignancy

37
Q

Definition: central neck dissection

A

Remove soft tissues from:
Hyoid to manubrium
Carotid to carotid

38
Q

Pemberton maneuver/sign

A

Demonstrates the presence of latent pressure in the thoracic inlet. Patient elevates both arms until they touch the sides of the face.

A positive Pemberton’s sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute.

39
Q

Staging criteria for well-differentiated thyroid cancers

A

Age: for patients <45y, stage II is the highest possible stage
Tumor size: 2, 4, >4cm
Extrathyroidal spread: at least stage III
Lymph node involvement: at least stage III
Distant mets: Stage IVc

40
Q

Management: Bethesda IV

A

Surgical lobectomy

Follicular lesion or follicular neoplasm

41
Q

5y survival anaplastic thyroid cancer

A

5-10%

42
Q

10y survival Hurthle cell cancer

A

75%

43
Q

After diagnosis of medullary thyroid cancer, what is necessary prior to OR?

A

Rule out pheo

44
Q

External branch of superior laryngeal nerve supplies:

A

Cricothyroid muscle

45
Q

Ligament of Berry

A

Anchors thyroid to the inferior aspect of the cricoid cartilage

46
Q

PTC associated with which hereditary diseases?

A 
FAP
Gardner's
Cowden's disease
Werner's syndrome
Carney's complex

A patient with any of these and a thyroid nodule has an increased risk of PTC.

47
Q

When should prophylactic thyroidectomy be done in patients with MEN 2A?

A

By age 5

48
Q

10y survival medullary thyroid cancer

A

70-90%

49
Q

10y survival follicular thyroid cancer

A

85-92%

50
Q

Management: Bethesda I

A

Repeat FNA

Nondiagnostic

51
Q

How much does the ioPTH need to be drop to indicate that the correct gland has been removed?

A

At least 50% and in the normal range

52
Q

Total thyroidectomy for patients with PTC >1cm who (8):

A 
Are <15y or >45y
Have a history of radiation
Known distant mets
Bilateral nodules
Extrathyroidal extension
Tumor >4cm
Lymph node mets
Aggressive histology (including tall cell)
53
Q

Location of superior parathyroid

A

At the ligament of Berry and the tubercle of Zuckerkandl

54
Q

FNA finding suspicious for medullary thyroid carcinoma

A

Plasmacytoid, monomorphic morphology. Chromatin pattern is salt and pepper.

55
Q

What aldosterone to renin ratio are you looking for to determine if an adrenal mass is an aldosteronoma?

A

> 20

General Surgery (12 decks)

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