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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?

25
Equation to correct calcium for hypoalbuminemia
Corrected calcium = serum calcium + 0.8(4 - albumin) Add 80% of the albumin deficit to the serum calcium
26
Definition of Bethesda II and risk of malignancy
Benign, 0-3%
27
In patients with primary hyperparathyroidism, what proportion have a solitary adenoma>
80-85%
28
Frequency follicular thyroid cancer
11% of primary thyroid malignancies
29
Tubercle of Zuckerkandl
Posterolateral pyramidal extension of the thyroid Marker for location of superior parathyroid gland at ToZ and ligament of Berry
30
Sensitivity of sestamibi scan alone in localizing single parathyroid adenoma
80-90%
31
Trismus
Tonic contraction of the muscles of mastication (lockjaw)
32
What is the only thyroid cancer that is not female predominant?
Medullary thyroid cancer
33
Position of superior parathyroid gland in relation to RLN and inferior thyroid artery
Posterior to RLN, superior to inferior thyroid artery
34
Indications for central neck dissection (5)
``` (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
Definition of Bethesda I and risk of malignancy
Nondiagnostic, 1-4%
36
Management: Bethesda V
Surgical lobectomy or total thyroidectomy | Suspicious for malignancy
37
Definition: central neck dissection
Remove soft tissues from: Hyoid to manubrium Carotid to carotid
38
Pemberton maneuver/sign
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
Staging criteria for well-differentiated thyroid cancers
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
Management: Bethesda IV
Surgical lobectomy | Follicular lesion or follicular neoplasm
41
5y survival anaplastic thyroid cancer
5-10%
42
10y survival Hurthle cell cancer
75%
43
After diagnosis of medullary thyroid cancer, what is necessary prior to OR?
Rule out pheo
44
External branch of superior laryngeal nerve supplies:
Cricothyroid muscle
45
Ligament of Berry
Anchors thyroid to the inferior aspect of the cricoid cartilage
46
PTC associated with which hereditary diseases?
``` 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
When should prophylactic thyroidectomy be done in patients with MEN 2A?
By age 5
48
10y survival medullary thyroid cancer
70-90%
49
10y survival follicular thyroid cancer
85-92%
50
Management: Bethesda I
Repeat FNA | Nondiagnostic
51
How much does the ioPTH need to be drop to indicate that the correct gland has been removed?
At least 50% and in the normal range
52
Total thyroidectomy for patients with PTC >1cm who (8):
``` 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
Location of superior parathyroid
At the ligament of Berry and the tubercle of Zuckerkandl
54
FNA finding suspicious for medullary thyroid carcinoma
Plasmacytoid, monomorphic morphology. Chromatin pattern is salt and pepper.
55
What aldosterone to renin ratio are you looking for to determine if an adrenal mass is an aldosteronoma?
>20

General Surgery (12 decks)

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