Endocrine, Head & Neck

Question 1

Management of septal hematoma

Answer 1

Early I&D (otherwise there can be fibrosis and necrosis of septal cartilage)

Question 2

Cushing disease

Answer 2

ACTH-secreting pituitary adenoma

Question 3

Diagnosis of gastrinoma

Answer 3

Serum gastrin >1000 or
Paradoxical increase in gastrin with secretin administration

Question 4

Symptoms of glucagonoma

Answer 4

Anemia, diabetes, stomatitis, dermatitis, weight loss

Question 5

Diagnosis of glucagonoma

Answer 5

Fasting serum glucagon >500-1000

Question 6

Insulinoma symptoms

Answer 6

Anxiety, dizziness, confusion, personality changes, seizures (sx worse in the morning)

Question 7

Diagnosis of insulinoma

Answer 7

72hr observed fast

Question 8

Location of insulinoma

Answer 8

Evenly distributed throughout pancreas

Question 9

Somatostatinoma symptoms

Answer 9

Steatorrhea, diabetes, hypochlorhydria, cholelithiasis

Question 10

Somatostatinoma diagnosis

Answer 10

Fasting plasma somatostatin >100

Question 11

VIPoma diagnosis

Answer 11

Serum VIP level 250-500

Question 12

What cancers are Peutz-Jeghers at risk for

Answer 12

Pancreatic, breast

Question 13

S-100 tumor marker - associated with?

Answer 13

Melanoma, neurofibroma, schwannoma

Question 14

Vimentin tumor marker - associated with?

Answer 14

Melanoma, colon, esophageal, gastric

Question 15

KRAS tumor marker - associated with?

Answer 15

Melanoma, colon

Question 16

HER2 tumor marker - associated with?

Answer 16

Breast, ovarian, lung, gastric, oral cancers

Question 17

Management incidentaloma - when to resect?

Answer 17

When >6cm (consider if 4-6cm)

Question 18

Chemoprevention for patients with FAP after TAC + ileorectal anastomosis

Answer 18

Sulindac

Question 19

VHL screening for which cancers

Answer 19

CNS and retinal hemangioblastomas, RCC, and pheochromocytomas

Question 20

Most common location for undifferentiated spindle cell tumor

Answer 20

Proximal tibia and distal metaphysis of femur

Question 21

Histology of undifferentiated spindle cell tumor

Answer 21

Fibroblasts in whirling patterns with multinucleated giant cells, inflammatory cells, and foamy mononuclear giant cells

Question 22

Management of spindle cell tumors

Answer 22

Neoadjuvant chemo -> surgery with wide margins

Question 23

Histology of pleomorphic adenoma (salivary gland tumor)

Answer 23

Stromal tissue with groups of epithelial and myoepithelial cells

Question 24

Most common mutation in PDAC

Answer 24

KRAS

Question 25

Only thyroid cancer that metastasizes hematogenously

Answer 25

Follicular

Question 26

Management of follicular thyroid cancer

Answer 26

Partial thyroidectomy
Total thyroidectomy only done if: radioactive iodine therapy is planned, nodule is >4cm, extrathyroidal invasion, or mets

Question 27

Pathology of papillary thyroid cancer

Answer 27

Intranuclear inclusion bodies (Orphan annie eyes), Psammoma bodies

Question 28

Follow-up for medullary thyroid cancer after resection

Answer 28

CEA & calcitonin q3-6mo
[Neck US if any suspicion of recurrence]

Question 29

MEN1 syndrome

Answer 29

Pituitary adenomas
Hyperparathyroidism
PNETs

Question 30

MEN2A

Answer 30

Medullary thyroid cancer
Hyperparathyroidism
Pheochromocytoma

Question 31

MEN2B

Answer 31

Medullary thyroid cancer
Pheochromocytoma
Mucosal neuromas
Marfanoid habitus

Question 32

MEN4 syndrome

Answer 32

Hyperparathyroidism
Pituitary tumors
Neuroendocrine tumors
Uterine, testicular, colonic tumors

Question 33

Gene mutation in MEN4 syndrome

Answer 33

CDKN1B

Question 34

Maxillary torus

Answer 34

Benign osteoblastic tumor arising from the hard palate

Question 35

What to give if hypertensive episode occurs intraop with pheochromocytoma

Answer 35

Nicardipine or nitroprusside (titratable agents)

Question 36

What if you get Hurthle cells on thyroid FNA?

Answer 36

Non-diagnostic -> patient should get a diagnostic thyroid lobectomy

Question 37

Gastrinoma triangle borders

Answer 37

CBD, neck of pancreas, and 3rd portion of duodenum

Question 38

Most common location of an ectopic superior parathyroid gland

Answer 38

Tracheoesophageal groove

Question 39

Boundaries of a central neck dissection

Answer 39

Hyoid bone (superior)
Innominate artery (inferior)
Carotid arteries (lateral)

Question 40

Most common location for Ewing sarcoma

Answer 40

Pelvis (onion skin appearance)

Question 41

What is the hypothesized reason for resistance to radiation therapy?

Answer 41

Tumor hypoxia and low levels of oxygen free radicals

Question 42

When to FNA a thyroid nodule

Answer 42

> 1cm
Hypoechoic
Solid
Irregular margins
Any calcifications
Taller-than-wider shape

Question 43

Bethesda criteria for thyroid cytopathology: I

Answer 43

Nondiagnostic
Repeat FNA in 4-6wks

Question 44

Bethesda criteria for thyroid cytopathology: II

Answer 44

Benign
Observation with repeat US in 1-2yrs

Question 45

Bethesda criteria for thyroid cytopathology: III

Answer 45

Atypia/follicular lesion of unknown significance
Molecular testing or surgery

Question 46

Bethesda criteria for thyroid cytopathology: IV

Answer 46

Follicular neoplasm
Molecular testing or surgery

Question 47

Bethesda criteria for thyroid cytopathology: V

Answer 47

Suspicious for malignancy
Surgery

Question 48

Bethesda criteria for thyroid cytopathology: VI

Answer 48

Malignant
Surgery

Question 49

Calcium-to-creatinine clearance ratio >0.02 with hypercalcemia

Answer 49

Primary hyperparathyroidism

Question 50

Calcium-to-creatinine clearance ratio <0.01 with hypercalcemia

Answer 50

FHH

Question 51

Monitoring for nonfunctioning adrenal tumor

Answer 51

Imaging in 6, 12, and 24 mo
Annual hormone testing for 4yrs
(If growth more than 1cm/yr or hormonal secretion: resect)