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ABSITE Flash Cards > Endocrine Surgery > Flashcards

Endocrine Surgery Flashcards

1
Q

When does calcitonin reach its nadir after thyroidectomy

A

several months later

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2
Q

which medications cause an increase in hepatic metabolism of thyroid hormone?

A

anti-epileptics (e.g. phenobarbital, carbamazepine, and phenytoin)

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3
Q

Patient with hyperparathyroidism and thyroid nodule consistent with medullary thyroid carcinoma, what should you think about?

A

MEN2A
- check metanephrines prior to surgery

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4
Q

patient s/p 3 1/2 parathyroidectomy, obs overnight. Perioral numbness and finger tip numbness refractory to oral calcium…next step

A

IV calcium gluconate, BMP draw

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5
Q

Initial treatment for hypercalcemia secondary to hyperparathyroidism

A
  • fluid resuscitation
  • then after they are resuscitated loop diuretic and sestamibi scan
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6
Q

First test to order in any patient after some kind of thyroid resection if they have symptoms

A

TSH

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7
Q

indication for surgical treatment of hyperparathyroidism

A
  • Ca concentration 1.0 or above
  • T-score of -2.5 or less
  • Vertebral fracture
  • Creatinine clearance < 60 mL/min
  • 24 urinary calcium > 400 mg/d
  • presence of nephrolithiasis
  • age < 50
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8
Q

parathyroid taken for histology shows single focus of chief cells, surrounded by a compressed rim of normal tissue

A

parathyroid adenoma

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9
Q

parathyroid taken for histology shows diffuse proliferation of clear cells with little remaining normal tissue

A

parathyroid hyperplasia

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10
Q

parathyroid taken for histology shows marked mitotic activity, dense fibrous stroma, and evidence of local invasion into the capsule or surrounding vessels

A

parathyroid malignancy

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11
Q

parathyroid taken for histology shows the presence of C cell hyperplasia and dispersed plasmacytoid cells

A

medullary thyroid carcinoma

You got a lymph node not a parathyroid gland

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12
Q

female with strong family history of thyroid cancer, genetic testing shows gain of function in RET protocol-oncogene. what type of cancer is she predisposed to?

A

Medullary thyroid cancer

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13
Q

Patient with hyperthyroidism, with diffuse uptake on imaging (no hot or cold nodules). What is the first step in treatment?

A

initiation of anti-thyroid medication and beta-blockade

must be euthyroid before any definitive management

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14
Q

risk of malignancy in patients younger than 14 if they have a thyroid nodule

A

50%

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15
Q

Miami Criterion for intraoperative PTH monitoring

A

50% drop in PTH at 10 minutes post excision, if not met then redraw PTH at 20 minutes post excision. If still above the 50% threshold at 20 minutes then explore other parathyroid glands

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16
Q

What do you use the Secretin Stimulation test for?

A
  • presence of gastrinoma
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17
Q

How do you test for the presence of a gastrinoma?

A
  • Secretin stimulation test
  • considered positive if gastrin level > 120 pg/mL
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18
Q

Adrenal mass that measures 4.1 cm and has loss of signal on opposed-phase chemical shifting imaging (MRI). What is this mass most likely

A

Adrenal Adenoma

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19
Q

Which anti-thyroid medication is used during the first trimester?

A

Propylthiouracil (PTU)

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20
Q

Which anti-thyroid medication is used after the start of the second trimester?

A

Methimazole (MMI)

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21
Q

Which anti-thyroid medication is preferred if there are no contraindications

A

Methimazole (MMI)

Better side effect profile

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22
Q

net effect of parathyroid hormone release

A

elevation of serum calcium levels

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23
Q

scan used to assess pheochromocytomas

A

FDG F-DOPA

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24
Q

best treatment for recurrent parathyroid cancer?

A

repeat surgery

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25
Q

Features on US that would suggest thyroid malignancy

A
  • taller than wide
  • solid component
  • hypo-echoic echogenicity
  • irregular borders
  • hyper-vascular
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26
Q

you find parathyroid tissue invading adjacent structures when exploring for a presumed parathyroid adenoma, what is this?

A

Parathyroid malignancy

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27
Q

what kind of resection is standard for a parathyroid malignancy

A
  • enbloc resection of parathyroid mass and any adjacent tissue (ipsilateral thyroid lobe and isthmus)
  • central lymph node dissection
28
Q

what lab value do you use to track recurrence of thyroid carcinoma?

A

thyroglobulin

29
Q

what is the next step after identification of a pheochromocytoma

A

Alpha blockade

30
Q

describe post-operative subclinical hypothyroidism after a thyroid lobectomy

A
  • asx patient
  • elevated TSH
  • low or normal free thyroxine (T4)
31
Q

what test can you use that is specific for graves disease

A

Thyroid-Stimulating hormone receptor Antibodies (TRAb)

32
Q

first line anti-hypertensive intra-op for a pheochromocytoma

A

Nitroprusside

33
Q

what does Bethesda III correspond to

A

atypia of undetermined significance, for a thyroid nodule

  • repeat FNA or lobectomy
34
Q

patient with goiter and elevated anti-thyroid peroxidase antibodies, what do they have

A

Hashimoto Thyroiditis

35
Q

when performing a 4-gland exploration in the setting of MEN1 for hyperparathyroidism, what else needs to be included to ensure all hyperactive parathyroid tissue is removed

A

Thymectomy

36
Q

major landmarks to identify during thyroidectomy to avoid injuring recurrent laryngeal nerve

A
  • superior parathyroid
  • tubercle of Zuckerkandl
  • ligament of berry
  • tracheoesophageal groove
  • crossing of inferior thyroid artery
37
Q

most common location to injure recurrent laryngeal nerve during thyroidectomy

A

ligament of berry (where thyroid attaches to tracheal rings)

38
Q

what is a normal value for TSH

A

.05-5.0 mlU/L

39
Q

which IV steroid is short-acting

A

Hydrocortisone

40
Q

which IV steroid is long-acting

A

Methylprednisone

41
Q

what is a “stress dose” of hydrocortisone in a patient with adrenal crisis

A

100 mg IV

42
Q

how do you treat a trauma patient with suspected HPA suppression

A
  • 100 mg IV bolus of hydrocortisone
  • followed by 200 mg/24hr of hydrocortisone (continuous or in bolus 50mg/6hr)
43
Q

Mnemonic for adrenal gland hormone production by location within the gland

A

GFR
salt, sugar sex

  • aldosterone - Zona glomerulosa
  • glucocorticoids - Zona fasciculata
  • sex steroids - Zona reticulosa
44
Q

in what part of the adrenal gland are mineralocorticoids made

A

Zona glomerulosa

45
Q

in what part of the adrenal gland are glucocorticoids made

A

Zona fasciculata

46
Q

in what part of the adrenal gland are sex steroids made

A

Zona reticulosa

47
Q

what kind of parathyroid surgery do you perform in MEN1

A

excision of 3.5 glands to prevent recurrent hyperparathyroidism

48
Q
  • aldosterone is made in what part of the adrenal gland
A

Zona glomerulosa

49
Q
  • glucocorticoids is made in what part of the adrenal gland
A
  • Zona fasciculata
50
Q
  • sex steroids are made in what part of the adrenal gland
A
  • Zona reticulosa
51
Q

Patient with MEN1, what kind of parathyroid resection do you need

A

3.5 glands removed

52
Q

how do you determine the dose of glucocorticoid replacement in a patient

A

12 mg/m^2

53
Q

where are superior parathyroid glands typically located?

A

posteromedial surface of middle/superior thyroid. posterior to recurrent laryngeal nerve

54
Q

where is the most common location for an ectopic superior parathyroid gland

A

tracheo-esophageal groove

55
Q

what compartments are included a lateral neck dissection

A

II, III, IV, and V

56
Q

What landmarks in the neck, in the longitudinal plane separate compartments?

A

Hyoid bone and cricoid cartilage

57
Q

what landmarks in the neck, in the horizontal plane, separate compartments

A

Midline, carotid artery, and lateral edge of sternocleidomastoid

58
Q

tumor marker for papillary thyroid cancer

A

Thyroglobulin

59
Q

Tumor Marker for medullary thyroid cancer

A

Calcitonin

60
Q

Most common atypical location for pheochromocytoma?

A

Peri-aortic fat at that bifurcation of aorta

61
Q

What is the collection of chromaffin cells within the peri-aortic fat at the bifurcation of the aorta called, and what is the significance?

A

Organ of Zuckerandl

  • atypical location of pheochromocytoma
62
Q

Psammoma bodies on FNA of a thyroid nodule…pathognomonic for?

A

thyroid cancer

63
Q

Classic cytologic features of papillary thyroid cancer?

A

overlapping nuclei
intranuclear grooves

64
Q

what must you do whenever you encounter a patient with an adrenal mass

A

measure 24-hour urine catecholamines and metabolites

  • need to rule out pheochromocytoma
65
Q

most common locations for ectopic inferior glands, during parathyroidectomy

A
  • thymus
  • thyroid lobe, after division of middle thyroid vein to allow more mobilization
  • last step is hemi-thyroidectomy
66
Q

What is the role of glucocorticoids in thyroid storm

A

decrease the peripheral conversion of T4 to T3

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