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True Learn Studying 2021 > Endocrine Surgery review > Flashcards

Endocrine Surgery review Flashcards

1
Q

What structure does the left recurrent laryngeal nerve pass under?

A
  • ligamentum arteriosus (ductus arteriosus in fetal development)
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2
Q

What nerve innervates the cricothyroid muscle?

A
  • external branch of superior laryngeal nerve
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3
Q

What does the cricothyroid muscle do?

A
  • controls pitch of voice
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4
Q

Patient reports low pitch after thyroidectomy…what happened?

A
  • you injured the external branch of the superior laryngeal nerve
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5
Q

Describe primary hyperparathyroidism

A
  • unregulated overproduction of PTH resulting in elevated calcium levels
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6
Q

Describe secondary hyperparathyroidism

A
  • up regulation of PTH in the setting of low calcium

- seen frequently in patients with ESRD

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7
Q

Describe tertiary hyperparathyroidism

A
  • up regulation of PTH as a result of chronic secondary hyperparathyroidism
  • patient has developed thyroid hyperplasia
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8
Q

how do you treat tertiary hyperparathyroidism

A
  • resection of 3.5 parathyroid glands
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9
Q

what is the first thing you check when working up a patient’s thyroid function?

A
  • get a thyroid stimulating hormone level (TSH)
  • in clinical practice you will usually pair this with a T3/T4 level on the off chance the TSH is abnormal…easier for patient to get both test simultaneously
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10
Q

what germinal area are the inferior parathyroid glands derived from?

A

3rd pharyngeal pouch

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11
Q

where are ectopic inferior parathyroid glands typically located?

A

within the thyrothymic ligament

  • remember that inferior parathyroid glands descend with the thymus from the 3rd pharyngeal pouch
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12
Q

what size of thyroid nodule gets FNA no matter what else is seen on Ultrasound

A

1.5 cm or larger get an FNA no matter what

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13
Q

what are the suspicious features of a thyroid nodule that would prompt FNA

A
  • solid vs cystic
  • irregular borders
  • hypoechogenicity
  • microcalcifications
  • more tall than wide
  • increased intranodular vascularity
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14
Q

most common cause of hyperaldosteronism

A

bilateral adrenal hyperplasia

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15
Q

what is Conn Syndrome

A

primary aldosteronism

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16
Q

Hypertension refractory to medication
hypokalemia

what does this person have

A

Conn Syndrome

- AKA: primary aldosteronism

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17
Q

is radiation uptake increased or decreased in acute thyroiditis?

A

decreased

18
Q

how does PTH cause release of calcium from bones?

A
  • activate Osteoblasts which intern activate the osteoclasts that cause calcium to be released from bones
  • Osteoclasts do not have PTH receptors
19
Q

how does PTH work to increase calcium absorption in the gut?

A
  • indirectly increase absorption via vitamin D increase

- does this by increasing activity of enzyme 1-alpha-hydroxylase found on renal tubes (activate precursor to Vitamin D)

20
Q

You encounter Hurthle cells on FNA from a thyroid nodule, next step?

A
  • diagnostic thyroid lobectomy

hurthle cells can be seen in hashimotos, colloid nodules, and Hurthle cell carcinoma

21
Q

Confirmed Hurthle cell carcinoma in thyroid nodule, next step?

A

Total thyroidectomy with central lymph node dissection +/- modified radical neck dissection if + LNs found

22
Q

severely elevated calcitonin levels, what should you think about?

A

medullary thyroid carcinoma

23
Q

you suspect medullary thyroid carcinoma, what should you check for

A

pheochromocytoma, 25% of MTCs are caused by RET proto-oncogene mutation

24
Q

most common cause of congenital adrenal hyperplasia

A

deficiency of 21-hydroxylase

results in deficiency of glucocorticoids and mineralocorticoids, which causes negative feedback on pituitary -> increase in ACTH production

25
Q

most common lab abnormality in congenital adrenal hyperplasia, which will diagnose the issue

A

elevated 17-hyrdoxyprogesterone

because there is a deficiency in 21-hydroxylase

26
Q

what should your AM cortisol and ACTH be in primary adrenal insufficiency?

A

low cortisol

high ACTH

27
Q

you suspect adrenal insufficiency, you do an AM cortisol and ACTH. They come back low for both…next step?

A
  • so this may be secondary or tertiary adrenal insufficiency
  • CRH stimulation test
28
Q

what is a normal response to a 250 mcg ACTH test?

A

a cortisol level greater than 18 mcg/dL

29
Q

what kind of islet cells make insulin?

A

beta islet cells

30
Q

what kind of islet cells make glucagon?

A

alpha islet cells

31
Q

what kind of islet cells make somatostatin?

A

delta islet cells

32
Q

What causes the hyperpigmentation in adrenal insufficiency?

A

lack of negative feedback on pituitary causes unregulated increase in ACTH, which stimulates melanocytes

33
Q

how do you treat a thyroid storm

A
  • treat precipitating event
  • methimazole or propylthiouracil (PTU if after thyroidectomy)
  • dexamethasone can be useful
34
Q

if you have a non-recurrent RLN on the left, what other anomaly does the patient have?

A
  • a right sided aortic arch
35
Q

if you have a non-recurrent RLN on the right what other anomaly does the patient have?

A
  • an aberrant subclavian that runs behind the esophagus (arteria lusoria)
36
Q

indication for resection in an adrenal mass < 4cm, based on imaging

A
  • heterogenous
  • hyper vascular
  • > 10 hounds field units
37
Q

orientation of RLN and inferior thyroid artery

A
  • on right the RLN runs anterior to ITA

- on left the RLN runs posterior to ITA

38
Q

During pregnancy which anti-thyroid Drug can you use?

A
  • PTU is preferred during 1st trimester

- can be changed to methimazole afterwards

39
Q

how do you track recurrence of well differentiated thyroid cancer

A

thyroglobulin

40
Q

common metabolic derangement of primary hyperaldoteronism

A
  • hypernatremia

- hypokalemia

True Learn Studying 2021 (27 decks)

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