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Endocrinology Fellowship > Endocrine University 2014 > Flashcards

Endocrine University 2014 Flashcards

0
Q

How big does a thyroid nodule need to be to be detected by thyroid ultrasonography?

A

2 - 3 mm

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1
Q

How much does the thyroid gland weigh?

A

20 - 25 grams

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2
Q

Describe echogenicity of normal thyroid gland on thyroid ultrasonography.

A

High intensity homogeneous echo pattern with little identifiable internal architecture.

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3
Q

Describe echogenicity of Hashimoto’s thyroiditis on thyroid ultrasonography.

A

Heterogeneous hypoechoic echotexture.

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4
Q

How thick is a normal thyroid isthmus?

A

Less than 5 mm

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5
Q

How do you measure the volume of the thyroid gland on ultrasonography?

A

Calculate volume by multiplying the three dimensions (W x D x L) and then multiplying by a correction factor (formula of an ellipsoid).
Traditional correction factor: pi/6 = 0.524
WHO recommendation: 0.479
Acceptable correction factors: 0.494 - 0.554.

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6
Q

What is a nodule with a hilar line on thyroid ultrasonography?

A

Lymph node

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7
Q

What happens to the lymph nodes in Hashimoto’s thyroiditis?

A

Matted clustered nodes, often with abnormal shape and loss of hilar line.

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8
Q

Frequency of which cancer is increased in Hashimoto’s thyroiditis?

A

Papillary thyroid cancer.

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9
Q

What should you do when you feel a thyroid nodule?

A

Get a thyroid ultrasound.

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10
Q

Thyroid Ultrasonography

Are benign nodules more likely to be hyper- or hypoechoic?

A

Hyperechoic

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11
Q

Thyroid Ultrasonography

Smooth margin often with a ‘halo’.

More likely to be:
Benign or malignant?

A

Benign

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12
Q

Thyroid Ultrasonography

Thick, irregular halo.

More likely to be:
Benign or malignant?

A

More suggestive of malignancy.

Follicular or Hurthle cell carcinoma or adenoma.
Encapsulated papillary cancer follicular variant.

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13
Q

Thyroid Ultrasonography

Thin-walled cyst without a solid component.

More likely to be:
Benign or malignant?

A

Benign.

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14
Q

Thyroid Ultrasonography

Colloid within cystic nodule - comet tail or ‘cat’s eye’.

More likely to be:
Benign or malignant?

A

Benign

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15
Q

Thyroid Ultrasonography

Intact eggshell calcification.

More likely to be:
Benign or malignant?

A

Benign

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16
Q

Thyroid Ultrasonography

Interrupted eggshell calcifications.

More likely to be:
Benign or malignant?

A

More likely malignant.

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17
Q

Thyroid Ultrasonography

Low vascularity.

More likely to be:
Benign or malignant?

A

Benign.

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18
Q

Thyroid Ultrasonography

Multiple blocks of hyperechogenicity separated by bands of hypoechogenicity.

More likely to be:
Benign or malignant?

A

Benign

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19
Q

Thyroid Ultrasonography

Do discrete nodules need to be evaluated individually?

A

Yes

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20
Q

Thyroid Ultrasonography

Spongiform echotexture.

More likely to be:
Benign or malignant?

A

Benign

Only 1 in 360 cancers have this appearance.
Specificity: 99.7%

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21
Q

Thyroid Ultrasonography

Name the nodules with the following descriptions:

  • aggregation of multiple microcystic components in more than 50% of the volume of the nodule.
  • “honeycomb of internal cystic spaces”
A

“Spongiform” nodules

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22
Q

What is the best indication of a benign thyroid nodule on thyroid ultrasonography?

A

Shrinkage of a nodule over time.

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23
Q

Thyroid Ultrasonography

Hypoechoic solid nodule.

More likely to be:
Benign or malignant?

A

Malignant

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24
Q

Thyroid Ultrasonography

What are the following characteristics suggestive of?

  • Hypoechoic or heterogeneous nodule.
  • Irregular or ‘infilterative’ margins.
  • Irregular mural component of cyst.
  • Invasion of adjacent tissue/muscle.
  • Sonographically suspicious cervical lymphadenopathy.
  • Microcalcifications/macrocalcifications
  • ‘Taller than wide’ shape on transverse view.
A

Papillary thyroid cancer

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25
Q

Thyroid Ultrasonography

‘Intra-cystic cauliflower appearance’

What is the likely diagnosis?

A

Cystic papillary carcinoma

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26
Q

Thyroid Ultrasonography

How big are macrocalcifications and what do they look like?

A

More than 2 mm.

Dense hyperechoic spots with acoustic shadowing.

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27
Q

What is the term ‘thyroid inferno’ used to describe?

A

Increased vascularity seen on Doppler US in Grave’s Disease.

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28
Q

Is there one definition of ‘adequate sample’ when preparing thyroid slides?

A

No

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29
Q

Adequate thyroid FNA biopsy according to The Papanicolaou Society of Pathology …

A

6 - 8 groups of well preserved follicular cells with 10 or more cells per group.

“6 groups of 10”

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30
Q

How many surgical levels in the neck are they?

A

6

Labeled in Roman numerals.

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31
Q

Surgical compartments of the neck:

Compartment I

A

Submandibular to the hyoid bone in the center (under the chin).

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32
Q

Surgical compartments of the neck:

Compartment VI

A

From the submandibular notch to the hyoid bone - in the center of the neck.

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33
Q

Surgical compartments of the neck:

Compartment V

A

Posterior to the sternocleidomastoid.

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34
Q

Surgical compartments of the neck:

Compartment IV

A

From the clavicle to the cricoid cartilage deep to the sternocleidomastoid on the lateral sides of the neck.

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35
Q

Surgical compartments of the neck:

Compartment III

A

Between the cricoid cartilage and the hyoid bone deep to the sternocleidomastoid on the lateral sides of the neck.

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36
Q

Surgical compartments of the neck:

Compartment II

A

From the hyoid bone to the base of the skull and angle of the mandible.

IIB - deep to the sternocleidomastoid.
IIA - anterior to the sternocleidomastoid.

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37
Q

Does prophylactic lateral neck dissection improve recurrence free survival in patients with preoperative US negative for lymph nodes?

A

No

38
Q

Does lateral neck dissection alter the outcome in patients with preoperative US positive for lymph nodes?

A

Modified neck dissection at the time of initial thyroidectomy improves survival if there is ‘macroscopic’ lateral lymph node metastasis on ultrasonography.

39
Q

What should be done when an abnormal/suspicious lymph node is detected on thyroid ultrasonography?

A

If a positive result would change management then the lymph node should be biopsied for cytology with thyroglobulin measurement in the needle wash out fluid.

40
Q

How big does an abnormal lymph node found on thyroid US have to be before it can be biopsied?

A

Greater than 5 - 8 mm in its smallest diameter.

41
Q

What gauge needle should you use for thyroid FNA biopsy?

A

25 - 27 gauge

42
Q

What gauge needle should you use for draining thyroid cysts?

A

22 gauge

43
Q

If there is blood in the hub is the dwell time too long or too short?

A

Too long.

44
Q

Which receptor is cabergoline specific for?

A

D2

45
Q

Which drug has been shown to be more likely to cause valvular abnormalities - bromocriptine or cabergoline?

A

Cabergoline

46
Q

When was I-131 discovered?

A

1938

47
Q

Who discovered I-131?

A

Glen Seaborg

48
Q

What is the half life of I-131?

A

8 days

49
Q

Do Doppler grades apply to parathyroid glands?

A

No

50
Q

Is the brand name of the machine and the mHz of the probe relevant to the thyroid ultrasound report?

A

No

51
Q

Which two words do you use to describe the texture of the thyroid gland on ultrasonography?

A

Heterogeneous

Homogeneous

52
Q

Does growth hormone deficiency persist into adulthood?

A

It does usually persist.

53
Q

What is the AACE recommended HbA1c goal for patients without concurrent illness and at low risk for hypoglycemia?

A

6.5% or less.

54
Q

Name two alpha glucosidase inhibitors.

A

Acarbose.

Miglitol.

55
Q

What is the mechanism of action of alpha-glucosidase inhibitors?

A

Delays/decreases carbohydrate absorption from the intestine.

56
Q

Name one amylin analogue.

A

Pramlintide.

57
Q

What is the mechanism of action of amylin analogues?

3 points

A
  • Decreases glucagon secretion.
  • Slows gastric emptying.
  • Increases satiety.
58
Q

What is the mechanism of action of biguanides?

2 points

A
  • Decreases HGP

- Increases glucose uptake in muscle.

59
Q

Name one bile acid sequestrant.

A

Colesevelam

60
Q

Name four DPP-4 inhibitors.

A

Saxagliptin
Sitagliptin
Linagliptin
Alogliptin

61
Q

What is the mechanism of action of DPP-4 inhibitors?

2 points

A
  • Increase glucose-dependent insulin secretion.

- Decreases glucagon secretion.

62
Q

Brand Name: Nesina

Generic: ?

A

Alogliptin

63
Q

Brand name: Tradjenta

Generic: ?

A

Linaglipin

64
Q

Brand Name: Onglyza

Generic: ?

A

Saxagliptin

65
Q

Brand Name: Januvia

Generic: ?

A

Sitagliptin

66
Q

Brand Name: Cycloset

Generic: ?

A

Bromocriptine

67
Q

Name two glinides.

A

Nateglinide

Repaglinide

68
Q

Brand Name: Starlix

Generic: ?

A

Nateglinide.

69
Q

Brand Name: Prandin

Generic: ?

A

Repaglinide.

70
Q

What is the mechanism of action of glinides?

A

Increase insulin secretion.

71
Q

What is the mechanism of action of GLP-1 inhibitors?

Four points

A
  • Increases glucose-dependent insulin secretion.
  • Decreases glucagon secretion.
  • Slows gastric emptying.
  • Increases satiety.
72
Q

Brand Name: Byetta

Generic: ?

A

Exenatide

73
Q

Brand Name: Bydureon XR

Generic: ?

A

Exenatide XR

74
Q

Brand Name: Victoza

Generic: ?

A

Liraglutide

75
Q

What is the mechanism of action of SGLT2 inhibitors?

A

Increases urinary excretion of glucose.

76
Q

Brand Name: Invokana

Generic: ?

A

Canagliflozin

77
Q

Brand Name: Amaryl

Generic: ?

A

Glimipiride.

78
Q

Brand Name: Glucotrol

Generic: ?

A

Glipizide.

79
Q

Brand Name: Actos

Generic: ?

A

Pioglitazone

80
Q

Brand Name: Avandia

Generic: ?

A

Rosiglitazone.

81
Q

Brand Name: Glynase

Generic: ?

A

Glyburide.

82
Q

Brand Name: Diabeta

Generic: ?

A

Glyburide.

83
Q

Brand Name: Micronase

Generic: ?

A

Glyburide

84
Q

What is the mechanism of action of thiazolidinediones?

Two points

A
  • Increases glucose uptake in the muscle and fat.

- Decreases HGP

85
Q

For diagnosing a pheochromocytoma, which is more reliable…

Imaging phenotype or biochemical testing?

A

Imaging phenotype.

86
Q

What should the Hounsfield units be if an adrenal mass is suspicious for a pheochromocytoma?

A

Greater than 20 Hounsfield Units.

87
Q

What should the contrast washout be if an adrenal mass is suspicious for a pheochromocytoma?

A

Less than 50% contrast washout at 10 minutes.

88
Q

Where are epinephrine/metanephrine predominant tumors usually localised to?

(Hint: two places)

A
  • Adrenal medulla

- Organ of Zuckerkandl

89
Q

Where are norepinephrine/normetanephrine predominant tumors usually localised to?

(Hint: two places)

A
  • Adrenal medulla

- Sympathetic paraganglioma in the neck, chest, abdomen or pelvis.

90
Q

What is the TSH target for women before conception?

A

0.3 - 2.5 mIU/L

91
Q

What is the TSH target in the first trimester of pregnancy?

A

0.01 - 2.5 mIU/L

92
Q

What is the TSH target for the second and third trimester of pregnancy?

A

0.01 - 3 mIU/L

Endocrinology Fellowship (30 decks)

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