Fiser ABSITE Ch. 23 Parathyroid Flashcards

1
Q

Where do the superior parathyroid originate? and inferior?

A

4th pharyngeal pouch, 3rd pharyngeal pouch

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2
Q

Where are the superior parathyroids in relation to the RLNs? and the inferior?

A

lateral, medial

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3
Q

Where are the superior parathyroids in relation to the inferior thyroid artery? and inferior parathyroids?

A

above, below

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4
Q

What is the blood supply to the parathyroids?

A

inferior thyroid artery

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5
Q

What is the most common ectopic site for parathyroids?

A

tail of the thymus

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6
Q

What is a normal Ca level range?

A

8.5-10.5

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7
Q

What is a normal PTH level range?

A

5-40

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8
Q

What is the most common cause of hypoparathyroidism?

A

previous thyroid surgery

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9
Q

What is the name form bone lesions from Ca resorption; characteristic of hyperparathyroidism?

A

Osteitis firbrosa cystica (brown tumors)

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10
Q

Indications for parathyroid surgery include symptomatic disease or asymptomatic disease with Ca above what level?

A

13

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11
Q

What percentage of pts with hyperparathyroid have single adenoma? multiple adenomas? diffuse hyperplasia?

A

single adenoma 80%
multiple adenomas 4%
diffuse hyperplasia 15%

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12
Q

Hyperparathyroidism in pregnancy carries a risk of still birth. In what trimester do you operate?

A

2nd

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13
Q

What is the half-life of PTH?

A

10 minutes

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14
Q

What should be done if parathyroid CA is found?

A

radical parathyroidectomy and take ipsilateral thyroid

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15
Q

What are the three causes of postop hypocalcemia after parathyroid surgery?

A

bone hunger, hypomagnesmia, failure of parathyroid remnant or graft

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16
Q

Hypocalcemia postop after parathyroid surgery. What will the levels of PTH and HCO3- be if the cause is bone hunger? and what if it is aparathyroidism?

A

Bone hunger - normal PTH, decreased HCO3_ Aparathyroidism - decreased PTH, normal HCO3_

17
Q

What is the study that is used in hyperparathyroidism that is good for picking up adenomas and ectopic glands but not 4-gland hyperplasia?

A

sestamibi-technetium-99

18
Q

What is the most common indication for surgery in secondary hyperparathyroidism?

A

bone pain

19
Q

What diagnosis should you consider if pt has Ca 9-11, normal PTH (30-60), _ urine Ca?

A

Familial hypercalcemic hypocalciuria

20
Q

What is the cause of familial hypercalcemic hypocalciuria?

A

Caused by defect in PTH receptor in distal convoluted tubule of the kidney that causes _ resorption of Ca

21
Q

What is the tx for familial hypercalcemic hypocalciuria?

A

Nothing, no parathyroidectomy because Ca generally not that high

22
Q

What is the most common location for metastases of parathyroid cancer?

A

the lung

23
Q

List the MEN syndromes and components?

A

MEN I: parathyroid hyperplasia, pancreatic islet cell tumors, pituitary adenomas
MEN IIa: parathyroid hyperplasia, pheochromocytoma, medullary CA of the thyroid
MEN IIb: pheochromocytomas, medullary CA of thyroid, mucosal neuromas, marfan’s habitus

24
Q

Name the drug used in the management of hypercalcemia that inhibits osteoclasts (used with malignancies or failure of conventional treatment); has hematologic, liver, and renal side effects.

A

Mithramycin

25
Q

When breast CA metastases to bone, what causes hypercalcemia?

A

release of PTHrp

26
Q

What hormone is responsible for duct development of the breast? and lobular development? and what hormone synergizes those two?

A

estrogen, progesterone, prolactin