Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Head & Neck > thyroid & parathyroid > Flashcards

thyroid & parathyroid Flashcards

1
Q

FNA results on medullary thyroid carcinoma

A

amyloid deposits from calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

True or false. Parathyroid carcinoma has a high rate of local recurrence

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

indications for surgical intervention for asymptomatic primary hyperparathyroidism:

A

age younger than 50
calcium level greater than 1 mg/dL above normal range
nephrolithiasis
osteoporosis with T score higher than -2.5 standard deviations from mean
compression fractures, nephrolithiasis, or nephrocalcinosis on imaging
urinary calcium >400micrograms per 24 hrs or high risk stone panel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bethesda III

A

atypia of undetermined significance; repeat FNA or lobectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

treatment of papillary thyroid cancer <4cm without nodal involvement or invasion and normal contralateral lobe:

A

thyroid lobectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

true or false. lymph node dissection is necessary for papillary thyroid cancer even if there is no evidence of nodal involvement on imaging or exam

A

false

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Miami criterion for parathyroid removal:

A

more than 50% drop in PTH level at 10 minutes following excision of suspected gland compared to teh highest pre-incision or pre-excision PTH level is predictive of surgical cure
if criterion not met at 10 minutes post excision, repeat at 20 minutes
if PTH still not decreased >50% at 20 min, the remaining parathyroids should be explored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

treatment of a thyroid storm:

A

first give beta blockade
then methimazole to reduce production and release of thyroid hormone
give steroids to decrease peripheral conversion of T3 to T4 and decrease exophthalmos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

true or false. nodules on thyroid ultrasound that are purely cystic do not require routine sonographic follow up when they are less than 1 cm

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

for patients with highest risk RET proto-oncogene mutation, thyroidectomy is recommended when?

A

at age 1 or time of diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment of parathyroid adenoma in the setting of MEN 1:

A

bilateral cervical exploration with resection of n3.5 glands and bilateral thymectomy; there is risk of supranumery glands and thymic carcinoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

true or false. a lesion less than 1 cm on thyroid US with benign features can be observed

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

treatment of hypercalcemic symptomatic patients:

A

hydration, bisphosphonates; loop diuretics have fallen out of favor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

treatment of asymptomatic hypercalcemic patients:

A

calcitonin and bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

best single place to stimulate with the nerve monitor to confirm a functional vocal cord at the end of neck surgery

A

ipsilateral vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

sonographic thyroid nodule features suspicious for malignancy:

A

solid hypoechoic nodule, irregular margins, microcalcifications, taller than wide shape, rim calcifications, extrathyroidal extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

you should bx suspicious thyroid nodules that are >___

A

1cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

sonographic thyroid nodule features that are not suspicious for malignancy/likely benign:

A

isoechoic or hyperechoic solid nodule; no irregular margins or calcifications; spongiform appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

you should bx benign appearing thyroid nodules when they are >__

A

2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

genetic disorder due to inactivating mutations in the calcium-sensing receptor of the parathyroids and kidneys

A

familial hypocalciuric hypercalcemia; benign condition, no treatment needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lab findings of familial hypocalciuric hypercalcemia:

A

reduction in excretion of urinary calcium; can have mild hypercalcemia with “normal” or minimally elevated PTH

higher than normal serum calcium is required to reduce PTH release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

a tumor marker for papillary thyroid cancer that can be used as a marker for disease recurrence

A

thyroglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

steps intraoperatively when facing a missing inferior parathyroid:

A

mobilize the thymus and resect it

if the glad is still missing, ligate the middle thyroid vein and divide to allow mobilization of the thyroid lobe and provide additional exposure

if gland still missing, the last step before aborting is lobectomy of the thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

true or false. papillary and follicular thyroid carcinoma <1cm can be managed with partial thyroidectomy

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

mainstay treatment of parathyroid carcinoma

A

en bloc resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

true or false. FNA is contraindicated for suspected papillary thyroid cancer

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

treatment of secondary hyperparathyroidism:

A

control of hyperphosphatemia with dietary restriction and phosphate binding gels; also give calcium supplementation; administer vitamin D sterol; correct acidosis with diasylate bath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

zona glomerulosa makes

A

mineralocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

zona fasciculata makes

A

glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

zona reticularis makes

A

sex steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

first line intervention for most thyroid and parathyroid cancer suspected recurrences

A

ultrasound of the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

histology findings of papillary thyroid cancer:

A

psammmoma bodies, calcifications, squamous metaplasia, and fibrosis; on cytology overlapping nuclei may be seen that are clear (Orphan Annie nuclei)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

histology findings of medullary thyroid cancer:

A

c cell hyperplasia and dispersed plasmacytoid cells with sudden anisonucleosis

34
Q

treatment of thyroid lymphoma:

A

chemo plus radiation (R-CHOP); radiation only if compressive symptoms develop

35
Q

Bethesda I

A

nondiagnostic; repeat bx

36
Q

Bethesda II

A

benign

37
Q

Bethesda V

A

suspicious for malignancy; lobectomy or thyroidectomy indicated

38
Q

Bethesda VI

A

malignant; total thyroidectomy

39
Q

what biochemical marker can be used to detect medullary thyroid cancer recurrence?

A

calcitonin

40
Q

true or false. all four glands are identified in a comprehensive parathyroidectomy

A

true

41
Q

where do the true vocal cords attach?

A

thyroid cartilage anteriorly; arytenoids posteriorly

42
Q

what drug is associated with 4 gland parathyroid hyperplasia

A

lithium

43
Q

why is it hard to establish a dx of parathyroid carcinoma histologically

A

there are no pathognomic features for parathyroid cancer

44
Q

True or false. a noninvasive follicular thyroid neoplasm with papillary-like nuclear features is malignant

A

false

45
Q

most appropriate patient population for a minimally invasive thyroidectomy

A

benign, unilateral disease in patients who haven’t had prior surgery

46
Q

true or false. nearly 50% of thyroid nodules in children under 14 are malignant

A

true

47
Q

extremely high levels of serum calcium >13 are associated with ____ until proven otherwise

A

malignancy (most commonly breast, multiple myeloma, SCC, lymphoma)

48
Q

MEN2A

A

parathyroid\ hyperplasia, pheochromocytoma, MTC

RET mutation inherited in AD fashion

49
Q

lab findings of primary hyperparathyroidism

A

high serum calcium, low serum phosphate, high urine calcium

50
Q

what surgery should be performed first for MEN1?

A

tx of hyperparathyroidism with 4 gland resection and autoimplantation (due to hyperplasia and not adenoma)

51
Q

treatment of papillary thyroid cancer during pregnancy

A

thyroidectomy postpartum; if there is evidence of lymph node metastasis or substantial growth, can perform during second trimester

52
Q

treatment of Hashimoto thyroiditis

A

thyroid hormone therapy; surgery reserved for those with large goiter or compressive symptoms

53
Q

most common location of ectopic superior parathyroid

A

tracheoesophageal groove

54
Q

most common location of ectopic inferior parathyroid

A

thymus (thyrothymic ligament)

55
Q

most common location of a missed (no found on initial exploration) parathyroid adenoma

A

tracheoesophageal groove

56
Q

histologic findings of round laminated calcifications in the core papillae on FNA

A

Psammoma bodies

57
Q

most significant risk factor for papillary thyroid cancer

A

radiation exposure during childhood

58
Q

Bethesda IV

A

follicular lesion; genetic evaluation or lobectomy

59
Q

most likely nerve to be injured during a thyroidectomy

A

external branch of superior laryngeal nerve

60
Q

treatment of medullary thyroid cancer

A

total thyroidectomy with level VI bilateral (central) neck dissection

61
Q

true or false. thyroid cancer tends to involve level VI nodes before levels II-IV

A

true

62
Q

management of exophthalmos from Graves

A

total thyroidectomy or thioamides; radioactive iodine will worsen it

63
Q

most important prognostic factor in thyroid cancer

A

age

64
Q

Treatment of choice for Graves

A

I 131

65
Q

True or false. Incidentally discovered thyroid nodules < 1cm size can be followed with repeat US in 6 months

A

true

66
Q

True or false. Incidentally discovered thyroid nodules with intermediate or high risk features in size range of 1-1.5cm and all nodules >1.5 cm should undergo FNA

A

true

67
Q

Thyroid lobectomy is adequate treatment for intrathyroid papillary thyroid cancer in the absence of prior radiation, familial thyroid cx, or clinically detectable nodes when the nodule is what size?

A

4 cm or smaller and unifocal

68
Q

features of MEN2A

A

medullary thyroid cancer, pheochromocytoma, and primary hyperparathyroidism

69
Q

minimum surgery recommended for medullary thyroid cancer without evidence of clinical nodal metastasis:

A

total thyroidectomy with central neck dissection

70
Q

True or false. Long term vitamin D deficiency leads to secondary hyperparathyroidism

A

true

71
Q

True or false. Parathyroid cancer has a low rate of recurrence.

A

False

72
Q

Initial test for recurrence of parathyroid cancer

A

ultrasound of the neck +/- FNA

73
Q

When facing a missing inferior parathyroid gland, the first step is

A

to mobilize the thymus and resect it. if still missing, then the middle thyroid vein should be divided to mobilize the thyroid lobe and provide additional esophageal and tracheal exposure; final step is thyroid lobectomy before abandoning the procedure

74
Q

Contraindications to RAI for Graves disease:

A

pregnancy, plans to become pregnant within 1 year of treatment, presence of cancer, symptomatic/compressive goiter

75
Q

True or false. Antiepileptics (phenbarbital, carbamazepine, phenytoin) increase hepatic metabolism of thyroid hormone.

A

true

76
Q

True or false. Patients with MEN1 have a mutation the can cause 4 gland hyperplasia of the parathyroids and not just an adenoma.

A

True

77
Q

Mainstay parathyroid surgery for patients with MEN1:

A

subtotal resection of parathyroid glands (3.5) plusbilateral cervical exploration and bilateral thymectomy

78
Q

True or falsae. Serum calcitonin falls rapidly after total thyroidectomy.

A

false. falls slowly in many patients; nadir is not reached for several months.

79
Q

True or false. Serum calcitonin falls rapidly after total thyroidectomy.

A

false. falls slowly in many patients; nadir is not reached for several months.

80
Q

treatment of hypercalcemia from PTH overload

A

cinacalcet (decreases PTH production); useful in Parathyroid cancer and ectopic PTH production

Head & Neck (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions