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MRCS > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Development of upper parathyroid glands

A

Arise from fourth branchial arch

Usually found at the back of the thyroid above the inferior thyroid artery

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2
Q

Development of the lower parathyroid glands

A

Arise from the third branchial arch

Usually in association with thyrmus

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3
Q

Level of the thyroid glands

A

Lie on front of trachea and larynx at C5-C7

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4
Q

Superior thyroid artery

A

Branch of external carotid artery

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5
Q

Inferior thyroid artery

A

Branch of thyrocervical trunk of subclavian artery

As the inferior thyroid artery appraoches the galdn it normally passes in front of the recurremt laryngeal nerve

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6
Q

Lymphatic drainage of the thyroid

A

Pretracheal and mediastinal nodes

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7
Q

Veins of the thyroid

A

Superior
Middle
Inferior
.. thyroid veins

All drain into the internal jugular and innominate veins

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8
Q

Innervation of the intrinsice muscles of the larynx

A

Recurrent laryngeal nerve supplies all of them except Cricothyroid

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9
Q

Innervation of the cricothyroid muscles

A

External branch of the superior laryngeal nerve

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10
Q

Innervation providing sensation above the vocal cords

A

Internal branch of the superior laryngeal nerve

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11
Q

Innervation providing sensation below the vocal cords

A

Recurrent laryngeal nerve

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12
Q

Non-toxic multinodular goitre

A

Multiple nodules
Caused by iodine deficiency

If biochemistry normal, no need for radio-isotype uptak e scan

Mx: Thyroidectomy and replacement

Can become toxic: a long-standing non-toxic goitre develops hyperactive nodule(s) that function independently of TSH levels

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13
Q

Management of hashimoto’s

A

Replacenebt thyroxine

Thyroidectomy seldom needed and carries higher riusk of recurrently laryngeal nerve injury due to firmness of gland

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14
Q

Firm painless swelling and tracheal compression

A

Riedel’s thyroiditis

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15
Q

Mx: Aspirated cysts that do not re-fill with negative cytology

A

OP follow-up

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16
Q

Residual aspirate or blood-stained aspirare

A

Suspect Papilllary carcinoma

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17
Q

FNAC cannot distinguish bewteen…

A

cytopathologist cannot distinguish between a follicular adenoma and follicular carcinoma

Histopath needed

18
Q

Primary thyrotoxicosis

A

Grave’s Disease

Toxic multi-nodular goitre

Toxic Adenoma

19
Q

Management of primary thyrotoxicosis

A

Block and replace
Carbimazole (15mg QDS) and Thyroxine

Radio-iodine

Surgery

  • Carbomazole used pre-op to render euthyroid
  • B-blockers used pre-op to decrease vascularity
  • B-blockers continued 7 days post op to avoid effects of thyroid storm
20
Q

Most common thyroid cancer

A

Papillary carcinoma (50%)

21
Q

Papillary carcinoma

A

Most prevalent before the age of 40

Slow-growing solitary growth

Lymphadenipathy palpable in 1/3

Complex papillary folds lined by several layers of cuboidal cells project into cystic space

Mx:
Thyroxine replacement to supress TSH

Commonly multifocal, so bilateral total lobectomy

Microscopic disease (< 1cm and unifocal) and tumours with favourable histology and < 2cm in size may be treated by single lobectomy

Radio-isotype scan post-op to detect possible mets

10-year survival rates approaching
90%

22
Q

Follicular carcinoma

A

30% of thyroid carcinomas

Commonest age 30-50 yrs

Presents as a solitary thyoid mass

Haematogenou spread common, lymph node spread rare

Malignant cells are arrange dinto solid mass with rudimentary acini

Mx:
Total thyroidectomy with sparing of parathyroids

Post-op radio-isotype scan, use radio-ionide to treat mets

Replace with T3 and then T4 to supress TSH

Thyroglobulin should be undetectable - if found indicates recurrence

10-year survival rate is 75%.

23
Q

Anaplastic carcinoma

A

Elderly women

Highly malignant

Peri-neural invasion –> recurrently laryngeal and cervical sympathetic (horners)

Pulmonary metastasis common

Mx
Surgery rarely appropriate, but can used to relieve tracheal compresison

External bean radiotherapy

24
Q

Medullary carcinoma

A

Parafollicular C Cells - Raised Calcitonin

MEN II (Sipple’s Syndrome)

Hard enlargement of one or both thyroid glands

50% have cervical lymph node invasion

Pre-Op CT screening for phaeochromocytoma

Ret - proto oncogene

Mx
Total thyroidectomy and, if the calcitonin
level is raised, dissection of the lymph nodes in the
central compartment of the neck (levels 6 and 7).

25
Q

Structures divided durng thyroidectomy

A

Travserse skin incision 2cm above sternal notch

Longitudinal division of fascia

Separation of strap muscles

Each lobe is mobilized by dividing the vessels supplying the superior pole, the middle and inferior thyroid veins, and the inferior thyroid artery

26
Q

Damage to the external branch of the superior laryngeal nerve

A

Damaged whilst securng superior thyroid pedicle

  • -> inability to tense vocal cords: weaker voice with ptich-range change
  • -> lack of sensation to mucous membrane of upper larynx: allows foreign bodies to enter larynx more readily
27
Q

Damage to the recurrent laryngeal nerve

A

Division –> paralsysis of vocal cords in cadaveric position

Normal cord on the other side compensates by crossing the midline in phonation, but the voice is altered in timbre, hoarse, weak and breathy
Some degree of stridor

28
Q

Bilateral recurrent laryngeal nerve injury

A

Bilateral nerve injury results in stridor and ineffective
coughing when the endotracheal tube is withdrawn at theend of the operation

The tube is reinserted immediately and, if there is no early improvement, tracheostomy may be required. The paralysis is originally flaccid, but fibrosis draws the cords together and, even if tracheostomy has been
avoided, increasing dyspnoea on exertion may be troublesome.

29
Q

Blood supply to the parathyroids

A

Inferior thyroid artery

30
Q

Development of anterior pituitary

A

The anterior pituitary develops from an epithelial outgrowth from the pharynx (Rathke’s pouch).

31
Q

Complications of transcranial approach to hypophysectomy

A

Anosmia

Diabetes insipidus

32
Q

Development of adrenal cortex

A

Mesoderm

33
Q

Development of adrenal medulla

A

Chromaffin ectodermal cells of the neural crest

34
Q

Adrenal phaeochromocytomas

A

Secrete noradrenaline and adrenaline

35
Q

Extra-adrenal phaeochromocytomas

A

Secrete noradrenaline only

36
Q

Adrenal ‘incidentaloma’

A

If non-functioning and <3.5 cm in diameter, further

investigation and exploration are unwarranted

37
Q

Indications for adrenalectomy

A

Cushing’s syndrome caused by adrenal tumours

Cushing’s disease not controlled by pituitary surgery

Conn’s syndrome caused by adrenal tumour

Phaeochromocytoma

38
Q

APUD Cells

A

Have capacity to store and synthesise amines: ATCH, catecholamines, calcitonin, secretin, gastrin, cholecystokin, enteroglucagon, somatostatin, VIP

Found in:

  • anterior pituitary
  • adrenal medulla
  • thyroid gland
  • intestine
39
Q

MEN I

A

Hyperplasia or adenaomas of the:

  • Pancreatic islets
  • Parathyroid
  • Anterior pituitary

There may also be non-functioning tumours of the thyroid, pituitary, adrenal cortex and soft tissues (lipomas), and functioning carcinoid tumours of the gut or lungs.

Mutations in the MENIN gene on chromosome 11

40
Q

MEN II

A

Medullary carcinoma of the thyroid
Phaeochromocytoma
Parathyroid hyperplasia

Ret proto-oncogene chromosome 10

41
Q

Urinary 5-hydroxyindolaecatic acid

A

Carcinoid disease

42
Q

Carcinoid syndrome

A 
Periodic flushing
Diarrhoea
Bronchoconstriction
Wheezing 
Red-purple discoloration of the face

Right-sided heart disease, notably pulmonary stenosis -> death

MRCS (24 decks)

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