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ENDOCRINE > ENDOCRINE MIX > Flashcards

ENDOCRINE MIX Flashcards

1
Q

origin the superior thyroid artery

A

external carotid artery

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2
Q

What is the adrenal cortex and derived from

A

MESODERM

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3
Q

Was adrenal medulla derived from

A

Neural crest

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4
Q

Origin of superior adrenal artery

A

Inferior phrenic artery

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5
Q

origin of middle adrenal artery

A

aorta

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6
Q

Origin of inferior adrenal artery

A

Renal artery

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7
Q

RET thyroid cancer

A

oncogene
Medullary thyroid cancer
Papillary thyroid cancer

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8
Q

Ras oncogene thyroid cancer

A

papillary thyroid cancer
Follicular adenoma
Follicular carcinoma

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9
Q

new drug for melanoma

A

Yervoy (ipiluminab)

inhibits B-Raf oncogene

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10
Q

painful thyroiditis

A 
most commonly 30-40-year-olds
Often preceded by upper respiratory tract infection
4 stages:
 hyperthyroid and
Euthyroid
Hypothyroid
Euthyroid persisting greater than 90%
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11
Q

Treatment of painful thyroiditis subacute thyroiditis

A

Nonsteroidal anti-inflammatory

may require steroids

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12
Q

operation for medullary thyroid cancer

A

Total thyroidectomy with central neck dissection

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13
Q

What levels the central neck dissection excised

A

ONLY 6

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14
Q

What is spared and modified radical in neck dissection; what levels are resected

A

Cranial nerve 11 (trapezium; posterior triangle)
Sternocleidomastoid
IJ
2345

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15
Q

describe her level VII is

A

Retrosternal

Where you look for missing parathyroid at the level of thymus)

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16
Q

Surgery for parathyroid cancer

A 
Hemithyroidectomy 
En bloc resection of strap muscles:
Sternohyoid
Thyrohyoid
et al..
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17
Q

Most common thyroid cancer for radiation exposure

A

Papillary

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18
Q

Precursor of all steroids

A

Pregnenolone

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19
Q

MEN I

A

pituitary (prolactinoma - treated with bromocriptine)
Parathyroid (HYPERPLASIA - treat subtotal with replantation)
Pancreas tumor (most common nonfunctional; second most insulinoma; third most gastrinoma)

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20
Q

MEN IIa

A

pheochromocytoma
Parathyroid HYPERPLASIA
Thyroid medullary carcinoma

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21
Q

MEN IIb

A 
pheochromocytoma
Thyroid medullary carcinoma
MARFAN'S
Neuroendocrine
Mucinous neurofibromas
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22
Q

most common cause of Cushing syndrome

A

exogenous steroid

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23
Q

Most common cause of Cushing’s disease

A

pituitary adenoma

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24
Q

Mechanism of all aldosterone

A 
SODIUM Na  driven
 juxtaglomerular sensed
 decreased renal perfusion causes a release:
 angiotensinogen
 converted to angiotensin I in kidney
 converted to angiotensin II in  lung
 acts on adrenal cortex
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25
Q

Most common adrenal incidentaloma

A

adrenal adenoma

26
Q

most sensitive test for pheochromocytoma

A

PLASMA metanephrine

27
Q

Treatment for bilateral pheochromocytoma

A

Cortical sparing of one side

28
Q

Chloride and phosphorus her relationship with parathyroid

A

Increased chloride and
Decrease soft
Acidosis
Increase calcium

29
Q

Cinacalcet

A

New drug for secondary hyperparathyroidism

Down regulates parathyroid hormone by increasing calcium receptor sensitivity

30
Q

FAP gene

A

APC gene

Tumor suppressor

31
Q

What is the problem with unopposed beta blockade for pheochromocytoma

A

beta-2 cause vasodilation drop the bottom out of pressure

32
Q

Name alpha-blocker date for pheochromocytoma

A

prazosin

33
Q

Von Hippel-Lindau

A

hemangioblastomas of the central nervous system

34
Q

VAPTAN New drug

A

vasopressin (ADH) receptor blocker

Used for SIADH

35
Q

Standard treatment for SIADH and what is seen

A

decreased sodium ( because resorbing water)
Treatment:
Fluid restriction
Sodium supplement only of severe

36
Q

Pseudohypoparathyroidism

A

Genetic insensitivity to parathyroid hormone
stubby fingers
decrease calcium
Decrease phosphate
Increased PTH
Short/obese
Treatment with oral calcium and vitamin D supplements

37
Q

Treatment for cancer found in thyroglossal duct cyst

A

usually papillary-85%
Also see squamous, peripheral cell, anaplastic
Total thyroidectomy controversial (but done with: older age, large tumor, cystic wall invasion, lymph node metastases)

38
Q

screening for medullary thyroid cancer

A

calcitonin level

39
Q

Parathyroid carcinoma

A

severe elevated calcium example 14
Histology is unreliable
Treatment in block resection of parathyroid tumor with ipsilateral thyroidectomy modified radical lymph node dissection if nodes detected
add cinacalcet to control severe hypercalcemia

40
Q

Which parathyroid gland is most likely to be ectopic

A

Inferior gland

41
Q

Where are inferior glands most likely to be found

A

within 2 cm of the inferior thyroid pole

42
Q

Steps for finding inferior ectopic glands

A

cervical thymectomy sent for frozen
Carotid sheath
Ultrasound for intrathyroid gland-if not available, ipsilateral thyroidectomy

43
Q

Intraoperative gamma probe also helpful

A

Intraoperative PTH assay for confirmation of removal

44
Q

Best test to monitor recurrent disease for follicular thyroid cancer

A 
Serum thyroglobulin
Parentheses also helpful for papillary)
Most sensitive when the patient is hypothyroid with increased TSH
Checked at six-month intervals
If elevated iodine-131 scan
45
Q

What is checked for recurrent medullary thyroid cancer

A

Calcitonin level

46
Q

Single best test to workup solitary thyroid nodule

A

FNA

47
Q

Percentage of cold nodules are malignant

A

15%!

1% of hot lesions are malignant

48
Q

4 possible results from FNA of thyroid nodule

A 
#1 malignant
#2 suspicious
#3 benign
#4 nondiagnostic
49
Q

Management FNA suggests follicular neoplasm

A

Excision via lobectomy

50
Q

can the diagnosis of medullary or anaplastic cancer be made with FNA

A

yes

51
Q

Most common malignancy found in the thyroglossal duct cyst; What is management if found incidentally

A

papillary

subsequent total thyroidectomy

52
Q

what does the recurrent laryngeal nerve innervating

A

intrinsic muscles of larynx (EXCEPT cricoid muscles-innervated by external branch of the superior laryngeal nerve)

53
Q

Describe what is found with injury to recurrent laryngeal nerve

A

Paralysis of its lateral vocal cord
Cord becomes fixed in paramedian or abducted position
Paramedian position causes weak voice
Abducted position causes coarse voice/ineffective cough

54
Q

Best test to rule out primary thyroid insufficiency

A

TSH

Decreased T3 and T4 also will be found

55
Q

List attributes of calcitonin

A

Produced by parafollicular C. cells (superior lateral aspect of thyroid)
Does not play important role in regulating calcium
Used to treat a hypercalcemic crisis (inhibit osteoclastic bone resorption)
Stimulated by calcium, pentagastrin, alcohol, choline, cholecystokinin, and glucagon
Increases phosphate excretion by kidneys
Marker for medullary thyroid carcinoma

56
Q

Factors that increase parathyroid hormone level

A

Lithium
Low-dose radiation
Decreased renal function

57
Q

Most likely complication of division of superior thyroid artery

A

EXTERNAL branch of SUPERIOR laryngeal nerve
Pregnancies lives on inferior pharyngeal constrictor to send along superior thyroid artery-innervated cricothyroid muscle) and
inability to tense lateral cord

58
Q

Treatment thyroid storm

A

Aggressive wound
PTU
Methimazole
Propranolol (for catecholamine control, also inhibits peripheral conversion of T4-T3)
Steroid decrease conversion to T4-T3
Aspirin contraindicated decrease his protein binding of thyroid hormones and may increase on rebound T3 and T4

59
Q

Substernal thyroid goiter

A

Primary form:
Originates in the mediastinum with blood supply from intrathoracic vessel-very rare

Secondary form:
Extension from cervical goiter
Must recommend surgery for all
Moser symptomatic
May harbor unsuspected malignancy
Mostly we approached the cervical collar incision
Sternotomy is very rarely needed
Even with tracheal compression tracheostomy is rarely needed
60
Q

Treatment of prolactinoma

A

bromocriptine

resect large tremors

61
Q

clinical findings associated with glucagonoma

A

hyperglycemia
Cachexia
Anemia
NECROLYTIC MIGRATORY ERYTHEMA

62
Q

with infant with RET protoncogene-positive when should thyroidectomy be done

A

before 6 months!

ENDOCRINE (4 decks)

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