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Question 1

What do the parathyroid glands develop from?

Answer 1

The third and fourth pharyngeal pouches

The parathyroid glands are embryologically derived from these specific structures.

Question 2

How many parathyroid glands do most adults have?

Answer 2

Four

This is the typical number found in adult anatomy.

Question 3

Which parathyroid gland is more consistent in position?

Answer 3

The superior parathyroid gland

This gland’s location is more reliable compared to the inferior gland.

Question 4

Where is the superior parathyroid gland commonly found?

Answer 4

In fat above the inferior thyroid artery and close to the cricothyroid articulation

Its anatomical location is relatively fixed.

Question 5

Where is the inferior parathyroid gland usually located?

Answer 5

On the inferior pole of the thyroid lobe

This is a common anatomical position for the inferior gland.

Question 6

What type of molecule is parathormone?

Answer 6

An 84-amino acid peptide

This defines its structure and classification.

Question 7

What is the primary function of parathormone?

Answer 7

Controls the level of serum calcium in extracellular fluid

This hormone is crucial for calcium homeostasis.

Question 8

When is parathormone released?

Answer 8

In response to a low serum calcium or high serum magnesium level

These conditions trigger its secretion.

Question 9

What effect does parathormone have on osteoclasts?

Answer 9

Activates osteoclasts to resorb bone

This process increases calcium levels by breaking down bone tissue.

Question 10

How does parathormone affect calcium reabsorption?

Answer 10

Increases calcium reabsorption from urine

This helps to retain calcium in the body.

Question 11

What role does parathormone play in vitamin D activation?

Answer 11

Increases renal activation of vitamin D

This leads to increased gut absorption of calcium.

Question 12

What is primary hyperparathyroidism commonly associated with?

Answer 12

Hypercalcaemia & inappropriately raised serum PTH

Primary hyperparathyroidism can be sporadic or familial, with sporadic cases being more common.

Question 13

What percentage of patients with sporadic primary hyperparathyroidism have a single adenoma?

Answer 13

85%

This is the most common pathological finding in sporadic cases.

Question 14

Which gender is more affected by primary hyperparathyroidism?

Answer 14

Women

The condition increases with age and affects women more than men.

Question 15

What are the familial conditions associated with familial hyperparathyroidism?

Answer 15

• MEN1 (Werner’s syndrome)
• MEN2A (Sipple syndrome)
• Familial hyperparathyroidism

These conditions are genetically determined.

Question 16

What is the classic quartet of symptoms associated with primary hyperparathyroidism?

Answer 16

‘Stones, bones, abdominal groans and psychic moans’

This presentation is rarely observed in developed countries.

Question 17

What is the diagnostic criterion for primary hyperparathyroidism?

Answer 17

Elevated or normal PTH levels in the presence of high serum calcium

This finding is key to diagnosing primary hyperparathyroidism.

Question 18

What percentage of patients with sporadic primary hyperparathyroidism have hyperplasia affecting all four glands?

Answer 18

13%

This is a less common pathological finding compared to single adenomas.

Question 19

What is a rare finding in developed countries related to primary hyperparathyroidism?

Answer 19

Severe bone disease (von Recklinghausen’s disease)

Diagnosis is usually detected on serum calcium estimation before severe manifestations occur.

Question 20

What is a common laboratory finding in primary hyperparathyroidism?

Answer 20

Hypophosphataemia

This is often present alongside elevated serum calcium.

Question 21

What is the most common cause of hypercalcaemia in advanced malignancy?

Answer 21

Suppressed PTH levels

This differentiates malignancy-related hypercalcaemia from primary hyperparathyroidism.

Question 22

Fill in the blank: In familial disease, multiple gland enlargement is _______.

Answer 22

usual

This contrasts with sporadic cases where a single adenoma is more common.

Question 23

What is the only curative option for primary hyperparathyroidism?

Answer 23

Surgery

Surgery should be offered to all patients with significant hypercalcaemia provided they are otherwise fit for the procedure.

Question 24

What are medical therapies for mild hyperparathyroidism?

Answer 24

• Low calcium diet
• Withdrawal of drugs (diuretics and lithium)
• Calcium reducing agents such as bisphosphonates
• Calcium receptor agonist cinacalcet

Medical therapies are considered when surgery is not an option or in cases of mild hyperparathyroidism.

Question 25

What are the indications for parathyroidectomy in primary hyperparathyroidism?

Answer 25

* Urinary tract calculi * Deteriorating renal function * Reduced bone density * Age <50 years * Symptomatic hypercalcaemia ## Footnote These indications help determine the necessity for surgical intervention.

Question 26

What percentage of enlarged glands can neck ultrasound identify?

Answer 26

75 percent ## Footnote Neck ultrasound is a common preoperative localization technique.

Question 27

What imaging technique uses Technetium-99m for identifying abnormal parathyroid glands?

Answer 27

Sestamibi (MIBI) isotope scans ## Footnote This technique also identifies approximately 75 percent of abnormal parathyroid glands.

Question 28

Which imaging modalities are not indicated prior to first-time neck exploration?

Answer 28

* CT * PET * MRI ## Footnote These imaging techniques are generally not used for initial localization in primary hyperparathyroidism.

Question 29

True or False: Medical therapies are the primary treatment for significant hypercalcaemia in primary hyperparathyroidism.

Answer 29

False ## Footnote Surgery is the only curative option and should be prioritized for significant cases.

Question 30

Fill in the blank: A calcium receptor agonist used in the treatment of primary hyperparathyroidism is _______.

Answer 30

cinacalcet ## Footnote Cinacalcet helps to lower calcium levels in patients with hyperparathyroidism.

Question 31

What is parathyroid crisis?

Answer 31

A condition where serum calcium is greater than 3.5 mmol/L, leading to confusion, nausea, abdominal pain, cardiac arrhythmias, hypotension, and acute renal failure. ## Footnote This condition requires immediate medical attention.

Question 32

What are the treatment options for parathyroid crisis?

Answer 32

Intravenous fluid and bisphosphonate therapy. ## Footnote These treatments help lower serum calcium levels.

Question 33

What causes secondary hyperparathyroidism?

Answer 33

Chronic renal failure, which prevents the conversion of vitamin D into its active form, leading to reduced intestinal calcium absorption and increased phosphate levels. ## Footnote This results in elevated parathyroid hormone secretion.

Question 34

What happens to the parathyroid glands in secondary hyperparathyroidism?

Answer 34

Prolonged stimulation leads to parathyroid hyperplasia, which is initially reversible after renal transplantation. ## Footnote If autonomous hyperfunction develops post-transplant, it is termed tertiary hyperparathyroidism.

Question 35

How common is parathyroid carcinoma?

Answer 35

It is rare, accounting for 1 percent of cases of hyperparathyroidism. ## Footnote This type of cancer presents unique diagnostic challenges.

Question 36

What are the typical features of parathyroid carcinoma?

Answer 36

Very high calcium and PTH levels, often with a palpable neck swelling or lymphadenopathy. ## Footnote Diagnosis may require imaging support.

Question 37

What challenges exist in diagnosing parathyroid carcinoma?

Answer 37

The diagnosis is difficult to make histologically and may only become apparent when recurrent disease presents with hypercalcaemia and increased serum PTH. ## Footnote This complicates early detection.

Question 38

What surgical procedures are recommended for parathyroid carcinoma?

Answer 38

Excision of the tumour mass with en bloc thyroid lobectomy and node dissection when indicated. ## Footnote This approach aims to remove all cancerous tissues effectively.

Question 39

When might palliative radiotherapy be indicated in parathyroid carcinoma?

Answer 39

Palliative radiotherapy may be indicated for symptom relief in advanced cases. ## Footnote This treatment helps manage complications associated with the disease.

Question 40

What is hypoparathyroidism?

Answer 40

Results from removal or devascularisation of the parathyroid glands

Question 41

What are the symptoms of mild hypoparathyroidism?

Answer 41

Circumoral and digital numbness and paraesthesia

Question 42

What are the symptoms of severe hypoparathyroidism?

Answer 42

Tetanic symptoms with carpopedal or laryngeal spasms, cardiac arrhythmia and fits

Question 43

What chronic complications can arise from hypoparathyroidism?

Answer 43

Abnormal bone demineralisation, cataracts, calcification in basal ganglia, and consequent extrapyramidal disorders

Question 44

What is Chvostek's sign?

Answer 44

Percussion of the facial nerve just below the zygoma causes contraction of the ipsilateral facial muscles

Question 45

What is Trousseau's sign?

Answer 45

Carpopedal spasm can be induced by occlusion of the arm with a blood pressure cuff above systole

Question 46

What ECG changes are associated with hypoparathyroidism?

Answer 46

Prolonged QT intervals and QRS complex changes

Question 47

What is the medical emergency threshold for acute symptomatic hypocalcaemia?

Answer 47

If the calcium level is <1.90 mmol/L

Question 48

What is the urgent treatment for acute symptomatic hypocalcaemia?

Answer 48

Intravenous injection of calcium

Question 49

When should serum calcium be checked after total thyroidectomy?

Answer 49

Within 24 hours or earlier if symptomatic

Question 50

What is the recommended intravenous calcium dosage for acute hypocalcaemia?

Answer 50

10 mL of 10 percent calcium gluconate intravenously over 10 min

Question 51

What is the oral calcium dosage for hypoparathyroidism?

Answer 51

1 g of oral calcium three or four times daily

Question 52

What is the recommended oral dosage of 1-alpha-vitamin D for hypoparathyroidism?

Answer 52

1–3 μg daily