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Flashcards in Endocrine Deck (62)
1

patient presents wit ha thyroid nodule and decreased TSH, what is the next step?

Technecium uptake scan and start a beta-blocker (propranolol)

2

What disorders can a technicium thyroid scan differentiate between?

Functional adenoma and graves disease

3

What is the chance of malignancy from Hurthle cell cytology from a thyroid nodule?

20-30% cancer;
can be either hurthle cell carcinoma or oncocytic variant of PTC

4

What endocrine tumors can be treated with enucleation?

Only do for functional tumors (insulinoma, gastrinoma etc) or low malignancy hereditary disorders MEN?)

5

What is best palliation for hepatic metastasis from PNET?

TACE - Palliates pain in 75-100% of liver PNETs

6

Thyroid nodule with low TSH; what is next step?

thyroid uptake scan and start propranolol.

7

thyroglobulin positive cells in a lymph node?

is metastatic thyroid cancer. Need a total thyroidectomy and ipsilateral neck dissection.

8

MEN I

pituitary
hyper parathyroid
pancreas masses

9

gene for MEN I

mennin

10

function of menin

transcription regulator.

11

MEN II

medullary thyroid cancer
Pheochromocytoma
Hyperparathyroid

12

gene for MEN II

ret-proto oncogene

13

Von Hippel-Lindau

RCC
pheochromocytoma
pNETs
CNS hemangioblastoma

14

Key differentiation between MEN and VHL?

VHL does not get hyperparathyroid

15

gene for Von Hippel-Lindau

vHL; regulates VEGF and HIF1alpha

16

Best control of symptoms from bulky metastatic carcinoids?

TACE

17

Medullary Thyroid Cancer prompt

always think about the pheo

18

Treatment for metastatic MTC

TKIs
vandetanib and cabozatinib
Both have PFS advantage in RCTs.

19

SCC that is P16 positive is caused by:

HPV

20

SCC in a neck node on FNA with no primary, next step:

Go to OR for laryngoscopy, esophagoscopy and bronchoscopy.

Random biopsy if necessary

21

Most common location of occult primary H&N SCC

90% are in the tonsilar pillar or base of tongue.

22

treatment for adenoid cystic carcinoma?

Parotidectomy and adjuvant RT

23

Recurrence pattern of adenoid cystic carcinoma

Late, and also "skip lesions" along the nerve.
Very rare to have lymph nodes

24

FNA proves thyroid mass is PTC; what is next step?

neck ultrasound for lymphadenopathy.

25

ATA guidelines for central and lateral neck dissection

Do ultrasound
FNA all suspicious nodes
neck dissection only if FNA is positive

26

most common side effect of central LN dissection

transient hypocalcemia

27

Second line therapy for hypocalcemia after oral calcium carbonate

calcitriol

28

ATA indications for total thyroidectomy and indeterminate nodules

tumors > 4cm
marked atypia
"suspicious for PTC"
family history of thyroid cancer
radiation exposure

29

Most common location for a missing parathyroid

open the deep tracheoesophageal groove

30

Management of secondary hyperparathyroidism

subtotal parathyroidectomy (leave 1/2 a gland behind) with cervical thymectomy.

31

How long until PTH gland starts to work after forearm autotransplantation?

6-8 weeks

32

Firm parathyroid gland with severe hypercalcemia

Be prepared to do cancer operation without definitive diagnosis

33

What do you do for a patient less than 30 years old with a new diagnosis of hyperparathyroidism?

Genetic testing for MEN I (mennin)

34

PET avid adrenal in setting of lung cancer? What next

Still do endocrine work-up

35

Two different optimization drugs for pheos

phenoxybenzamine is classic
diltiazem also works

36

Hyperaldosteronemia and an adrenal mass?

Still do selective adrenal vein sampling; most adrenal masses arebenign and non-functional.

37

When do you do a nephrectomy for adrenocortical carcinoma

Only with direct invasion.

38

adjuvant therapy for adrenocortical carcinoma?

Mitotane

39

When do you give mitotane for adrenocortical cancer?

high grade
tumor rupture
vascular or capsular invasion

40

toxicities of mitotane

adrenal insufficiency
ataxia
confusion
rash

41

When do you give cytotoxic chemo for adrenocortical carcinoma?

Stage IV or unresectable;

42

Role of radiation for adrenocortical carcinoma?

Possibly for R1 resection; poor evidence

43

Most common location for an extra-adrenal pheo?

organ of Zuckerkandl at the aortic bifurcation.

44

What do you do before the OR on all re-operative necks?

laryngoscopy to confirm vocal cord function

45

25 year old with previous thyroidectomy presents with hypercalcemia, what next?

24-hr urine metanephrines to rule out pheo!

46

Which MTC patients do you send for genetic testing?

All of them (for RET proto-oncogene)

47

Which pheos do you send for genetic counseling?

Can get away with saying all of them (aggressive)
definitely all bilateral and <45yr olds

48

difference between vHL and MEN pheos?

vHL - norepinephrine
MEN - epinephrine

49

size indication for adrenalectomy:

nodule >4cm

50

surveillance for adrenal nodules

CT every 3-6 months for first year; then anually for 1-2 years. Hormonal evaluation yearly for 5 years.

51

what is the most effective medication at preventing duodenal ulceration for a gastrinoma?

PPI

52

Reversal of RLN injury

can be spontaneous in 3-6 months

53

Nephrectomy for ACC?

No, unless direct invasion

54

Treatment for incidentally discovered PTC on total thyroidectomy? (ATA 2009)

Nothing if < 1cm

55

most common side for non-recurrent LN?

right 3%, associated with aberrant subclavian

56

anatomy associated with a non-recurrent left LN?

Situs inversus

57

risk of cancer in a Bethesda 4 follicular neoplasm

20-30%

58

ATA recommended operation for a Bethesda 4 lesion

diagnostic lobectomy

59

Surgery for Follicular Thyroid cancer?

Total thyroidectomy without lymph node dissection

60

Adjuvant treatment for Follicular Thyroid Cancer

radioactive iodine and Thyroid suppression for all.

61

Choices for ACC with vena cava invasion?

Adrenalectomy with venotomy and thrombectomy if R0 resection can be performed.

62

Imaging for cystic parathyroid glands?

4DCT; Sestamibi doesn't work.