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75 Cards in this Set
- Front
- Back
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What are the two systems involved in maintaining homeostasis?
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• autonomic nervous system
• endocrine system |
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What hormones control the release of growth hormone?
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• growth hormone-releasing hormone (GHRH)
• somatostatin (SS) |
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What hormones control the release of prolactin?
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• prolactin releasing-inhibiting hormone (PIH)
• prolactin releasing hormone (PRH) |
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How is the anterior lobe of the pituitary gland stimulated?
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from hormones via venous vessels from the posterior pituitary (hypothalamic-hypophyseal portal system)
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Where is ADH and oxytocin produced and stored?
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• produced in the hypothalamus
• stored in the posterior lobe |
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Which anterior pituitary hormones are not regulated by negative feedback?
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• prolactin
• growth hormone |
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The 2 lobes of the thyroid gland are connected by the thyroid isthmus. The thyroid isthmus is located at approximately which tracheal ring?
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2nd tracheal ring
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Which muscles cover the thyroid gland?
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• Anteriorly: platysma
• Anterolaterally: sternocleidomastoid, sternohyoid, & sternothyroid muscles |
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What arteries supply the thyroid gland?
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• Superior thyroid arteries (1st branch of the external carotid artery)
• Inferior thyroid arteries (a branch of the thyrocervical trunk that arises from the subclavian artery) |
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Which veins drain the thyroid gland?
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superior, middle, and inferior thyroid veins
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Which nerve can be injured during thyroid surgery?
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recurrent laryngeal nerve
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What are the 2 groups of hormone-producing cells of the thyroid gland?
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• Follicular cells: produce, store, and release T4 and T3
• Parafollicular cells (C cells): secetes calcitonin |
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Which thyroid hormone is more active?
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T3
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What is the storage form of thyroid hormone?
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iodinated thyroglobulin
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What is the function of calcitonin?
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• inhibits osteoclast activity
• decreases serum calcium levels |
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How is hyperthyroidism diagnosed?
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• history & physical
• increased radioactive iodine uptake • increased T3 & T4 levels |
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How can you determine wheter hyperthyroidism is putuitary dependent or independent?
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• Pituitary-independent: serum TSH levels are decreased
• Pituitary-dependent: serum TSH levels are increased |
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What is the immunoglobin that is asociated with Graves disease?
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TSAb (a circulating IgG)
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What are treatment options for hyperthyroidism?
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• medically:
- Iodine (potassium iodine; Lugol's solution) - Propanolol - Propylthiouracil (PTU) - Methimazole (Tapazole) • radioactive iodine ablation • subtotal or total thyroidectomy |
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What is the isotope of choice for the radioablation of hyperactive thyroid tissue?
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I ^(131)
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What is the treatment of choice for hyperthyroidism (Graves disease)?
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radioactive iodine ablation
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What is the treatment of choice for hyperthyroidism in pregnany women?
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subtotal thyroidectomy
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What is the a toxic adenoma?
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• a solitary tumor of the thyroid gland
• produces excessive amounts of thyroid hormone • causes clinically overt hyperthyroidism |
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How does the hyperthyroidism caused by toxic adenoma differ from Graves' disease?
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• patients with toxic adenoma do not have associated ophthalmoopathy or pretibial myxedema
* toxic adenoma is not an autoimmune disease |
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What is Plummer's disease?
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toxic multinodular goiter
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What is the difference between a "hot" and "cold" nodule?
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• a hot nodule is a functional hyperplasia (usually not cancerous)
• a cold nodule is suggestive of carcinoma |
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What is the treatment for pituitary or hypothalamic hypothyroidism?
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hydrocortisone treatment before thyroid replacement therapy
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True/False: A solitary nodule/lesion in a man is significantly more likely to be a malignant than a comparable nodule in a women
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The correct answer is: True
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What is a Pemberton's sign?
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• raising the arms above the head, causing venous compression at the thoracic inlet with engorgement of the head and neck and a feeling of strangulation
• indicates compression in patients whose goiter is retrosternal |
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What is the single most important study in evaluating a thyroid mass?
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fine-needle aspiration cytology
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What is the treatment of patients with solid nodules that are diagnosed as benign on fine-needle aspiration?
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• monitor for 3-6 months
• treat with oral thyroid hormone to suppress TSH stimulation of tumor growth |
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What is the treatment for patient with a thyroid nodule suspected of being cancer?
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• intial procedure is thyroid lebectomy and isthmectomy
• if frozen-section analysis shows cancer, total thyroidectom is performed |
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What are different types of thyroid carcinomas?
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• Papillary carcinoma
• Follicular carcinoma • Medullary carcinoma • Anaplastic carcinoma • Lymphoma |
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Which is the most common thyroid malignancy in the US, occuring in approximately 70%-80% of cases?
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papillary carcinoma
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Which type of thyroid carcinoma has the worst prognosis?
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medullary carcinoma
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Which nodule is more suspicious for cancer, lateral or midline nodules?
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lateral nodules
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What are symptoms of hyperparathyroidism?
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"stones, bones, moans, groans, and psychic overtones"
• renal calculi • decalcified bones • puptic ulcer and pancreatitis • diffuse joint and muscle pains • depression or worsening psychosis |
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What are the different types of hyperparathyroidism?
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• Primary: hyperplasia, adenoma or carcinoma
• Secondary: from hypocalcemia • Tertiary: chronnic form of secondary type |
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What are the 3 distinct lesions that can cause primary hyperparathyroidism?
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• parathyroid adenoma (85%)
• parathyroid hyperplasia (15%) • parathyroi carcinoma (<1%) |
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What are some causes of secondary hyperparathyroidism?
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• renal failure
• vitamin D deficiency |
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What is the most common cause of outpatient hypercalcemia?
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primary hyperparathyroidism
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What is the most frequent source of inpatient hypercalcemia?
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malignancy (either by paraneoplastic syndrome or bony metastases)
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What are some tumors of epithelial origin that may produce PTH and cause hypercalcemia?
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• bronchial squamous cell carcinoma (most common)
• breast tumors • renal tumors • ovarian tumors |
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What are other cause of hypercalcemia that do not elevate parathyroid-hormone-related peptide (PTHrP)?
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• bone destruction by primary cancer (ex. multiple myeloma)
• granulomatous lesions activating Vitamin D (ex. sarcoidosis) • lytic bone metastases • Vitamin D analogues (ex. lymphoma) |
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What are options for medical management of hypercalcemia?
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• saline
• loop diuretics • drugs (ex. bisphosphonates, calcitonin) • acute dialysis |
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What is the surgical treatment for a single gland adenoma?
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resection of the tumor
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What is the surgical treatment of parathyroid hyperplasia?
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subtotal (3½ gland) resection
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What are the arteries that supply the adrenal gland?
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superior, middle, and inferior adrenal arteries
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Where do the left and right adrenal veins drain?
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• right adrenal vein drains into the inferior vena cava
• left adrenal vein drains into the left renal vein |
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What is unusual about the innervation of the adrenal medulla?
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there are no postganglionic cells
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What are the 3 layers of the adrenal cortex and what hormones does each layer produce?
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• Outer zona glomerulosa: secretes mineralocorticoids (ex. aldosterone)
• Middle zona fasiculata: secretes glucocorticoids (ex. cortisol) • Inner zona reticularis: secretes adrenal androgens (ex. progesterone, androgen) |
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What is the imaging modality of choice for adrenal cortical carcinomas?
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CT scan
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What is the treatment of choice adrenal carcinoma?
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surgical excision with removal of all visible tumors
• adrenalectomy and excision of involved regional lymph nodes (in early disease) • ipsilateral nephrectomy and resection of contiguous structures or hepatic metastases with presence of local invasion of visceral metastases |
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What is the organ of Zuckerkandl?
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• an area of chromaffin tissue inferior to the take-off of the inferior mesenteric artery and anterior to the aorta
• a possible location of pheochromocytoma |
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Surgical excision is the standard of care for pheochromocytoma. What must be done first to prepare the patient for surgery?
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administration of the alpha-adrenergic blocking agent phenoxybenzamine to control blood pressure
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Adrenal insufficiency is an important postoperative complication of adrenalectomy. What are common signs and symptoms of adrenal insufficiency?
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• abdominal pain
• fatigability • hyperkalemia • hyponatremia • nausea/vomiting • postural hypotension • weakness |
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When should an adrenal incidentaloma be excised?
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• if its hyperfunctional
• larger than 6 cm (due to high likelihood of malignancy) |
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Which neurotransmitters are pre- and post-ganglionic?
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• pre-gangilonic: ACH
• post-ganglionic: epinephrine |
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The effect of epinephrine and norepinephrine are similar in many ways. In what ways do their effects differ?
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• Epinephrine activated the reticular formation in the brain, while norepi has little effect
• Epinephrine promotes the breakdown of glycogen to glucose and causes hyperglycemia, while norepi has little effect on blood sugar |
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How can very low and very high levels of ACTH help differentiate the etiology of Cushing's syndrome?
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• very low levels of ACTH indicate hyperadrenocorticism due to primary adrenal causes (ex. adenoma, nodular hyperplasia, or carcinoma)
• very high levels of ACTH are diganostic for a pituitary adenoma or ectopic ACTH secretion |
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What is the most common cause of ectopic ACTH production?
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• bronchial carcnoids
• lung cancer |
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What is the treatment of choice for a solitary adrenal adenoma?
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unilateral adrenalectomy
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What is Waterhouse-Friderichsen Syndrome?
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• hemorrhagic necrosis of the adrenal gland during the course of meningococcemia
• causes marked hypotension, purpura, fever, shock |
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What are the 4 multiple endocrine neoplasia syndromes?
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• MEN-1
• MEN-2A • MEN-2B • Familial medullary thyroid carcinoma |
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What is MEN-1?
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• parathyroid hyperplasiam
• pituitary adenoma (prolactin is most common) • pancreatic islet cell carcinoma • carcinoid tumors and lipomas |
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What is the most common endocrine disorder in MEN-1?
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primary hyperparathyroidism (occurs in 90% of cases)
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What is the most common functional and non-functional islet cell neoplasm of MEN-1?
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• functional: gastrinoma
• non-functional: islet cell neoplasm that secretes pancreatic polypeptide |
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What is MEN-2A?
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• medullary thyroid cancer
• pheochromocytoma • primary hyperparathyroidism |
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What is MEN-2B?
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• medullary cancer of the thyroid
• pheochromocytoma • gangloneuromas |
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What are characteristics of Familial Medullary Thyroid Carcinoma?
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• medullary thyroid carcinoma as the their only inherited endocrine disorder
• arised from the parafollicular (or C cells) of the thyroid |
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What is the gene responsibile for MEN-2A, MEN-2B, FMTC?
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RET protooncogene on chromosome 10
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What is the treatment for MEN-1?
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• resection of pituitary adenoma
• parathyroidectomy • pharmacologic or surgical management of pancreatic tumor |
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What is the treatment for MEN-2?
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• resect pheochromocytoma
• total parathyroidectomy |
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When should a RET-positive patients with MEN-2A undergo total thyroidectomy? with MEN-2B?
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• MEN-2A: before 6 years-old
• MEN-2B: before 6 months-old |
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What is the characteristic phenotype of MEN-2B?
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• bumpy tongue
• hyperflexible joints • marfanoid habitus • prognathism • puffy lips |
