Surgery 09: Parathyroid

Front 1

arterial supply of PT glands is from ___

Back 1

inferior thyroid a.

Front 2

__% of total body calcium is in the skeleton

Back 2

99

Front 3

acidosis raises/lowers serum calcium

Back 3

raises

Front 4

___% of serum ca is protein bound, mostly to ___.

Back 4

55
albumin

Front 5

___ (electrolyte) is required for PTH release

Back 5

Mg

Front 6

at kidney, PTH causes ___ (3)

Back 6

reabsorption of Ca
excretion of phosphate
upregulation of 1alpha hydroxylase

Front 7

calcitonin works more in adults/children

Back 7

children

Front 8

main effect of 1,25(OH)2 vitamin D is

Back 8

intestinal Ca absorption

Front 9

2 risk factors for primary hyper-PT

Back 9

female
age (>50)

Front 10

2 multigland disorders associated with primary hyper-PT

Back 10

MEN I
MEN IIa

Front 11

MEN I affects

Back 11

parathyroid (90%)
pituitary (66%)
pancreas (66%)

Front 12

pancreatic tumors in MEN I

Back 12

gastrinoma
insulinoma
VIPoma

Front 13

MEN IIa affects

Back 13

medullary thyroid carcinoma (100%)
parathyroid (50%)
pheochromocytoma (33%)

Front 14

___% of PHPT have single ademonas
___% have multpile gland hyperplasia

Back 14

80
15

Front 15

MEN I almost always has ___
MEN II always has ___

Back 15

parathyroid adenoma
medullary thyroid ca

Front 16

___% of PHPT is asymptomatic

Back 16

80

Front 17

4 kinds of complaints in PHPT

Back 17

kidney
skeletal
neuromuscular
abdominal

Front 18

kidney complaint in PHPT

Back 18

nephrolithiasis

Front 19

skeletal complaint in PHPT

Back 19

osteoporosis

Front 20

neuromuscular complaint in PHPT

Back 20

weakness
fatigue

Front 21

GI complaints in PHPT

Back 21

vague

Front 22

5 kinds of causes of hypercalcemia

Back 22

excess PTH
malignancy related
hypervitaminosis D
accelerated bone turnover
renal loss

Front 23

3 kinds of excess PTH

Back 23

PHPT (adenoma, MEN)
Li (stimulates PT glands)
Familial hypocalciuric hypercalcemia

Front 24

3 kinds of malignancy-related hypercalcemia

Back 24

bone invasion
paraneoplastic
hematologic

Front 25

bone invasion is characteristic of ___

Back 25

breast ca
prostate ca

Front 26

paraneoplastic hypercalcemia is caused by ___

Back 26

PTHrP

Front 27

2 causes of paraneoplastic hypercalcemia

Back 27

SCC of lung
RCC

Front 28

hematologic cancer hypercalcemia is caused by ___ aka ___

Back 28

IL-1
osteoclast activating factor

Front 29

3 causes of hematologic cancer hypercalcemia

Back 29

leukemia
MM
lymphoma

Front 30

workup for hypercalcemia

Back 30

albumin
phosphate
Mg
urine calcium
ABG

Front 31

given hypercalcemia is present, determine ___ level

Back 31

PTH

Front 32

given hypercalcemia with hyper-PTH is present, determine ___.

Back 32

renal function

Front 33

if hypercalcemia with hyper-PTH and ESRD is present, hyper-PTH is ___
if ESRD is not present, rule out ___ (3) and you can diagnose ___.

Back 33

tertiary
thiazides
Li
FHH
PHPT

Front 34

2 signs of hypercalcemic crisis

Back 34

oliguria/anuria
somnolence/coma

Front 35

tx for hypercalcemic crisis (4)

Back 35

IV saline
furosemide
bisphosphonates
emergency hemodialysis

Front 36

5 indications for parathyroidectomy in asymptomatic patients

Back 36

hypercalcemia
hypercalciuria
reduced CCT
reduced bone density
age < 50

Front 37

indications for surgery:
hypercalcemia > ___
hypercalciuria > ___
CCT reduced by ___
bone density reduced below ___

Back 37

11.5 mg%
400 mg/24h
30%
2.5sd below mean

Front 38

PTH localization done with ___ scan

Back 38

Tc sestamibi

Front 39

___ is useful for locating ectopic PT tissue
it uses ___ with ___

Back 39

SPECT
Tc sestamibi
CT

Front 40

___ is the most widely used intraop PTH test

Back 40

rapid PTH

Front 41

if neck US and sestamibi implicate the same PT gland, do ___
otherwise, do __.

Back 41

unilateral PT exploration
bilateral neck exploration

Front 42

in excising superior PT glands, it's important to watch out for ___ (2)

Back 42

superior thyroid a.
superior laryngeal nerve

Front 43

in excising inferior PT glands, it's important to watch out for ___ (2)

Back 43

inferior thyroid a.
recurrent laryngeal nerve

Front 44

medical tx for PHPT

Back 44

Ca supplement
Vitamin D supplement
tamoxifen
bisphosphonates

Front 45

PHPT patients should have ___ every 6 months and ___ every year

Back 45

calcium level
bone densitometry

Front 46

parathyroid cancer is ___% of all PHPT. suspect parathyroid cancer if ___ (3)

Back 46

1
Ca > 14
PTH very high
PT gland palpable

Front 47

if PT cancer suspected, do ___ with resection of ___ (2).
if nodal mets present, do ___

Back 47

bilateral neck exploration
tumor
ipsilateral thyroid
modified radical neck dissection