ABSITE ch 23 parathyroid.txt

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alshada
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3714
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ABSITE ch 23 parathyroid.txt
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2010-01-11 11:04:13
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parathyroid ABSITE
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ABSITE parathyroid
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  1. Embryologic origin of superior parathyroids
    4th pharyngeal pouch
  2. Location of superior parathyroids
    Lateral to RLNs, above inferior thyroid artery
  3. Embryologic origin of inferior parathyroids
    3rd pharyngeal pouch
  4. Location of inferior parathyroids
    Medial to RLNs, below inferior thyroid artery
  5. Most common ectopic site for parathyroids
    Tail of thymus
  6. Ectopic sites for parathyroids (4)
    Tail of thymus, intrathyroid, posterior mediastinal, near tracheoesophageal groove
  7. Blood supply to all parathyroid glands
    Inferior thyroid artery
  8. Role of PTH
    Increase serum Ca, increase Ca release from bone, increase Vit D production in kidney
  9. Role of Vitamin D in Calcium and phosphorus
    Increase intestinal absorption by increasing calcium binding protein
  10. Role of calcitonin
    Decrease serum Ca, decrease bone resorption of Ca, increase urinary Ca and Phos excretion
  11. Normal calcium level
    8.5-10.5
  12. Normal ionized calcium level
    4.4-5.5
  13. Normal PTH
    5-40
  14. Most common cause of hypoparathyroidism
    Previous thyroid surgery
  15. Oncogene that increases risk of parathyroid adenomas
    PRAD-1
  16. Lab values in primary hyperparathyroidism (Ca, Phos, Cl)
    Inc calcium, dec phos, Cl:Phos ratio >33
  17. Metabolic derangement seen in primary hyperparathyroidism
    Hyperchloremic metabolic acidosis
  18. Bone lesions from calcium resorption seen in hyperparathyroidism
    Osteitis fibrosa cystica
  19. Symptoms of hyperparathyroidism (4)
    Stones (nephrolithiasis), bones (bone pain, patholological fractures, muscle weakness, myalgia), groans (pancreatitis, PUD, constipation, nausea, vomiting), psychiatric overtones (mental status changes, depression)
  20. Indications for parathyroidectomy in primary hyperparathyroidism
    Symptomatic disease, Ca >13, dec creatinine clearance, substantially dec bone mass
  21. Most common cause of primary hyperparathyroidism
    Single adenoma
  22. Causes of primary hyperparathyroidism (3)
    Adenomas (multiple or single), diffuse hyperplasia, parathyroid adenocarcinoma
  23. Treatment of parathyroid hyperplasia
    Resect 3 � glands, or total resection + auto-implant
  24. Half-life of PTH
    18 minutes
  25. Most common position of missing gland (at reoperation)
    Normal anatomic position
  26. Diagnostic imaging to localize parathyroids (2)
    Thallium-technetium scan, Sestamibi-iodine scan
  27. Increased PTH in response to low Ca, seen in patients with renal failure
    Secondary hyperparathyroidism
  28. Aluminum accumulation in bones after several years of hemodialysis
    Renal osteodystrophy
  29. Indications for surgery in secondary parathyroidism
    Bone pain, fractures, pruritis
  30. Increased PTH despite corrected renal disease
    Tertiary hyperparathyroidism
  31. Defect in PTH receptor in kidney causing increased resorption of Ca
    Familial hypercalcemic hypocalciuria
  32. Defect in PTH receptor in kidney which causes a lack of response to PTH
    Pseudohyperparathyroidism
  33. Most common location of parathyroid cancer mets
    Lung
  34. Treatment of parathyroid cancer
    Parathyroidectomy and ipsilateral thyroidectomy
  35. Mortality cause of parathyroid cancer
    Hypercalcemia
  36. Tumors seen in MEN1 (3)
    Parathyroid hyperplasia, pancreatic islet cell tumors, pituitary adenoma
  37. First part to become symptomatic in MEN1
    Parathyroid
  38. Most common pancreatic islet cell tumor in MEN1
    Gastrinoma
  39. Tumors seen in MEN2a (3)
    Pheo, parathyroid hyperplasia, MTC
  40. Most common symptom of MTC in MEN2a and 2b
    Diarrhea
  41. #1 cause of death in MEN2a and 2b
    MTC
  42. First part to become symptomatic in MEN2a
    MTC
  43. Tumors seen in MEN2b
    Pheochromocytoma, MTC, mucosal neuromas
  44. Gene implicated in MEN1
    MENIN
  45. Gene implicated in MEN2a and 2b
    RET
  46. Causes of hypercalcemia (11)
    Calcium administration, hyperparathyroidism, immobility/iatrogenic, milk-alkali syndrome, Paget�s disease, Addison�s disease, neoplasm, thiaZide diuretics, excess vit D, excess Vit A, sarcoid/TB
  47. Drug used in malignancies after failed conventional treatment; inhibits osteoclasts
    Methramycin
  48. Hormone released by breast cancer bone mets and SCLC causing hypercalcemia
    PTHrp

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