23 Parathyroid ANATOMY AND PHYSIOLOGY

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Questions and Answers

Where are the superior parathyroids located?

  • Medial to recurrent laryngeal nerves, more anterior, below inferior thyroid artery
  • Intra-thyroid, mediastinal, near tracheoesophageal groove
  • In the tail of the thymus
  • Lateral to recurrent laryngeal nerves, posterior surface of superior portion of gland, above inferior thyroid artery (correct)

Which artery supplies blood to both superior and inferior parathyroid glands?

  • Superior thyroid artery
  • Brachiocephalic trunk
  • Inferior thyroid artery (correct)
  • Carotid artery

What is the most common ectopic site for inferior parathyroids?

  • Intra-thyroid
  • Near tracheoesophageal groove
  • Mediastinal
  • In the tail of the thymus (correct)

Which pharyngeal pouch is associated with the inferior parathyroids?

<p>3rd pharyngeal pouch (A)</p>
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Which of the following conditions is characterized by a defect in the PTH receptor in the distal convoluted tubule of the kidney, leading to increased resorption of calcium?

<p>Familial hypercalcemic hypocalciuria (B)</p>
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What is the treatment for familial hypercalcemic hypocalciuria?

<p>No treatment is required (C)</p>
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Which condition results from a defect in the PTH receptor in the kidney, making it unresponsive to PTH?

<p>Pseudohypoparathyroidism (A)</p>
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In which location is lung most commonly affected by metastases in parathyroid cancer?

<p>Lung (B)</p>
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What is the 5-year survival rate for parathyroid cancer?

<p>50% (D)</p>
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Which gene mutation is associated with MEN I syndrome?

<p>MENIN gene (D)</p>
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What is the primary cause of death in patients with MEN IIa and MEN IIb syndromes?

<p>Medullary thyroid carcinoma (D)</p>
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Which condition is the most common cause of outpatient hypercalcemia?

<p>Hyperparathyroidism (B)</p>
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What is the mechanism of action of Mithramycin in treating hypercalcemia?

<p>Inhibits osteoclasts (B)</p>
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Which type of cancer can release PTHrP, leading to hypercalcemia?

<p>Breast cancer (B)</p>
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What is the primary cause of hypercalcemic crisis?

<p>Hyperparathyroidism (B)</p>
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What is the prevalence of pheochromocytoma in MEN IIa syndrome?

<p>Nearly all patients (D)</p>
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What is the primary role of parathyroid hormone (PTH) in the body?

<p>Increasing renal calcium reabsorption (C)</p>
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What is the most common cause of hypoparathyroidism?

<p>Previous thyroid surgery (A)</p>
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Which hormone decreases serum calcium levels?

<p>Calcitonin (C)</p>
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What is the characteristic bone lesion seen in hyperparathyroidism?

<p>Osteitis fibrosa cystica (brown tumors) (B)</p>
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What are the symptoms of primary hyperparathyroidism?

<p>Muscle weakness, nephrolithiasis, and depression (A)</p>
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What diagnostic workup is recommended for primary hyperparathyroidism?

<p>Serum protein electrophoresis and 24-hour urinary calcium determination (A)</p>
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What is the treatment for parathyroid adenoma?

<p>Total parathyroidectomy with autotransplantation (A)</p>
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What is the management approach for missing parathyroid glands during surgery?

<p>Checking inferiorly in thymus tissue for ectopic location (A)</p>
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What is the most common location for a missing parathyroid gland during surgery?

<p>Intra-thyroid (A)</p>
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What can cause hypocalcemia postoperatively after parathyroid surgery?

<p>Bone hunger or failure of parathyroid remnant/graft (A)</p>
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What is the preferred imaging modality for locating overactive parathyroid glands?

<p>Sestamibi scan (B)</p>
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What is the management approach for secondary hyperparathyroidism in patients with renal failure?

<p>Control diet phosphate and use phosphate-binding gel (sevelamer chloride) (C)</p>
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