Chapter 20: Surgical Endocrinology Flashcards
A 44yo man is being evaluated for PUD that has not healed despite empiric triple drug tx for Helicobacter pylori and proton pump inhibitors. Serum gastrin is elevated and abdominal CT scan discloses a 2cm mass in the pancreatic tail. Prior to distal pancreatectomy, which one of the following blood tests is most appropriate?
a. Calcium
A 26yo woman is seen in the clinic b/c of a neck mass. She has otherwise been healthy. There is a 1.8cm nodule in the right lobe of her thyroid. A FNA cytology shows mainly Hurthle cells. What is the next best step in management?
Thyroid lobectomy
A 40yo man is seen in the office in f/u of HTN. He was dx 6mo ago w/ new onset HTN and despite multiple drug therapy, his pressure remains poorly controlled. His PE is normal except for sweaty palms and bilateral fine tremor of his hands. Which one of the following is the most appropriate next test for diagnosis?
Serum metanephrines
A 60yo man w/ end-stage renal disease has undergone hemodialysis 3x weekly for 10yrs. Over the past 6mo, his serum calcium level has risen from 9.0 mg/dL (normal 8.2-10.2) to 11.2 mg/dL. Adjustment of his dialysis prescription, phosphate binder, and vitamin D dosing does not lower his calcium level. Which one of the following mechanisms most likely accounts for his rising calcium?
Autonomous parathyroid gland function
A 22yo woman comes to the office b/c of a large neck mass. She has no other sxs and has otherwise been healthy. She is afebrile. Vital signs are normal. There is a large mass in the right neck that moves with swallowing. U/s shows a 4.8 cm solid mass in the right lobe of her thyroid. FNA cytology shows papillary carcinoma. Serum T3, T4, and TSH levels are normal. What is the next best step in management?
Total thyroidectomy
A 70yo man is admitted w/ mental status changes. CT scan of the head and lumbar puncture results are within normal limits. He underwent right upper lobectomy for squamous cell lung cancer one yr ago. His calcium is 13.0 mg/dL and phosphorus is 3.5 mg/dL. His hypercalcemia will e worsened by the administration of which one of the following?
Hydrochlorothiazide
A 26yo woman is seen in the office in preparation for surgery for a thyroid cancer. She feels well and has otherwise been healthy. She takes no meds. Her mother had similar cancer and also had tumors of her pancreas and adrenal gland. Vital signs are normal. There is a 2cm irregular mass in the right lobe of the thyroid. The remainder of her PE is completely normal. Her serum calcitonin level is elevated. Which of the following should be obtained prior to proceeding w/ surgery?
Urinary catecholamine levels
A 25yo woman is seen in clinic two weeks after being dx w/ HTN. She was started on hydrochlorothiazide and has been taking it daily. She now complains of diffuse muscle m/n for the past week. Her BP is 120/75 mmHg. Electrolyte results are: Na 142, K 3.2, Cl 98, HCO3 28. The next step in management should be screening for which of the following conditions?
Primary hyperaldosteronism
A 50yo previously healthy man is found to have a right adrenal mass on CT of the abd performed after a MVC in which he was restrained front seat passenger. He is tender over his left lower costal margin. CT scan is w/in normal limits except for fx of the left 9th and 10th ribs. The adrenal mass is 2.1 cm in greatest dimension, solid, and homogenous. The borders of the mass are well defined and regular. The next step in management for the adrenal mass should be which of the following?
Repeat adrenal CT scan
A 42yo woman comes to the office b/c of tremulousness and palpitations for the past 3 weeks. She says she feels nervous all of the time. She has otherwise been healthy and takes no meds. She is afebrile. She has exophthalmos. Her pulse is irregular. Her hair is thin and there is pretibial edema. Her thyroid is diffusely enlarged and firm. TSH level is low. What is the most likely mechanism for her condition?
Circulating IgG antibody that stimulates TSH receptors on follicular cells
