Dr. Pestana's Notes--Gen Surg Flashcards
1
Q
Best way to dx GERD
A
pH monitoring
2
Q
Typical pt presenting w/ GERD
A
overweight, complains of burning retrosternal pain and “heartburn” brought about by bending over, wearing tight clothes or lying flat in bed at night; relieved by antacids or OTC H2 blockers
3
Q
Dx peptic esophagitis and possible Barrett’s esophagus
A
endoscopy and bx
4
Q
When is surgery indicated for GERD? (3)
A
(1) longstanding GERD that cannot be controlled by medical means, (2) developed ulcers/stenosis, or (3) dysplastic changes
5
Q
Tx GERD [w/ dysplasia]
A
Nissen fundoplication [+ radiofrequency ablation]
6
Q
Sxs motility problems in upper GI; Dx
A
crushing pain w/ swallowing in uncoordinated massive contraction and/or dysphasia; Manometry w/ barium swallow
7
Q
Sxs achalasia
A
(MC in women) dysphagia, pt sits up to allow gravity to help, occasional regurgitation of undigested food
8
Q
Dx achalasia. Tx
A
CXR or manometry shows megaesophagus; balloon dilation by endoscopy
9
Q
Progressive sxs esophageal cancer
A
dysphagia starting w/ meat, then other solids, then liquids w/ significant weight loss
10
Q
Esophageal cancers: (A) Squamous cell seen in ____ w/ hx of ______ (B) Adenocarcinoma seen in people w/ ______
A
[black] men; smoking and drinking; longstanding GERD
11
Q
Dx esophageal cancers
A
barium swallow, then endoscopy + bx; CT to assess operability; most cases only get palliative care
12
Q
Mallory-Weiss tear; Dx/Tx
A
occurs post prolonged, forceful vomiting, causing bright red blood to come up; endoscopy; photocoagulation
13
Q
Progression of sxs in Boerhaave syndrome
A
post prolonged, forceful vomiting leading to esophageal perforation; sudden low sternal pain followed by fever, leukocytosis and “sick” pt
14
Q
Dx Boerhaave syndrome; Tx
A
contrast swallow [Gastrorafin first, barium if negative]; surgery
15
Q
MCC esophageal perforation; sxs
A
instrumental perforation of esophagus via endoscopy; emphysema in lower neck
16
Q
Dx esophageal perforation; Tx
A
contrast studies; immediate surgery
17
Q
Gastric adenocarcinoma is MC in ____ population. Sxs
A
elderly; wt loss, anorexia, vague epigastric pain, early satiety, sometimes hematemesis
18
Q
Dx gastric adenocarcinoma; tx
A
endoscopy + bx, followed by CT to assess operability; sx
19
Q
Gastric _____ presents similarly to gastric adenocarcinoma but is treated by chemotherapy/radiotherapy. Surgery only done if risk of _____.
A
lymphoma; perforation during therapy
20
Q
A ______ can be reversed by eradication of H. pylori
A
MALTOMA [low-grade lymphomatoid transformation]
21
Q
MCC mechanical intestinal obstruction
A
adhesions in pts w/ prior laparotomy
22
Q
Sxs mechanical BOO
A
colicky abdominal pain, protracted vomiting, progressive abd distention [low obstruction], no flatus or BM; high-pitched bowel sounds
23
Q
Dx mechanical BOO
A
Abd xray–distended loops of sm bowel w/ air-fluid levels
24
Q
Tx mechanical BOO
A
(1) NPO, NG suction and IV fluids, hoping for spontaneous resolution (2) Surgery if unsuccessful after 24hrs
25
What sxs indicated BOO w/ strangulated bowel? Tx?
fever, leukocytosis, constant pain, signs of peritoneal irritation, ultimately full-blown peritonitis or sepsis; emergency sx required!!
26
Physical exam for mech intestinal obstruction caused by incarcerated hernia
irreducible hernia that used to be reducible; also fever, leukocytosis, and other sxs related to bowel strangulation
27
Tx incarcerated hernia
surgery: (A) strangulation, after proper rehydration (B) reducible hernia, electively
28
Cause of Carcinoid syndrome
small bowel carcinoid tumor w/ liver mets
29
Sxs carcinoid syndrome
diarrhea, flushing of face, wheezing, right-sided heart valvular damage (JVP)
30
Dx carcinoid syndrome
24hr urine 5HIAA (because only occurs sporadically and concentrations will only rise in the blood at those times, so must collect for 24hrs)
31
Sxs acute appendicitis; Tx
anorexia, periumbilical pain that becomes sharp, severe, constant and localized to RLQ; tenderness, guarding and rebound; low fever and leukocytosis (10-15,000) w/ neutrophilia and L-shift; Tx = sx
32
If unsure whether acute appendicitis, must do _____ to rule out other causes.
CT
33
Cancer of the _____ colon shows up w/ iron-deficiency anemia in the elderly. Stools 4+ for occult blood.
RIGHT
34
Dx colon cancer; Tx
colonoscopy/proctosigmoidoscopic exam + bx; surgery [R = right hemicolectomy, L = sx w/ preop chemoradiation for large tumors]
35
Caner of the ____ colon shows up w/ bloody bowel movements where blood coats the outside of the stool. May be constipation and stools may be "pencil-thin"
LEFT
36
Colonic polyps are premalignant. List risk of malignancy, starting w/ most likely (4)
(1) familial polyposis (Gardener)
(2) familial multiple inflammatory polyps
(3) villous adenoma
(4) adenomatous polyp
37
List the 4 colon polyps that are NOT premalignant.
juvenile, Peutz-Jeghers, isolated inflammatory, hyperplastic
38
IBD sxs. Which one [Crohn's or UC] can be treated surgically?
severe diarrhea w/ blood and mucus; UC (except when Crohn's causing bleeding/stricture/fistulization)
39
Why is surgical tx of UC avoided?
b/c gets rid of rectal mucosa, needing stoma or ileoanal anastomosis
40
When do you operate on UC? [usually avoided]
active dz >20yrs, severe nutritional depletion, mult hospitalizations, need for high-dose steroids/immunosuppressants, development toxic megacolon
41
MCC pseudomembranous enterocolitis caused by C. difficile
cephalosporins [also clindamycin]
42
Dx C. difficile; Tx
toxins in stool; abx discontinued, give metronidazole or vanco [DO NOT GIVE ANTIDIARRHEALS]
43
When do give emergency colectomy w/ C. difficile? What can you attempt to do before surgery?
when infection unresponsive to tx plus WBC >50,000 and serum lactate >5; fecal enema
44
Rule out anorectal cancer by doing a ______ exam
proctosigmoidoscopic
45
____ hemorrhoids bleed and can be treated w/ rubber band ligation; usually painless, but can become painfull and produce itching if _____
Internal; prolapsed
46
___ hemorrhoids hurt and can require surgery if conservative tx fails
external
47
Anal fissures usually happen to [this population]. Sxs
young women; extreme pain w/ defecation and blood streaks covering stools
48
MC location anal fissures; dx
posterior, in midline; physical exam, can be done under anesthesia (usually caused by tight sphincter)
49
MC Tx anal fissures
(1) diltiazem ointment 2% for 6wks have 80-90% success (2) botulinum toxin has 50% success. [Also....stool softeners, topical nitroglycerin, forceful dilation, lateral internal sphincterotomy]
50
Fissure, fistula or small anal ulceration that fails to heal and gets worse after surgical intervention is indicative of ______ because there is a lack of blood supply for healing
Crohn's dz
51
What is contraindicated in Crohn's dz of anus? How should fistulas be treated?
surgery; drained w/ setons + medical therapy + remicade
52
Sxs ischiorectal (perianal) abscess
febrile, perirectal pain that prohibits pt from sitting or having BMs, usually lateral to anus btwn rectum and ischial tuberosity
53
Tx ischiorectal abscess [if diabetic, must watch closely b/c necrotizing infection may occur!!]
incision and drainage (cancer must be ruled out)
54
______ can develop in pts who have ischiorectal abscess drained
Fistula-in-ano; epithelial migration from anal crypts and perineal skin form a permanent tract
55
Sxs Fistula-in-ano
soiling self and occasional perineal discomfort; PE shows opening lateral to anus w/ cordlike tract and discharge
56
Ddx Fistula-in-ano (what to rule out); Tx
necrotic and draining tumor; fistulotomy
57
Squamous cell carcinoma of anus most common in _____ population. Metastatic _____ nodes can be felt
HIV+ homosexuals w/ receptive sex; inguinal
58
Dx SqCC of anus; Tx
Bx; Nigro chemoradiation protocol (90% success) followed by surgery if residual tumor
59
MC location of GI bleeding (3/4 cases); 2nd MC location; 3rd
upper GI (nose to ligament of Treitz); colon/rectum; jejunum/ileum
60
Most colonic bleeding in elderly and MCCs are:
angiodysplasia, polyps, diverticulosis, cancer, hemorrhoids
61
When young person has GI bleed, most likely from ____; when older person gets bleed, most likely from _____
upper GI; either upper or lower [upper GI MC overall but age makes good candidate for lower GI bleeding]
62
Upper GI endoscopy is done when _______ or blood recovered by NG tube in pt w/ bleeding per rectum
vomiting blood
63
Melena always indicates _____ food. Must start workup with ____ GI endoscopy
digested; upper
64
Red blood per rectum occurs from _____ in the GI tract. Dx first includes
anywhere; NG tube and gastric content aspirate
65
In pt w/ blood per rectum, if NG tube plus gastric content aspirate has no blood with WHITE fluid, all but ___ of upper GI is excluded. ____ should follow for dx. If no blood and fluid is GREEN, ____ has been excluded.
duodenum; Upper endoscopy; entire upper GI
66
If upper GI excluded + red blood per rectum, ____ should be excluded first.
hemorrhoids (anoscopy; if bleeding, cannot do colonoscopy b/c can't see field)
67
When upper GI AND hemorrhoids excluded + red blood per rectum, use estimated rate of bleeding to do dx testing: (A) if exceeds ____, then do angiogram (B) if less than ____, wait until bleeding stops and do colonoscopy (C) if in between, then do _____ study, which is slow
2mL/min (1 unit blood q 4 hrs); 0.5mL/min; tagged red-cell
68
If tagged red-cell study in pt w/ red blood per rectum shows puddling on R or L, could help guide surgeon to do ______ in the future. If no puddling, do ____ for dx of bleeding.
"blind" hemicolectomy; colonoscopy
69
Pts w/ recent hx blood per rectum who are not actively bleeding should have a ___ if young and ___ if old
upper GI endoscopy; upper and lower GI endoscopy
70
MCC blood per rectum in child; dx
Meckel's diverticulum; technetium scan (look for ectopic gastric mucosa)
71
Massive upper GI bleed in stressed, multiple trauma or complicated postop pt probably from _____. ____ is confirmatory. Tx w/ _____ and _____
stress ulcers; Endoscopy; angiographic embolization maintaining gastric pH >4
72
Sxs acute abdomen caused by perforation; MCC
pt reluctant to move and protective of abd; peritoneal irritation (tenderness, muscle guarding, rebound, silent abd); peptic ulcer
73
Dx acute abdomen caused by perforation; tx
upright CXR shows free air under diaphragm; emergency sx
74
Sxs acute abdomen caused by obstruction of narrow duct (ureter, cystic, common)
sudden colicky pain w/ typical location; pt moving constantly
75
Sxs acute abdomen caused by inflammatory process; fever and leukocytosis, however, is NOT seen in ____
gradual onset (about 6-12hrs), starting constant and ill-defined and eventually localizes to area, then peritoneal irritation; pancreatitis
76
Severe abd pain and blood in gut lumen is indicative of ______
ischemic processes
77
______ should be suspected in child w/ nephrosis and ascites or adult w/ ascites w/ "mild" generalized acute abdomen +/- fever and leukocytosis
Primary peritonitis
78
Dx primary peritonitis; tx
cultures of ascitic fluid will yield single organism; abx
79
Tx generalized acute abdomen; if doesn't look like peritonitis, how do you rule out (A) MI (B) lower lobe pneumonia (C) PE (D) pancreatitis (E) urinary stones
exploratory laparotomy; (A) troponin, EKG (B) CXR (C) immobilized pt hx (D) amylase, lipase (E) abd CT
80
____ should be suspected in alcoholic w/ upper acute abdomen that occurs w/in a couple of hours w/ constant pain.
Acute pancreatitis
81
Dx acute pancreatitis
serum (from 12-48hrs) or urinary (from 3-6th day) amylase or lipase; CT if not clear
82
Tx acute pancreatitis
NPO, NG suction, IV fluids
83
_____ is suspected w/ colicky flank pain radiating to inner thigh and scrotum/labia
ureteral stones [can also have urgency/frequency and microhematuria in UA]
84
Dx ureteral stones
CT
85
LLQ abdominal pain is most likely ____
acute diverticulitis [in women, remember to check ovaries/fallopian tubes]
86
Sxs actue diverticulitis; Dx
fever, leukocytosis, peritoneal irritation in LLQ w/ occasional palpable mass; CT
87
Tx acute diverticulitis
start w/ NPO, fluids, abx; if sxs don't subside, need sx w/ possible percutaneous drainage if abscess is present [elective surgery in pt w/ 2 or more attacks]
88
URQ pain in elderly w/ severe abdominal distention is indicative of _______
volvulus of sigmoid colon
89
Dx volvulus of sigmoid colon
CXR shows air-fluid levels in small bowel w/ distended colon, huge air-filled loop in RUQ ("coffee-bean" sign)
90
Tx volvulus of sigmoid colon
proctosigmoidoscopic exam (resolves acute prob), rectal tube left in; recurrent cases requires elective sigmoid resection
91
_____ is seen in elderly, most often w/ development of acute abdomen following afib or recent MI. MCC is ____
mesenteric ischemia; clot in SMA
92
If there is acute abd pain w/ GI bleeding, usually indicative of ____. Acidosis and sepsis have developed.
mesenteric ischemia (elderly)
93
Early dx/tx mesenteric ischemia
arteriogram and embolectomy
94
MC underlying causes of primary hepatoma (HCC)
cirrhosis, Hep B or Hep C
95
Sxs HCC; Dx; Tx
vague RUQ discomfort w/ weight loss; AFP in serum, CT; resection if possible
96
Mets of liver outnumbers primary cancer in US by ____. Found via ____ if F/U for being treated for primary tumor or because of rising ____ levels in those w/ colonic cancer.
20:1 ; CT; CEA
97
If primary liver cancer is slow-growing, mets are confined to one lobe and _____ can be done; other tx can include _____
resection; radioablation
98
Hepatic adenomas are a potential complication of _____. They are a problem because they can _______. CT is dx and sx required
birth control pills; rupture and bleed massively in abdomen
99
____ is a complication of biliary tract dz, particularly acute ascending cholangitis
pyogenic liver abscess
100
Sxs, Dx, Tx pyogenic liver abscess
fever, leukocytosis and tender liver; sonogram or CT; percutaneous drainage
101
_____ of the liver favors med who have "Mexico connection"
Amebic abscess
102
Tx of amebic abscess of liver
metronidazole, seldom requiring drainage [b/c ameba doesn't grow in pus, it takes weeks for definitive serology diagnosis so empiric tx required]
103
Sxs hemolytic jaundice. Workup should see what is chewing up RBCs
elevated UNCONJUGATED bilirubin only w/ no bile in urine
104
Sxs hepatocellular jaundice; MCC
elevated unconjugated AND conjugated bilirubin w/ high transaminase levels and moderate elevation of ALP; hepatitis
105
Sxs obstructive jaundice
elevated unconjugated AND conjugated bilirubin w/ moderately elevated transaminase levels and high ALP
106
Dx obstructive jaundice includes ____, looking for dilation of biliary ducts. Stones in the _____ seldom seen; mostly seen in the _____.
sonogram; common duct; gallbladder
107
Courvoisier-Terrier sign in malignant obstructive jaundice
large, thin-walled distended gallbladder on sonogram
108
If gallstone suspected to be causing obstructive jaundice, must do ____ to confirm dx and then ____ to remove stone. _____ should follow
ERCP; sphincterotomy; cholecystectomy
109
Describe the ERCP procedure
endoscope descends into duodenum, the ampulla is cannulated and xray dye injected; need sedation; can do sphincterotomies, retrieve stones, drain pus, deploy stents, bx tumors
110
Describe MRCP procedure
noninvasive, fully-awake; need to be able to hold breath for 10 seconds; no further procedures can be done
111
3 different cancers responsible for obstructive jaundice tumor
adenocarcinoma of head of pancreas, adenocarcinoma of ampulla of Vater, cholangiocarcinoma of common duct
112
Dx cancers responsible for obstructive jaundice tumor; What if suspected (A) large pancreatic mass (B) ampullary mass (C) ductal neoplasm (D) tiny tumors in head of pancreas
CT, MRCP (smaller tumors visualized); (A) CT-guided percutaneous bx (B) endoscopy (C) ERCP and brushings (D) endoscopic US
113
_____ cancers suspected w/ malignant obstructive jaundice plus anemia and positive blood in stool; dx
ampullary; endoscopy
114
Procedure used to treat pancreatic cancer of head
Whipple procedure (pancreatoduodenectomy)
115
Ampullary cancer and cancer of lower end of common bile duct has about ____ cure rate
40%
116
_____ have the worst prognosis of ductal cancers; dx
cholangiocarcinomas arising w/in liver at bifurcation of hepatic ducts; MRCP
117
Typical characteristics of pt w/ gallstones
Fat, forty, fertile, female; Mexican Americans and Native Americans
118
Asxs gallstones are _____
left alone
119
Biliary colic occurs when stone temporarily occludes _____. Sxs.
cystic duct; colicky RUQ pain radiating to shoulder/back, often triggered by fatty foods and N/V w/out signs peritoneal irritation or inflammation
120
Tx biliary colic
anticholinergics
121
Acute cholecystitis starts as ____ but stone remains in ____ duct until inflammatory process develops. Sxs
biliary colic; cystic; constant pain, modest fever and leukocytosis w/ peritoneal irritation in RUQ w/ mildly affected LFTs
122
Sonogram in acute cholecystitis shows ____. Sometimes a ____ is used to show uptake in ducts
gallstones, thick-walled gallbladder and pericholecystic fluid; HIDA [radionucleotide scan]
123
Tx Acute cholecystitis; MC population to NOT respond to initial medical tx, requiring emergency cholecystectomy
Start w/ NG suction, NPO, fluids and abx, then elective cholecystectomy if needed; men and diabetics
124
Acute ascending cholangitis; sxs
stones reached common duct, producing partial obstruction and ascending infection; elderly pts w/ temp 104-105, chills, high WBC count (sepsis), sometimes hyperbilirubinemia, VERY HIGH ALP
125
Tx Acute ascending cholangitis
IV abx and emergency decompression of common duct (ERCP or percutaneous transhepatic cholangiogram or surgery); eventual cholecystectomy to follow
126
Sxs Biliary pancreatitis due to stone obstruction; Dx
transitory episode cholangitis w/ pancreatitis symptoms (elevated amylase/lipase); US
127
Tx Biliary pancreatitis due to stone obstruction
NPO, NG suction, fluids usually leads to improvement w/ elective cholecystectomy to follow; if not, ERCP and sphincterotomy to dislodge stone
128
Acute pancreatitis seen usually in ___ or ____
alcoholics, complication of gallstones
129
Sxs acute edematous pancretitis; most telling diagnostic feature
tenderness and mild rebound in upper abdomen; high serum amylase or lipase (early on) or urinary amylase/lipase (after couple of days); elevated hematocrit
130
Sxs acute hemorrhagic pancreatitis
starts like edematous but has LOWER hematocrit and the degree of amylase elevation doesn't correlate w/ severity of dz
131
What are the 3 factors in Ranson's criteria of acute hemorrhagic pancreatitis? [seen at time of presentation]
(1) elevated WBC (2) elevated blood glucose (3) low serum calcium
132
About a day post acute hemorrhagic pancreatitis, what do labs look like? Tx
Ht lower, serum calcium low despite calcium administration, BUN higher, metabolic acidosis and low arterial PO2; supportive therapy in ICU
133
_____ are recommended to prevent/ameliorate development of multiple pancreatic abscesses (about ____ after onset of pancreatitis) and to drain them. IV ____ or ___ can also be used.
Daily CT scans; 10 days; imipenem; meropenem
134
A ______ is done to tx necrotic pancreas when the dead tissue is well delineated, typically after ____ weeks. The procedure may be repeated until all dead matter cleared.
necrosectomy; four
135
Pancreatic _____ can be a late sequela of acute pancreatitis or pancreatic trauma, usually developing about _____ after primary incident.
pseudocyst; 5 weeks
136
Sxs Pancreatic pseudocyst
collection pancreatic juice outside ducts (lesser sac) and pressure causes early satiety, vague discomfort, deep palpable mass
137
Dx Pancreatic pseudocyts
CT or US
138
Tx of pancreatic pseudocyts (A) 6cm or smaller or those present less than 6 weeks (B) >6cm or cysts older than 6wks
(A) can be observed for spontaneous resolution (B) drainage (percutaneously, surgically into GI tract or endoscopically into stomach) b/c can rupture or bleed
139
Chronic pancreatitis, usually in alcoholics, can cause pts to develop these 4 things
(1) calcified, burned-out pancreas (2) steatorrhea (3) diabetes (4) chronic epigastric pain
140
Tx chronic-pancreatitis-caused (A) steatorrhea (B) diabetes (C) MRCP-indicated obstructions
(A) pancreatic enzymes (B) insulin (C) drainage pancreatic duct
141
2 types of hernias that do not require elective surgery
(1) umbilical hernias in pts
142
Hematogenous mets usually go to these 4 areas
liver, lung, brain and bone
143
Epithelial tumors and adenocarcinomas spread ____ and ____. Breast spreads mostly to ____ and ____. Abdominal adenos spread to _____. Sarcomas spread only _____ to the ____ mostly.
hematogenously; lymphatically; brain; bone; liver; hematogenously; lungs
144
Chemotherapeutic drugs causing following complications (A) myocardial damage (B) pulmonary fibrosis (C) hemorrhagic cystitis (D) neurotoxicity
(A) adriamycin (B) bleomycin (C) cyclophosphamide (D) platinum-based agents
145
Fibroadenomas seen in ____ women. Sxs; Dx; Tx
young; firm, rubbery, painless mobile mass; FNA or US; removal is optional
146
Cystosarcoma phyllodes seen in _____ women. Sxs; Dx; Tx
late 20yo; grow large and may distort breast, with most being benign and can be malignant sarcomas; core needle biopsy or incisional biopsy; must surgically remove
147
Mammary dysplasia (fibrocystic dz or cystic mastitis) seen in ____ women and goes away w/ ____. Sxs
30 and 40yo; menopause; bilateral tenderness related to menstrual cycle w/ multiple lumps that come and go
148
Dx mammary dysplasia
Aspiration done; if clear fluid and mass goes away, do nothing; if mass persists or recurs, formal bx required; if bloody fluid aspirated, sent to cytology
149
_____ seen in 20 to 40yo women w/ bloody nipple discharge. Mammogram to look for other potential lesions (will not show this small lesion). Dx/Tx.
Intraductal papilloma; Galactogram; Sx resection
150
Breast abscess only seen in _____ women. Tx
lactating; incision and drainage needed, also bx taken
151
Suspicious indicators of breast cancer
ill-defined fixed mass, retraction of overlying skin, peau-d'orange, recent retraction of nipple, eczematoid lesions of areola, palpable axillary LNs
152
Breast cancer during pregnancy diagnosed and treated same way except for NO ____ at any point in pregnancy and NO _____ during first trimester
radiotherapy/hormonal manipulations; chemotherapy
153
(A) Tx of resectable small breast cancer lesions (B) Tx resectable large breast cancer lesions (C) if LN not palpable (D) if enlarged LNs
(A) lumpectomy or segmental resection followed by radiotherapy (B) total mastectomy (C) sentinel node dissection (D) axillary node dissection
154
_____ is a type of infiltrating ductal carcinoma that has worse prognosis and need for neoadjuvant chemotherapy
inflammatory breast cancer
155
_____ IDC has the highest incidence of bilaterality, but not enough to justify bilateral mastectomy. Name other 2 kinds of IDC
Lobular; medullary and mucinous
156
DCIS cannot mets so NO ____ is needed; has a high incidence of recurrence if local resection, therefore usually ____ done. ____ is only done when confined to one quarter of breast.
axillary sampling; total mastectomy; lumpectomy + radiation
157
Inoperability of breast cancer based on _____, not metastases
local extent
158
In breast cancer patients, ____ should follow surgery in almost all cases, especially if ax LN (+). _____ is used if hormone receptor positive in premenopausal women and ____ is used in postmenopausal women.
hormone therapy; tamoxifen [SERM]; anastrozole [aromatase inhibitor]
159
_____ pain in women who had breast cancer suggests metastasis. ____ are diagnostic. Brain mets tx.
headache or back (vertebral pedicles); MRI; radiated or resected
160
Thyroid cancer can occur at any age and _____ affect thyroid function. Typically dx via _____, except for _____.
does not; FNA; follicular cancer
161
Because thyroid cancer is ____-growing, surgical resection dictated by size of tumor and _____.
slow; presence of metastatic nodes
162
Because it can use radioactive iodine, ____ cancer is usually treated w/ a total thyroidectomy in order to be able to identify future potential mets in a pt.
follicular thyroid
163
______ is an aggressive thyroid cancer and requires radical surgery. Workup for _____ is also indicated due to potential MEN2 diagnosis.
Medullary cancer (C cells); pheochromocytoma
164
_____ thyroid cancer seen mostly in elderly and incredibly aggressive; often only thing that can be done for pt is _____
Anaplastic; tracheostomy
165
Hyperthyroidism mostly treated w/
radioactive iodine; also methimazole and PTU
166
Sxs primary hyperPTH; 90% have single adenoma and ____ is curative
high serum calcium w/ low phosphorus and high PTH; parathyroidectomy (sestamibi scan can help localize adenoma)
167
Sxs Cushings
overweight, buffalo hump, osteoporosis, diabetes, HTN, mental instability;
168
Dx of Cushings includes overnight low-dose dexamethasone suppression test (positive if cortisol levels are ____), then high-dose suppression test--If no suppression then pt has ____; if suppressed, then probably ____. To confirm, do these diagnostic tests. Surgically remove adenoma.
the same; adrenal adenoma or paraneoplastic syndrome; pituitary microadenoma; MRI for pituitary, CT for adrenal
169
For dx Cushings, the Mayo clinic uses 24hr urine for free cortisol levels: pts w/ adrenal adenomas have levels _____ times normal. They also measure _____ to differentiate which kind of adenoma is present.
3 to 4; corticotropin
170
Dx Zollinger-Ellison; Tx
measure gastrin and do secretin test and locate w/ CT scan w/ contrast; surgically remove and omeprazole can help w/ mets
171
_____ produces CNS symptoms and low blood sugar when pt fasting.
Insulinoma [DDx includes reactive hypoglycemia and self-administration of insulin]
172
In insulinoma, both ____ and ____ are high in blood. Tx includes removal.
insulin, C-peptide [sulfonylureas to induce endogenous insulin secretion can mess up lab values]
173
Nesidioblastosis; Tx
hypersecretion of insulin in newborn; 95% pancreatectomy
174
_____ produces severe migratory necrolytic dermatitis resistant to all forms of therapy in pt w/ mild diabetes, anemia, glossitis, stomatitis.
Glucagonoma
175
Dx glucagonoma; Tx
glucagon assay; CT to locate tumor + resection is curative (if mets and inoperable use stomatostatin or streptozocin)
176
Primary hyperaldosteronism can be caused by ______ or ______. Key lab finding is _____ in hypertensive pt not on diuretics.
adenoma; hyperplasia; hypokalemia
177
Lab findings of primary hyperaldosteronism; If pt responds to postural changes, indicative of _____. If pt doesn't respond to postural changes, indicative of _____.
hypokalemia, high aldosterone concentration, low renin; hyperplasia; adenoma
178
Tx Primary hyperaldosteronism
CT to localize and surgical removal of adrenal lesion
179
_______ seen in thin, hyperactive women w/ attacks of ppunding headache, perspiration, palpitations and pallor.
Pheochromocytoma
180
Dx workup pheochromocytoma. (Tumors usually large!)
24hr urinary VMA, metanephrines or free urinary catecholamines; follow w/ CT of adrenals or radionuclide studies (extra-adrenal)
181
Tx pheochromocytomas
surgery w/ prep of alpha-blockers like phenoxybenzamine
182
____ is usually in young pts w/ HTN in arms and normal pressure in LEs. Dx. Tx.
Coarctation of aorta; CXR shows scalloping of ribs and CT angio is diagnositc; surgery is corrective
183
Renovascular HTN seen in (2 groups)
(1) young women w/ fibromuscular dysplasia (2) old men w/ arteriosclerotic occlusive dz
184
Sxs renovascular HTN. Dx
resistant HTN w/ faint bruit over flank or upper abdomen; Duplex scanning of renal vessels, CT anio
185
Tx renovascular HTN
In young women, balloon dilation and stenting; tx in old men controversial due to arteriosclerosis
186
Define "-tomy"
to cut
187
Define "-ectomy"
to take out/resect
188
Define "-ostomy". If only one organ. If two organs.
to make a mouth/opening; opening to outside; opening is between them = anastamosis
189
Define "-plasty"
to change the shape of
190
Define "-plexy"
to fix in place
191
Define "-rrhaphy"
to saw together (ex. herniorrhaphy is historical way to fix hernia; ex. tarsorrhaphy is to saw eyelids together)
