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Surgical Recall > Emma Holliday for Surgery: Part VII > Flashcards

Emma Holliday for Surgery: Part VII Flashcards

1
Q

First step in working up a thyroid nodule

A

Check TSH

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2
Q

You check the TSH for a thyroid nodule, what next?

A

If low, do a RAIU scan to find the “hot nodule.” Excise it or kill it with radioactive iodide.

If normal, get an FNA

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3
Q

FNA of your nodule is done. What next?

A

If benign, leave it alone.

If malignant, excise it and check pathology

If indeterminant, re-bx it or check a RAIU scan

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4
Q

If the nodule comes back cold, what next?

A

Excise it, check pathology

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5
Q

5 types of cold nodular pathologies

A 
Papillary
Follicular
Medullary
Anaplastic
Thyroid lymphoma
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6
Q

Pathology of papillary cold thyroid nodule

A

MC type, spreads via lymph, psammoma bodies

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7
Q

What pre-disposes someone to a thyroid lymphoma

A

Predisposed by hashimotos

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8
Q

Pathology of follicular cold thyroid nodule

A

Spreads via the blood.

Better excise the whole thing

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9
Q

Pathology of Medullary cold thyroid nodule

A

Associated with MENII. Look for pheochromocytoma and hypercalcemia. You wil lsee amyloid and calcifications in pathology

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10
Q

Pathology of Anaplastic cold thyroid nodule

A

80% mortality in first year. No bueno.

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11
Q

4 functional versions on an adrenal nodule

A

Pheochromocytoma
Primary aldosteronism
Adrenocortical carcinoma
Cushing or silent cushing syndrome

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12
Q

Features of Pheochromocytoma and how we test for it

A

HTN, catechol symptoms

Get urine and plasma-free metanephrines

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13
Q

Features of primary aldosteronism and how we test for it

A

HTN, low K+ and low PRA

Plasma aldosterone-to-renin ratio

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14
Q

Features and testing for adrenocortical carcinoma

A

Virilization or feminization

Get a Urine 17-ketosteroid

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15
Q

Features and testing for cushings

A

Cushing symptoms or normal exam results otherwise

Test with an overnight 1-mg dexamethasone test

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16
Q

If the adrenal nodule is less than 5cm and non functional, what do you do

A

Observe with CT scans every 6 months

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17
Q

What if the adrenal nodule is greater than 6 cm or functional

A

Surgical excision.

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18
Q

Causes of hypothyroidism and what we see in the patient and labs

A

Typically from thyroidectomy

We see perioral numbness, chvostek’s and Trousseaus due to low calcium

Labs: Low calcium, high phosphate and low PTH

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19
Q

Presentation of hyperparathyroidism

A

Usually asymptomatic increase in calcium but can present with kidney stones, abdominal or psychiatric symptoms

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20
Q

Labs for hyperparathyroidism

A

High calcium, low phosphate, high Vitamin D and high parathyroid hormone

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21
Q

Diagnosing hyperparathyroidism

A

FNA of suspicious nodules. Can use Sestamibi scan

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22
Q

Treating hyperparathyroidism:

A

Surgical removal of adenoma. If hyperplasia, remove all 4 glands and implant 1 in the forearm

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23
Q

MEN 1

A

Pituitary adenoma, parathyroid hyperplasia, pancreatic islet cell tumor

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24
Q

MEN 2a

A

Parathyroid hyperplasia, medullary thyroid cancer, pheochromocytoma

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25
Q

MEN2b

A

Marfanoid, medullary thyroid cancer and pheochromocytoma

26
Q

U/S vs MRI for working up a breast mass

A

U/S can tell if solid or cystic. MRI is good for eval dense breast tissue, evaluating nodes and determining recurrent cancer.

–Best imaging for the young breast

–U/S good for determining fibroadenoma/cysto-sarcoma phyllodes.

27
Q

FNA vs. aspiration vs. cytology

A

Aspiration of fluid if cystic, FNA for cells if solid

–Send fluid for cytology if its bloody or recurs x2

28
Q

Symptoms of fibrocystic change and solutions to help with this

A

–Fibrocystic change: cysts are painful and change w/ menses. Fluid is typically green or straw colored.

•Restrict caffiene, take vitamin E, wear a supportive bra

29
Q

When do we do an excisional biopsy of breast tissue?

A

•Excisional biopsy if palpable or if fluid recurs

30
Q

Risk factors for breast cancer

A

RF: BRCA1 or 2, person hxof breast cancer, nulliparity, endo/exogenous estrogen.

31
Q

What do we do for DCIS?

A

Either excision w/ clear margins or simple mastectomy if multiple lesions (no node sampling) + adjuvant RT.

32
Q

What do we do for LCIS

A

More often bilateral. Consider bilateral mastectomy only if +FH, hormone sensitive, or prior hxof breast cancer

33
Q

What do we do for Infiltrating ductal/lobular carcinoma

A

–If small and away from nipple, can do lumpectomy w/ ax node sampling. Adjuvant RT. Chemo if node +. Tamoxifenor Raloxifen if ER +
–Modified radical mastectomy w/ ax node sampling w/o adjuvant RT gives same prognosis.

34
Q

What is Paget’s Dz of breast and what do we do about it

A

Looks like eczema of the nipple. Do mammogram to find the mass.

35
Q

Symptoms of inflammatory breast cancer

A

Red, hot, swollen breast. Orange peal skin. Nipple retratction

36
Q

What do we do about basal cell carcinoma?

A

Shave or punch bx then surgical removal (Moh’s)

37
Q

Precursor lesion to squamos cell

A

Actinic keratosis or keratoacanthoma

38
Q

How do we treat the keratosis before it becomes a squamos cell?

A

5FU or excision

39
Q

How do we treat squamos cell carcinoma?

A

Excisional bx at edge of the lesion then wide local excision. Rads can be used for tough locations

40
Q

Many forms of melanoma. What is the worst prognosis one and the best prognosis one?

A

Superficial spreading = best prog and is also the most common

Nodular is poor prognosis.

41
Q

This melanoma is on the palms, soles, mucous membranes in darker races

A

Acrolintiginous

42
Q

Lentigo maligna is found where?

A

Melanoma on the head and neck, actually has a good prognosis

43
Q

1 prognostic indicator for melanoma?

44
Q

First step when we see melanoma?

A

FULL THICKNESS bx. Not just bx. Remember depth is the most important thing.

45
Q

Treatment for melanoma

A

Excision with 1 cm margins if less than 1 mm thick. 2 cm margin if 1-4 mm thick. 3 cm margin if more than 4 mm thick.

46
Q

These drugs may help after biopsy for melanoma

A

High dose IFN or IL-2 may help

47
Q

This is often confused wit ha bruised muscle

A

soft tissue sarcoma

48
Q

Dx sarcoma?

A

Biopsy. NOT AN FNA.

Excisional if less than 3 cm, incisional otherwise.

49
Q

Tx for sarcoma

A

Wide local excision or amputation + RT

50
Q

First site for sarcoma to spread to

A

Lungs (hematogenously).

51
Q

If sarcoma spreads to the lungs, do we start chemotherapy?

A

Not yet.

You can do a wedge resection if this is the only met and the primary mass is under control.

52
Q

Liposarcomas usually arise from:

A

99% DO NOT come from Lipomas.

53
Q

Hard round mass on extremity:

A

Fibrosarcoma/Rhabdomyosarcoma/Lymphangiosarcoma

54
Q

These masses can occur in areas of chronic lymphedema

A

Fibrosarcoma/Rhabdomyosarcoma/Lymphangiosarcoma

55
Q

Rule of 7s for a neck mass

A

7 days is inflammatory
7 months is a cancer
7 years is congenital

56
Q

Most commonly a neck mass is just a reactive lymph node. So first step:

A

Look at teeth, tonsils, etc for inflammatory lesion or process

57
Q

If you find a lesion on inspection of a neck mass work up what do you do

A

Wait 2 weeks an FNA if still present

58
Q

If lymph node is firm and rubbery :

A

Excisional bx, look for lymphoma

59
Q

/in hodgkins lymphoma, what will we see on histo?

A

R-S cells. Lymphocyte predominance is a good prognostic indicator

60
Q

In non-hodgkins, what are the good prognostic indicators on histology

A

nodular and well differentiated

61
Q

Brancial vs thyroglossal duct cyst

A

Midline = Thyroglossal. Remove this surgically

Anterior to SCM = branchial

62
Q

If mass is spongy, diffuse and LATERAL to SCM what does this indicate?

A

Cystic hygroma 2/2 Turners, Downs, Klinefelters

Surgical Recall (15 decks)

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