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Surgical Oncology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

patient presents wit ha thyroid nodule and decreased TSH, what is the next step?

A

Technecium uptake scan and start a beta-blocker (propranolol)

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2
Q

What disorders can a technicium thyroid scan differentiate between?

A

Functional adenoma and graves disease

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3
Q

What is the chance of malignancy from Hurthle cell cytology from a thyroid nodule?

A

20-30% cancer;

can be either hurthle cell carcinoma or oncocytic variant of PTC

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4
Q

What endocrine tumors can be treated with enucleation?

A

Only do for functional tumors (insulinoma, gastrinoma etc) or low malignancy hereditary disorders MEN?)

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5
Q

What is best palliation for hepatic metastasis from PNET?

A

TACE - Palliates pain in 75-100% of liver PNETs

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6
Q

Thyroid nodule with low TSH; what is next step?

A

thyroid uptake scan and start propranolol.

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7
Q

thyroglobulin positive cells in a lymph node?

A

is metastatic thyroid cancer. Need a total thyroidectomy and ipsilateral neck dissection.

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8
Q

MEN I

A

pituitary
hyper parathyroid
pancreas masses

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9
Q

gene for MEN I

A

mennin

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10
Q

function of menin

A

transcription regulator.

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11
Q

MEN II

A

medullary thyroid cancer
Pheochromocytoma
Hyperparathyroid

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12
Q

gene for MEN II

A

ret-proto oncogene

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13
Q

Von Hippel-Lindau

A

RCC
pheochromocytoma
pNETs
CNS hemangioblastoma

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14
Q

Key differentiation between MEN and VHL?

A

VHL does not get hyperparathyroid

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15
Q

gene for Von Hippel-Lindau

A

vHL; regulates VEGF and HIF1alpha

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16
Q

Best control of symptoms from bulky metastatic carcinoids?

A

TACE

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17
Q

Medullary Thyroid Cancer prompt

A

always think about the pheo

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18
Q

Treatment for metastatic MTC

A

TKIs
vandetanib and cabozatinib
Both have PFS advantage in RCTs.

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19
Q

SCC that is P16 positive is caused by:

A

HPV

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20
Q

SCC in a neck node on FNA with no primary, next step:

A

Go to OR for laryngoscopy, esophagoscopy and bronchoscopy.

Random biopsy if necessary

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21
Q

Most common location of occult primary H&N SCC

A

90% are in the tonsilar pillar or base of tongue.

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22
Q

treatment for adenoid cystic carcinoma?

A

Parotidectomy and adjuvant RT

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23
Q

Recurrence pattern of adenoid cystic carcinoma

A

Late, and also “skip lesions” along the nerve.

Very rare to have lymph nodes

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24
Q

FNA proves thyroid mass is PTC; what is next step?

A

neck ultrasound for lymphadenopathy.

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25
ATA guidelines for central and lateral neck dissection
Do ultrasound FNA all suspicious nodes neck dissection only if FNA is positive
26
most common side effect of central LN dissection
transient hypocalcemia
27
Second line therapy for hypocalcemia after oral calcium carbonate
calcitriol
28
ATA indications for total thyroidectomy and indeterminate nodules
``` tumors > 4cm marked atypia "suspicious for PTC" family history of thyroid cancer radiation exposure ```
29
Most common location for a missing parathyroid
open the deep tracheoesophageal groove
30
Management of secondary hyperparathyroidism
subtotal parathyroidectomy (leave 1/2 a gland behind) with cervical thymectomy.
31
How long until PTH gland starts to work after forearm autotransplantation?
6-8 weeks
32
Firm parathyroid gland with severe hypercalcemia
Be prepared to do cancer operation without definitive diagnosis
33
What do you do for a patient less than 30 years old with a new diagnosis of hyperparathyroidism?
Genetic testing for MEN I (mennin)
34
PET avid adrenal in setting of lung cancer? What next
Still do endocrine work-up
35
Two different optimization drugs for pheos
phenoxybenzamine is classic | diltiazem also works
36
Hyperaldosteronemia and an adrenal mass?
Still do selective adrenal vein sampling; most adrenal masses arebenign and non-functional.
37
When do you do a nephrectomy for adrenocortical carcinoma
Only with direct invasion.
38
adjuvant therapy for adrenocortical carcinoma?
Mitotane
39
When do you give mitotane for adrenocortical cancer?
high grade tumor rupture vascular or capsular invasion
40
toxicities of mitotane
adrenal insufficiency ataxia confusion rash
41
When do you give cytotoxic chemo for adrenocortical carcinoma?
Stage IV or unresectable;
42
Role of radiation for adrenocortical carcinoma?
Possibly for R1 resection; poor evidence
43
Most common location for an extra-adrenal pheo?
organ of Zuckerkandl at the aortic bifurcation.
44
What do you do before the OR on all re-operative necks?
laryngoscopy to confirm vocal cord function
45
25 year old with previous thyroidectomy presents with hypercalcemia, what next?
24-hr urine metanephrines to rule out pheo!
46
Which MTC patients do you send for genetic testing?
All of them (for RET proto-oncogene)
47
Which pheos do you send for genetic counseling?
Can get away with saying all of them (aggressive) | definitely all bilateral and <45yr olds
48
difference between vHL and MEN pheos?
vHL - norepinephrine | MEN - epinephrine
49
size indication for adrenalectomy:
nodule >4cm
50
surveillance for adrenal nodules
CT every 3-6 months for first year; then anually for 1-2 years. Hormonal evaluation yearly for 5 years.
51
what is the most effective medication at preventing duodenal ulceration for a gastrinoma?
PPI
52
Reversal of RLN injury
can be spontaneous in 3-6 months
53
Nephrectomy for ACC?
No, unless direct invasion
54
Treatment for incidentally discovered PTC on total thyroidectomy? (ATA 2009)
Nothing if < 1cm
55
most common side for non-recurrent LN?
right 3%, associated with aberrant subclavian
56
anatomy associated with a non-recurrent left LN?
Situs inversus
57
risk of cancer in a Bethesda 4 follicular neoplasm
20-30%
58
ATA recommended operation for a Bethesda 4 lesion
diagnostic lobectomy
59
Surgery for Follicular Thyroid cancer?
Total thyroidectomy without lymph node dissection
60
Adjuvant treatment for Follicular Thyroid Cancer
radioactive iodine and Thyroid suppression for all.
61
Choices for ACC with vena cava invasion?
Adrenalectomy with venotomy and thrombectomy if R0 resection can be performed.
62
Imaging for cystic parathyroid glands?
4DCT; Sestamibi doesn't work.

Surgical Oncology (23 decks)

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