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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
Q

ATA guidelines for central and lateral neck dissection

A

Do ultrasound
FNA all suspicious nodes
neck dissection only if FNA is positive

26
Q

most common side effect of central LN dissection

A

transient hypocalcemia

27
Q

Second line therapy for hypocalcemia after oral calcium carbonate

A

calcitriol

28
Q

ATA indications for total thyroidectomy and indeterminate nodules

A 
tumors > 4cm
marked atypia
"suspicious for PTC"
family history of thyroid cancer
radiation exposure
29
Q

Most common location for a missing parathyroid

A

open the deep tracheoesophageal groove

30
Q

Management of secondary hyperparathyroidism

A

subtotal parathyroidectomy (leave 1/2 a gland behind) with cervical thymectomy.

31
Q

How long until PTH gland starts to work after forearm autotransplantation?

A

6-8 weeks

32
Q

Firm parathyroid gland with severe hypercalcemia

A

Be prepared to do cancer operation without definitive diagnosis

33
Q

What do you do for a patient less than 30 years old with a new diagnosis of hyperparathyroidism?

A

Genetic testing for MEN I (mennin)

34
Q

PET avid adrenal in setting of lung cancer? What next

A

Still do endocrine work-up

35
Q

Two different optimization drugs for pheos

A

phenoxybenzamine is classic

diltiazem also works

36
Q

Hyperaldosteronemia and an adrenal mass?

A

Still do selective adrenal vein sampling; most adrenal masses arebenign and non-functional.

37
Q

When do you do a nephrectomy for adrenocortical carcinoma

A

Only with direct invasion.

38
Q

adjuvant therapy for adrenocortical carcinoma?

A

Mitotane

39
Q

When do you give mitotane for adrenocortical cancer?

A

high grade
tumor rupture
vascular or capsular invasion

40
Q

toxicities of mitotane

A

adrenal insufficiency
ataxia
confusion
rash

41
Q

When do you give cytotoxic chemo for adrenocortical carcinoma?

A

Stage IV or unresectable;

42
Q

Role of radiation for adrenocortical carcinoma?

A

Possibly for R1 resection; poor evidence

43
Q

Most common location for an extra-adrenal pheo?

A

organ of Zuckerkandl at the aortic bifurcation.

44
Q

What do you do before the OR on all re-operative necks?

A

laryngoscopy to confirm vocal cord function

45
Q

25 year old with previous thyroidectomy presents with hypercalcemia, what next?

A

24-hr urine metanephrines to rule out pheo!

46
Q

Which MTC patients do you send for genetic testing?

A

All of them (for RET proto-oncogene)

47
Q

Which pheos do you send for genetic counseling?

A

Can get away with saying all of them (aggressive)

definitely all bilateral and <45yr olds

48
Q

difference between vHL and MEN pheos?

A

vHL - norepinephrine

MEN - epinephrine

49
Q

size indication for adrenalectomy:

A

nodule >4cm

50
Q

surveillance for adrenal nodules

A

CT every 3-6 months for first year; then anually for 1-2 years. Hormonal evaluation yearly for 5 years.

51
Q

what is the most effective medication at preventing duodenal ulceration for a gastrinoma?

A

PPI

52
Q

Reversal of RLN injury

A

can be spontaneous in 3-6 months

53
Q

Nephrectomy for ACC?

A

No, unless direct invasion

54
Q

Treatment for incidentally discovered PTC on total thyroidectomy? (ATA 2009)

A

Nothing if < 1cm

55
Q

most common side for non-recurrent LN?

A

right 3%, associated with aberrant subclavian

56
Q

anatomy associated with a non-recurrent left LN?

A

Situs inversus

57
Q

risk of cancer in a Bethesda 4 follicular neoplasm

A

20-30%

58
Q

ATA recommended operation for a Bethesda 4 lesion

A

diagnostic lobectomy

59
Q

Surgery for Follicular Thyroid cancer?

A

Total thyroidectomy without lymph node dissection

60
Q

Adjuvant treatment for Follicular Thyroid Cancer

A

radioactive iodine and Thyroid suppression for all.

61
Q

Choices for ACC with vena cava invasion?

A

Adrenalectomy with venotomy and thrombectomy if R0 resection can be performed.

62
Q

Imaging for cystic parathyroid glands?

A

4DCT; Sestamibi doesn’t work.

Surgical Oncology (23 decks)

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