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Surgery Clerkship > Endocrine diseases, surgical hypertension, vascular surgery > Flashcards

Endocrine diseases, surgical hypertension, vascular surgery Flashcards

1
Q

How to work up thyroid nodule?

A

Get TSH/T4. If elevated, do a RAIU scan. If hot nodule, do radioactive iodine ablation, if not hot, U/s guided FNA. If not hyperthyroid, get an fna. If cancer, I2 ablate or surgery.

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2
Q

Presentation of hyperparathyroidism?

A

Increased calcium, decreased phosphate, increased PTH. Patient will have bone pain, and brown cysts.

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3
Q

How to diagnose hyperparathyroidism?

A

Get a sestimibi scan.

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4
Q

How to treat hyperparathyroidism/

A

Resect parathyroids

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5
Q

F/u parathyroid resection?

A

Watch out for post-op hypocalcemia

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6
Q

ZE syndrome symtoms

A

Gastrin secrine tumor that causes horrendous PUD and diarrhea

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7
Q

How to diagnose ZE?

A

Increased gastrin levels, do a secretin stimulation test.

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8
Q

How to localize ZE?

A

Somatostatin receptor scintillography

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9
Q

How to treat ZE? Why is it important to treat?

A

Resect because it can cause gastric carcinoma.

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10
Q

Presentation of insulinoma?

A

Repeated episodes of hypoglycemia

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11
Q

How to diagnose insulinoma?

A

Look at insulin levels but also levels of C-peptide. If factitious, c-peptide levels will be low.
Get a CT scan to localize

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12
Q

How to treat insulinoma?

A

Resect

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13
Q

Presentation of glucagonoma?

A

Migratory necrolytic dermatitis, slight DM. Touch of anemia, glossitis, stomatitis.

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14
Q

How to diagnose glucagonoma?

A

Get glucagon levels with CT to localize

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15
Q

How to treat glucagonoma?

A

Surgically resect.

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16
Q

Patient with cushing syndrome?

A

Buffalo hump, purple striae, central obesity, HTN, DM.

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17
Q

How to diagnose cushing syndrome?

A

Low dex suppression. If fails to suppress then cushing dyndrome. Then get ACTH level, if decreased then adrenal tumor (cortisol producing). If ACTH high then ACTH producing tumor. Do high dose dex suppression. If suppresses, then cushing dz (dx with MRI). , if fails, then lung cancer (small cell), get a CT or PET to find.

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18
Q

Nesidioblastosis

A

Devastating hypersecretion of insulin in the newborn requiring 95% pancreatectomy

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19
Q

Primary hypoaldosteronemia patient presentation

A

HTN and decreased K. Mild metabolic alkalosis.

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20
Q

How to dx Conn syndrome? How to verify?

A

Get an aldo:renin ratio which will be >20. Localize/verify with CT scan.

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21
Q

How to treat conn syndrome?

A

Resect

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22
Q

Patient presentation with pheochromocytoma

A

Paroxysms of pain, palpitations, pressure, perspiration.

23
Q

How to diagnose pheochromocytoma?

A

Urinary VMA and metanephrines

24
Q

How to treat pheochromocytoma?

A

Alpha-blockade (phenoxybenzamine), then beta blockade, then resection

25
Q

Renal artery stenosis causes?

A

Atherosclerosis or fibromuscular dysplasia

26
Q

How to diagnose renal artery stenosis?

A

Aldo:renin ratio is

27
Q

How to treat FMD in young female?

A

Stenting

28
Q

How to treat RASin old male?

A

Surgery, ace inhibitors, aldosterone blockers.

29
Q

Coarctation of aorta presentation?

A

HTN in upper extremities, Hypotension in lower extremities. Rib notching. Claudication.

30
Q

How to diagnose coarctation of aorta?

A

CT/MRI/arteriogram

31
Q

How to treat coarctation of aorta?

A

Resect, anastamose.

32
Q

How to treat glucagonoma if disease is metastatic and inoperable?

A

Somatostatin and streptozocin

33
Q

Pathogenesis of AAA?

A

Patient with atherosclerosis, infrarenal,

34
Q

Typical AAA patient?

A

Old males>65 who have smoked. Asymptomatic with pulsatile mass

35
Q

How to diagnose AAA/

A

Ultrasound, ct scan.

36
Q

When to treat AAA?

A

If >5.5 cm or growing at a rate of 1cm/year.

OR if patient presents with horrible abdominal pain, pulsatile mass, back pain, which indicates rupture.

37
Q

Typical aortic dissection patient?

A

Hypertension with tearing chest pain. Asymmetric BP in arms, CXR shows widened mediastinum.

Patients may have marfan’s or syphilis.

38
Q

How to diagnose aortic dissection?

A

CXR, CTA, TEE best.

39
Q

How to treat aortic dissection?

A

Take to surgery immediately if ascending. Manage medically if descending.

40
Q

Pathogenesis of arterial thromboembolism?

A

Cholesterol embolism after catheterization or clot thrown from afib.

41
Q

How does patient with arterial thromboembolism present?

A

Painful, pulseless, paresthetic, poikilothermic, pale extremity.

42
Q

How to diagnose arterial thromboembolism

A

Ultrasound, doppler, arteriogram.

43
Q

How to treat arterial thromboembolism

A

Only 6 hours to treat, must move fast. Thrombectomy with fogery balloon or tPA.

44
Q

Peripheral vascular disease pathogenesis

A

atherosclerosis and smoking

45
Q

Patient presentation with peripheral vascular disease?

A

Claudication

46
Q

How to treat patients with claudication?

A

If it affects their lifestyle, intervene. Otherwise, don’t do anything.

47
Q

When is CLI expected?

A

When rest pain,

48
Q

How to diagnose peripheral vascular disease?

A

ABI 0.9-1.2 normal.

49
Q

How to treat all patients with peripheral vascular disease?

A

Cilostazol and clopidogrel.

50
Q

Addison’s disease symptoms.

A

Adrenal insufficiency. Hyperpigmented skin, abdominal pain, hyponatremia, hyperkalemia, hypotension.

51
Q

How to acutely treat hypercalcemia?

A

Immediate IVF, then calcitonin if in pain. Can give bisphosphonates long term.

52
Q

How long to put patients on alpha blockers for before pheo removal?

A

1-3 weeks

53
Q

Presentation of thyroid storm

A

Fever, palpitations, hypertension, shock, fever

54
Q

How to treat thyroid storm

A

IVF, cooling blankets, propranolol, PTU/methimazole, IV steroids. Then do surgery and I2 ablation.

Surgery Clerkship (11 decks)

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