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Surgery > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

0
Q

Hx of neck radiation w/ nodule –> next step?

A

Appropriate to move straight to thyroidectomy

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1
Q

Important factors in H&P of thyroid nodule?

A

Radiation hx, family hx, voice and airway, sx, thyroid nodule pattern

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2
Q

Which type of thyroid cancer is inherited? Dx?

A

Medullary (MEN syndromes - RET gene - AD trait)

Calcitonin levels

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3
Q

Signs/sx concerning for thyroid malignancy?

A

Hoarseness, hard/fixed nodule, dyspnea, dysphagia, cervical LN enlargement, vocal cord paralysis

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4
Q

Risk of solitary nodule vs dominant nodule in multinodular gland

A

15% vs 5%

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5
Q

T/F: radioactive iodine scanning is appropriate initial eval of solitary thyroid nodule

A

F

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6
Q

Usefulness of US in thyroid eval?

A

Distinguishing cyst from nodules, following the size or recurrence of cysts following FNA

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7
Q

FNA shows psammoma bodies?

A

Papillary cancer

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8
Q

FNA shows amyloid deposits

A

Medullary cancer

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9
Q

FNA shows Hurthle cells? Tx

A

Adenoma or low-grade cancer –> lobectomy, total thyroidectomy

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10
Q

FNA shows lymphocytic infiltrate? Dx, Tx

A

Lymphoma or chronic lymphocytic thyroiditis

Flow cytometry

Radiosensitive –> radiation appropriate

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11
Q

Risks of thyroid surgery?

A

Recurrent laryngeal nerve injury, ex branch of superior laryngeal nerve injury (alters high-pitch singing), parathyroid

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12
Q

MC type of thyroid cancer?

A

Papillary

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13
Q

Papillary cancer w/ prior head/neck radiation

A

Total thyroidectomy

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14
Q

Papillary cancer w/ no hx of radiation

A

lobectomy and isthmusectomy

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15
Q

thyroid cancer more prevalent in iodine-deficient areas?

A

Follicular

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16
Q

Follicular < 4 cm and > 4 cm (microinvasive)

Clear follicular cell carcinoma

A

Lobectomy/isthmusectomy vs total thyroidectomy

total thyroidectomy > 1 cm

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17
Q

Route of spread of follicular cancer?

A

Vascular

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18
Q

Medullary cancer cell type?

A

C cell hyperplasia (parafollicular cells) w/ amyloid

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19
Q

Papillary carcinoma prognosis

A

High survival in well-differentiated (100% at 10 years) and low in high-risk pts (20%)

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20
Q

Post-op management of papillary cancer

A

thyroid suppression w/ TH and maybe Iodine ablation

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21
Q

Follicular cancer prognosis and post-op tx

A

80% v 60%

Iodine ablation

22
Q

Medullary prognosis and post-op tx

A

80% vs 45%

NOT iodine/TH (wrong cells) –> CEA and calcitonin

23
Q

Most common met site of anaplastic thyroid cancer?

A

lung

24
Q

Hyperparathyroid localization?

A

Sestamibi scan

25
Q

MC location for missing inferior parathyroid gland?

A

Thymus

26
Q

Chvostek’s sign

A

tapping facial nerve near the ear results in spasm of orbicularis oris (hypocalcemia)

27
Q

Common malignant cause of hypercalcemia?

A

Metastatic carcinoma (breast), multiple myeloma, sarcoidosis, vitamin A intoxication, thiazides, renal cell carcinoma, SqCC of lung (PTHrP), familial hypocaliuric hypercalcemia

28
Q

Acute tx of hypercalcemia?

A

Results in an osmotic diuresis –> dehydration

  1. rehydrate w/ NS
  2. Lasix
  3. bisphosphonates
  4. mithramycin, calcitonin, glucocorticoids
29
Q

Surgical indications in Secondary Hyperparathyroidism

A

Bone pain, fx, intractable pruritis, ectopic calcifications in soft tissues (calcium tachyphylaxis)

30
Q

Hyperparathyroidism and HTN in same pt? Tx?

A

Possible pheochromocytoma. Combo alpha/beta blocker (never beta alone as unopposed alpha stimulation can be fatal)

31
Q

Test for Pheochromocytoma?

A

10% tumor; 10% malignant, extra-adrenal, epinephrine producers, and bilateral –> MRI T2 weighted, octreotide scan, MIBG scan (last resort) selects for chromaffin tissue

32
Q

Pheochromocytoma tx?

A

Alpha blockade - Phenoxybenzamine (10-14 days) prior to surgery
Beta blockade

Resection

33
Q

Resection of pheochromocytoma? Important step?

A

Resect w/ MINIMAL manipulation to avoid catecholamine surge. Ligate all venous drainage before manipulation

34
Q

Acute tender neck mass

A

Painful thyroiditis –> de Quervain’s thyroiditis

35
Q

de Quervain’s course?

A

Early = hyperthyroidism due to acutely injured follicles releasing TH

36
Q

de Quervain’s histology?

A

Giant cell granulomas

37
Q

de Quervain’s tx?

A

Analgesics, aspirin, steroids

38
Q

Is surgery appropriate in some cases of acute thyroid inflammation?

A

Bacterial infection (acute suppurative thyroiditis); Strep, Staph, Pseudomonas –> drainage

39
Q

PAINLESS thyroid mass w/ hypothyroidism

A

Hashimoto’s (chronic lymphocytic thyroiditis)

40
Q

Management of Hashimoto’s: Labs? Tx?

A

T3/T4, TSH ; Thyroid replacement, bx

41
Q

Higher incidence of malignancy w/ Hashimoto’s or de Quervain’s

A

Hashimoto’s (papillary, lymphoma)

42
Q

Hx of hyperparathyroidism (3 gland resection) and intractable duodenal ulcers. Next steps?

A
  1. r/o H. pylori

2. Serum gastrin level (> 600 suspect Zollinger-Ellison, > 1000 dxic)

43
Q

Sx of gastrinoma; Dx? Anatomy?

A

PUD, Diarrhea, esophagitis ; Serum gastrin, Secretin stimulation test ; Duodenum and head of pancreas (gastrinoma triangle)

44
Q

Two types of ZE?

A

Sporadic, familial (MEN-1)

45
Q

Pituitary sx from MEN-1?

A

Vision changes (local compression), hypersecretion (lactation)

46
Q

Surgery for gastrinoma?

A

Yes. Endoscopy to localize, US to isolate –> surgical enucleation or Whipple depending on location

47
Q

Medical management of gastrinoma?

A

Streptozocin.

48
Q

What is the Whipple triad?

A

fasting hypoglycemia (< 60), sx hypoglycemia, relief by admin of glucose –> elevated insulin secretion (C peptide measurement)

49
Q

MEN-2a

A

Medullary thyroid cancer, parathyroid hyperplasia, pheochromocytoma

50
Q

MEN-2b

A

Similar to MEN-2a w/ exception of associated MARFANoid habitus and ganglioneuromas

51
Q

Incidental adrenal mass: size suspicious of cancer?

A

> 5 cm

52
Q

Adrenal carcinoma: where might it be a met from?

A

Lung cancer, others (adrenals common met location)

53
Q

Incidental adrenal mass workup?

A

Catecholamines, Cortisol, Potassium –> if functional mass = removal

Nonfunctional –> serial CT observation

Surgery (7 decks)

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