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General Surgery > Endocrine Glands and Breast > Flashcards

Endocrine Glands and Breast Flashcards

1
Q

The pituitary gland: affects

A

The pituitary gland: affects bone growth and has growth factors

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2
Q

Which of the following hormones is produced in the anterior lobe of the pituitary gland?

(1) TSH
(2) ACTH
(3) GH
(4) PRI
(5) All of these

A

(5) All of these

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3
Q

T/F: the pituitary gland controls the hypothalamus-pituitary/portal circulation via feedback axis.

A

True.

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4
Q

Treatment of a prolactinoma is:

A

bromocriptine/cabergoline

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5
Q

Treatment of gigantism/acromegaly is:

A

somatostain analogues.

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6
Q

Diagnosis of pituitary tumors is achieved via

A

Diagnosis of pituitary tumors is achieved via elevated hormone levels + CT + MRI**.

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7
Q

Pituitary tumor surgery is indicated if there is:

A

COMPRESSION OF THE OPTIC CHIASMA (transsphenoidal, transnasal or sublabial).

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8
Q
  • SIADH: a generally ectopic hormone that is treated
A

primarily

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9
Q

thyroid gland develops as a

A

thyroid gland develops as a protrusion from the floor of the mouth (base of tongue) and migrates to the lower neck in midline.

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10
Q
  • **Note that the recurrent and superior laryngeal nerves are in close proximity to
A
  • Note that the recurrent and superior laryngeal nerves are in close proximity to the thyroid gland and are at risk during surgery.
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11
Q

Calcitonin levels are elevated in

A

Calcitonin levels are elevated in medullary carcinoma and MEN2

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12
Q

In the developing world, the major cause of hypothyroidism is:

A

iodine deficiency.

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13
Q

In the developing world, the amjor cause of hypothyroidism is:

A

In the developed world, surgery/radiation/genetics/drugs and peripheral hormone resistance are causes of hypothyroidism

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14
Q
  • Cytokines, interferon-alpha, interferon-2, lithium, amiodarone are associated with development of
A

hypothyroidism

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15
Q

A smooth goiter is associated with:

A

hyperthyroidism

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16
Q

A nodular goiter is associated with:

A

Plummer’s disease

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17
Q

Thyroid lab values of hyperthryoidism include:

A

High T3 and T4, low TSH

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18
Q

Hyperthyroidism is treated via:

A

(1) propylthiouracil/methimazole
(2) Radio I-131
(3) Anti-thyroid drugs
(4) beta blockers

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19
Q

A patient with subacute thyroiditis presents with:

A

fever, weight loss, fatigue, swelling with giant cells on spiration.

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20
Q

Treatment of subacute thyroiditis includes:

A

steroids/ACTH.

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21
Q

Treatment of Ridel’s (struma) thryoiditis is:

A

thyroxine and possibly surgery for obstruction.

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22
Q

The type of non-toxic goiter that is LEAST likely to be malignant:

(1) smooth or colloid goiter
(2) Multi-nodular goiter
(3) solitary nodule goiter

A

(1) smooth or colloid goiter is unlikely to be malignant.

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23
Q

A patient with a solitary nodule MOST likely has:

(1) A nodule with 5 - 10% malignancy.
(2) Is most likely to be male
(3) A nodule with 5 - 15% malignancy.

A

A patient with a solitary nodule MOST likely has: (3) A nodule with 5 - 15% malignancy.

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24
Q

A non-toxic goiter workup should include:

A

see if there is a history of MEN-2 and familial polyposis

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25
Q

The best imaging study for non-toxic goiter workup:

A
  • Imaging: ultrasound is the BEST imaging study
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26
Q

T/F: - Fine needle aspiration is 80% sensitive/41% specific especially for papillary carcinoma

A

True.

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27
Q

The most common type of thyroid cancer is:

(1) follicular cell origin
(2) Anaplastic
(3) lymphoma
(4) metastatic form

A

The most common type of thyroid cancer is (1) follicular cell origin.

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28
Q

The most common type of thyroid cancer is of follicular cell origin. The most common type of follicular cell carcinoma is:

(1) Papillary
(2) follicular
(3) Hurthle cell
(4) Medullary

A

The most common type of follicular carcinoma is (1) Papillary type

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29
Q

Calcium has an ______ relationship with phosphate and PTH.

A

Calcium has an inverse relationship with phosphate and PTH.

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30
Q

PRIMARY HYPERPTH can be caused by

A

adenomas or hyperplasia

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31
Q

HyperPTH presents with lab values of:

A

hypercalcemia and elevated serum PTH

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32
Q

Which of the following is a symptom of primary hyperPTH?

(1) osteomalacia
(2) constipation, peptic ulcers, pancreatitis
(3) myalgias
(4) kidney stones
(5) all of these

A

(5) All of these

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33
Q

The most common symptom of hyper PTH is:

A

myalgia and muscle weakness

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34
Q

Treatment of hyperPTH includes:

A

saline, diuresis with furosemide, bisphosphonates/calcitonin.

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35
Q

Secondary hyperPTH is seen in:

A

CKD and renal failure.

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36
Q

Metastatic calcification is associated with:

A

tertiary hyperPTH

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37
Q

Glucagonoma, Somatostatinoma and pancreatic polygastrinoma have malignancy rates of:

A

> 95%

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38
Q

Glucagonoma presents with:

A

diabetes mellitus and NME

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39
Q

Whipple’s triad is associated with:

A

insulinoma and severe hypoglycemia.

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40
Q

A somatstatinoma presents with symptoms of:

A

steatorrhea
Diabetes mellitus
GB

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41
Q

A VIPoma presents with

A

WDHA

severe diarrhea, hypokalemia, achlorhydria

42
Q

More than half of gastrinomas arise in the:

A

duodenum

43
Q

__% of gastrinomas are sporadic

A

75%

44
Q

__% of gastrinomas are associated with MEN-1.

A

25%

45
Q

Diagnosis of gastrinoma is made via:

A

serum gastrin > 1000 pg/mL, gastric pH < 2, basal acid > 5 mEq/hr. Diagnosis is via somatostatin receptor scintigraphy (> 95% accurate).

46
Q

Diagnosis of gastrinoma is 95% accurate when the diagnosis is made via:

A

somatostatin receptor scintigraphy.

47
Q

T/F: the cure rate of gastrinoma is low.

A

True.

48
Q

VIPOmas present with:

A

watery diarrhea and hypokalemic achlorhydria.

(2) Patients also have a pancreatic tumor.

49
Q

Treatment of VIPoma includes:

A

distal pancreatectomy

50
Q

Catecholamines are made in the

A

inner medullar

51
Q

The zona glomerulosa, zona fasciculata and zona reticulans are faound in the

A

outer medulla

52
Q

Aldosterone:

(1) is made in the zona fasciculata
(2) regulates electrolytes/fluid through kidney via the RAAS.
(3) produces glucocorticoids and sex hormones.

A

Aldosterone (2) regulates electrolytes/fluid through the kidney via RAAS

53
Q

The zona fasciculata contains:

A

glucocorticoids.

54
Q

Glucocorticoid secretion is controlled by:

A

CRF

55
Q

Glucocorticoid and sex hormone production is controlled by:

A

CRF and ACTH

56
Q

The majority of Cushing’s syndrome is :

A

ACTH dependent.

57
Q

Aldosteronoma (Conn’s syndrome) presents with:

A

HTN, polyuria, HYPOkalemia.

58
Q

Addison’s disease presents with:

A

HYPOnatremia and HYPERkalemia, as well as weight loss, hypotension, hypoglycemia and bronze pigmentation of the skin.

59
Q

The adrenal medulla contains chromaffin cells which secrete

A

dopamine, epinephrine and norepinephrine from tyrosine.

60
Q

Pheochromocytoma: results when the adrenal gland produces too much

A

epinephrine

61
Q

Diagnosis of pheochromocytoma is made via:

A

elevated plasma and urinary catecholamine and metabolite levels (VMA, metanephrine). Localize by using CT, MRI, MIBG

62
Q

Surgery is indicated for an incidentaloma if:

A

surgery if functional OR if there is > 6 cm risk of malignancy. Surgery is not indicated if < 4 cm AND non-functional.

63
Q

MEN-1 presents with:

A

pituitary adenoma

(2) parathyroid hyperplasia
(3) pancreatic tumors

64
Q

MEN-2A presents with:

A

(1) PTH hyperplasia
(2) Medullary thyroid carcinoma
(3) Pheochromocytoma

65
Q

MEN-2B presents with:

A

Muscosal neuromas

(2) Marfanoid body habitus
(3) MEdullary thyroid carcinoma
(4) pheochromocytoma

66
Q

treat parathyroid by near total parathyroidectomy for

A

MEN-1

67
Q

thyroidectomy is treatment for

A

thyroidectomy for MEN-2 after removing pheochromocytoma

68
Q

T/F: Systemic hormone disturbances can cause breast enlargement.

A

True

69
Q

Cooper’s ligaments are

A

Cooper’s ligaments are suspensory ligaments of connective tissue that provide lift to the breast.

70
Q
  • Nerves at risk in breast surgery are the
A

long thoracic, thoracodorsal, medial pectoral, lateral pectoral and intercostobrachial.

71
Q

at birth, the breast is scattered ducts at stroma; at PUBERTY,

A

hormones cause NEW ducts and lobules to form.

72
Q
  • Pregnant breast: has _____influence and enlarges and engorges with milk
A
  • Pregnant breast: has prolactin influence and enlarges and engorges with milk
73
Q
  • Lactating breast: evacuates milk due to _____effect on myoepithelial cells
A
  • Lactating breast: evacuates milk due to oxytocin effect on myoepithelial cells
74
Q

The current recommendation of mammorgrams is:

A

first mammo at 40 y/o, biennially until 50 y/o and annually thereafter.

75
Q

BIRADS-2 indicates:

A

benign breasts

76
Q

The BIRADS classifications that require a biopsy:

A

4 and 5

77
Q

Ultrasound: preferred method of imaging in patients

A

Ultrasound: preferred method of imaging in patients YOUNGER than 40 Y/O

78
Q

MRI: is used when mammogram is

A

equivocal, for DENSE BREASTS and for some high risk patients.

79
Q

Biopsy: fine needle aspiration is often done under ultrasound imaging for

A

Biopsy: fine needle aspiration is often done under ultrasound imaging for FNAB. It is 90 – 93% accurate.

80
Q

Core-needle and open biopsies are done for breasts with masses that are

A

non-palpable.

81
Q

Mastalgia/mastodynia: pain in the breast. This can be

A

This can be cyclical with menses/ovulation or non-cyclical, which is associated with diseases and cystic change

82
Q

Treatment of mastalgia/mastodynia is:

A

– treat with analgesics after ruling out more serious disease.

83
Q

A fibroadenoma is MOST common in:

A

Fibroadenoma: teenage to 30s; low risk of cancer.

*Dx: excision or needle biopsy after age 21.

84
Q

Juvenile and giant fibroadenomas that are > 5 cm may be a

A

phyllodes tumor (benign or malignant).

85
Q

A patient with a breast hamartoma MOST likely:

A

Has BENIGN tissue and is over 35 y/o, the patient may also have Cowden syndrome.

86
Q

Fibrocystic changes are seen in:

A

Fibrocystic change: seen in women 30 – 50 y/o; 90% may manifest as a mass. Needle aspirate if palpable or with sonogram guidance.

87
Q

Breast abscesses often occur during:

A

lactation

88
Q

A duct papilloma presents with:

A

bleeding from the nipple.

89
Q

A galactocele causes:

A

lactation

90
Q

Sclerosing lesions of the breast present as:

A

microcalcifications/radial scars.

91
Q

A patient presents with bleeding nipple discharge. The patient MOST likely has:

A

duct papilloma.

92
Q

Which of the following regarding granulomatous mastitis is TRUE?

(1) IT is most common in Caucasians
(2) It occurs 5 years of lactation.
(3) IT does not have to be biopsied to rule out cancer.
(4) antibiotics and drainage are not recommended.

A

(2) Granulomatous mastitis occurs within 5 years of lactation.

93
Q

Breast cancer risk factors include:

(1) Lynch syndrome
(2) Paternal inheritance
(3) typical ductal or lobular hyperplasia.

A

(1) Lynch syndrome

94
Q

The breast cancer model that ONLY focuses on family history (the number of first-degree relatives and age of onset)

A

Claus model

95
Q

Chemoprevention is via:

A

tamoxifen, as well as prophylactic mastectomies

96
Q

T/F: lobular carcinoma in situ is not a cancer, but a risk factor.

A

True.

97
Q

Phyllodes tumor is considered a

A

mixed connective/epithelial tumor

98
Q

The current golden standard of treatment for breast cancer is:

A
  • Wide excision with or without sentinel node biopsy/axillary dissection
99
Q

Aromatase inhbitors are breast cancer treatments for:

A

Aromatase inhbitors are treatments for post menopausal patients.

100
Q

Inflammatory cancers: are warm, erythematous and edematous. They are treated with

A

Inflammatory cancers: are warm, erythematous and edematous. They are treated with sequential neo-adjuvant chemotherapy/surgery and THEN adjuvant chemo-radiation

101
Q

The risk factors for male breast cancer are

A

BRCA-2, testicular tumors, Klinefelter syndrome, Jewish or Icelandic heritage.
Old age or renal failure.

General Surgery (12 decks)

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