General Points 2 Flashcards
Indications for surgery in primary hyperthyroidism
Elevated serum Calcium > 1mg/dL above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations below peak bone mass (T score lower than -2.5)
Primary hyperparathyroidism
Hormones
- PTH (Elevated)
- Ca2+ (Elevated)
- Phosphate (Low)
- Urine calcium : creatinine clearance ratio > 0.01
Features
- May be asymptomatic if mild
- Recurrent abdominal pain (pancreatitis, renal colic)
- Changes to emotional or cognitive state
Most cases due to solitary adenoma (80%), multifocal disease occurs in 10-15% and parathyroid carcinoma in 1% or less
Secondary hyperparathyroidism
Hormones
- PTH (Elevated)
- Ca2+ (Low or normal)
- Phosphate (Elevated)
- Vitamin D levels (Low)
Features
- May have few symptoms
- Eventually may develop bone disease, osteitis fibrosa cystica and soft tissue calcifications
Parathyroid gland hyperplasia occurs as a result of low calcium, almost always in a setting of chronic renal failure
Tertiary hyperparathyroidism
Hormones
- Ca2+ (Normal or high)
- PTH (Elevated)
- Phosphate levels (Decreased or Normal)
- Vitamin D (Normal or decreased)
- Alkaline phosphatase (Elevated)
Features
- Metastatic calcification
- Bone pain and / or fracture
- Nephrolithiasis
- Pancreatitis
Occurs as a result of ongoing hyperplasia of the parathyroid glands after correction of underlying renal disorder, hyperplasia of all 4 glands is usually the cause
Pancreatic cancer investigations and management
USS: May miss small lesions
Investigations
- CT Scanning (pancreatic protocol). If unresectable on CT then no further staging needed
- PET/CT for those with operable disease on CT alone
- ERCP/ MRI for bile duct assessment
- Staging laparoscopy to exclude peritoneal disease
Management
- Head of pancreas: Whipple’s resection (SE dumping and ulcers). Newer techniques include pylorus preservation and SMA/ SMV resection
- Carcinoma body and tail: poor prognosis, distal pancreatectomy, if operable
- Usually adjuvent chemotherapy for resectable disease
- ERCP and stent for jaundice and palliation
- Surgical bypass may be needed for duodenal obstruction
Pancreatic cancer info
Adenocarcinoma
Risk factors: Smoking, diabetes, adenoma, familial adenomatous polyposis
Mainly occur in the head of the pancreas (70%)
Spread locally and metastasizes to the liver
Carcinoma of the pancreas should be differentiated from other periampullary tumours with better prognosis
Features:
- Weight loss
- Painless jaundice
- Epigastric discomfort (pain usually due to invasion of the coeliac plexus is a late feature)
- Pancreatitis
- Trousseau’s sign: migratory superficial thrombophlebitis
Indications for wide local excision
Solitary lesion Peripheral tumour Small lesion in big breast DCIS <4cm Patient choice
Indications for mastectomy
Multifocal tumour Central tumour Large lesion in small breast DCIS >4cm Patient choice
Postmenopausal woman has a fracture - management?
Put on bisphosphonates, calcium and Vitamin D supplements (there is no need for a DEXA scan) as per osteoporosis guidelines
Boas’ sign
Refers to hyperaesthesia of the tip of the right scapula and is seen classically in association with acute cholecystitis
In which of the following conditions is a Ghon complex most likely to be found?
Infection with mycobacterium tuberculosis
A left sided varicocele is a recognised presenting sign of what and what should be done about it?
A renal tumour occluding the renal vein (into which the left testicular vein drains). An abdominal ultrasound should be undertaken to exclude this. Surgery for uncomplicated varicocele is usually unnecessary.
