Pre-Test (Endocrine/Breast, GI) Flashcards
Isolated focus of increased uptake on a thyroid scan virtually diagnostic of
Hyperfunctioning adenoma
Multifocal breast Ca means
Multiple tumors w/in 1 quadrant of the breast
Important prognostic factor in papillary and follicular thyroid Ca
Age (>45 years worse prognosis)
Papillary Ca thyroid description on path
Calcified clumps of sloughed cells
LCIS work up
Frequent self breast exams and yearly screening mammograms (LCIS considered risk factor for cancer development, not precursor)
Acute management of hypercalcemia
Vigorous hydration to restore intravascular volume and Lasix
Thiazides contra b/c they increase Ca
Cushing’s dz tumor
Pituitary tumor
Pre surgery pheo tx
Pre-op w/ alpha blockade (phenoxybenzamine) 1-3 weeks before
can add b-blockers
Tx of breast cancer in pregnant woman
Immediate surgery, chemo after 1st trimester
Radiation absolutely contraindicated
Workup for suspected Paget’s
Mammogram and biopsy of the affected area
Secretin test results for ZE syndrome
Rise in Gastrin
tx to prevent thyroid storm after thyroid removal in graves
10 days pre-op w/ Drops of Lugol iodide solution
B-blocker is tx for thyroid storm
Tx of single PTH adenoma
Removal of that adenoma
Tx for Hurtle cell thyroid tumor? What is it?
Surgery followed by radioiodine ablation
Is a type of follicular cancer, but is more often multifocal and bilateral
When is thyroid lobectomy ok
for single adenomas less than 4cm size
Most common cause of cushing syndrome
Iatrogenic
Indication for radical mastectomy
Locally advanced breast cancer with wide invasion of pec major muscle in pt who can handle surgery
Omeprazole MOA
Inhibits H+-K+ ATPase in secretory canaliculus of the gastric parietal cell
Platelet transfusions in ITP reserved for? Otherwise tx?
Acute bleeders
Otherwise (30k-50k) tx w/ steroids and IV-IG
Tx for adenocarcinoma of the spleen
Right hemicolectomy
Safest and most effective tx of achlasia
Esophagomyomyotomy (modified heller myotomy –> cutting LES)
Most frequent complication of end colostomies
Parastomal herniation –> commonly when stoma is placed lateral to, rather than through, rectus muscle
When do the majority of dumping syndrome cases resolve
Within 3 months
Medical mgmt of bleeding varices
Octreotide or vasopressin (balloon tamponade if those don’t work)
Don’t forget crystalloids
Lesions of Peutz-Jagers? Other things seen?
Hamartomas
Also melanin spots on oral mucosa
Indications for surgical intervention in dirverticular disease
Hemorrhage secondary to diverticulosis, recurrent episodes of diverticulitis, intractability to medical therapy, complicated (perforations with or w/out abscess and/or fistula)
When can gallbladder polyps be measured w/ serial CT’s? Sx for gall bladder cancer
when they are less than 1cm
Do radical cholecystectomy for gall bladder cancer
Tx for Entamoeba histolytica liver abscess
metronidazole
Important step prior to undergoing operative intervention for GERD
Endoscopy
Mgmt for non-necrotic chronic ischemic colitis
Expectant mgmt
Bowel Habits after colonic resection
Relatively normal
What part of the colon absorbs more salt and water
Right
When do you take out hepatic andenomas
When greater than 4cm (risk for rupture and risk for malignant transformation)
If performing appendectomy, Chron’s is noted, what do you do
Take out appendix as normal (90% who present like this will not progress to full blown disease)
Tx for biliary stricture? most likely cause?
End-to-side choledochojejunostomy (Roux-en-Y)
Most likely iatrogenic
90% of gastrinoma’s located where?
“gastrinoma triangle” - junction of 2nd and 3rd portions of duodenum, junction of neck and body of pancreas, and junction of cystic and common bile duct
Tx for insulinoma
Simple excision of the tumor
Apple core lesion on colon tx
Bowel prep followed by removal of area (obstructing)
Most likely dx in older person with markedly distended colon? Workup?
Cecal or sigmoid volvulus –> dx w/ sigmoidoscopy (also can be therapeutic) –> If neg think cecal location (do emergent celiotomy)
Procedure of choice for cecal volvulus
Right hemicolectomy
Kidney bean vs Coffee bean sign
Kidney bean - cecal volvulus
Coffee bean - sigmoid volvulus
Most common non-OB related surgical condition in pregnant women
Appendicitis
Paraesophageal vs Sliding hernia worse?
Paraesophageal (sliding hernia contained by intact pleura)
Olgivie’s syndrome tx
Bowel rest and NG tube (Unless >10 cm dilated)
First line tx for major hematobilia
Transarterial embolization
Crypt abscesses and superficial ulcerations in what bowel dz
UC
Test for small bowel bleeding in people under 30?
Tech 99 pertechnetate scan – Looking for Meckels (MCC of small bowel bleeding under 30)
Colectomy vs Simple appendix removal in carcinoid of appendix
Less than 1 cm just take appendix
1-2 based on location
>2 Right hemicolectomy
Where are stress ulcers usually found
Usually involve lower body and funds
Spare antrum
Tx for cholecystitis in critically ill
Tube cholecystostomy
How long until therapy for pancreatic pseudocysts
At least 6 weeks**
Where do carcinoid tumors originate? What do they look like in rectum
Crypts of Leiberkuhn
Definitive operation of choice for patients with UC
Total proctocolectomy w/ end ileostomy or illegal J-pouch anastomosis
