PreTest Surgery: Endocrine Problems and the Breast

Question 1

True or false: multifocal breast tumors cannot be treated with lumpectomy.

Answer 1

False

MultiCENTRIC disease (remotely separated tumors) cannot be treated with lumpectomy. MultiFOCAL means multiple tumors within one region, which can be treated with lumpectomy.

Question 2

What does dexamethasone suppression show in those with Cushing disease?

Answer 2

Suppression of cortisol

In ectopic Cushing’s, dexamethasone will not suppress cortisol but those are less likely than pituitary Cushing’s.

Question 3

_____________ is an important indicator of the prognosis in papillary thyroid carcinoma.

Answer 3

Age

Those younger than 45 do better.

Question 4

How should thyroid cancer with lymph node mets be treated?

Answer 4

Near total thyroidectomy with radical neck dissection

Question 5

You do a biopsy of a breast mass and diagnose lobular carcinoma in situ (LCIS). What intervention should you recommend to the patient?

Answer 5

Self-exam and yearly mammograms

LCIS is just an increased risk of breast cancer.

Question 6

Giant fibroadenomas are more common in which demographic?

Answer 6

Adolescent black girls

Question 7

The surface of fibroadenomas is said to be _____________.

Answer 7

whorled

Question 8

Give the indications for parathyroidectomy.

Answer 8

• Symptoms: bone pain, renal calculi, true AMS (e.g., confusion), abdominal pain
• Age younger than 50
• High urinary calcium (>400)
• High serum calcium (> 12)
• Decreased creatinine clearance (30% from baseline)
• Signs of osteoporosis

Question 9

True or false: Cushing disease can arise from a tumor on the adrenals.

Answer 9

False

Cushing disease results from a pituitary tumor.

Question 10

How long should a person be taking phenoxybenzamine before resection of a pheochromocytoma?

Answer 10

1 to 3 weeks

Question 11

How should breast cancer management be changed in a pregnant woman?

Answer 11

• No radiation
• No sentinel lymph node biopsy (which uses radioactive dye)
• Modified radical mastectomy

Question 12

Describe the management of Paget disease of the breast.

Answer 12

• First, diagnose Paget’s by getting a mammogram and biopsy in women with areolar itching and erythema.
• Second, do a modified radical mastectomy in women with confirmed Paget.

Question 13

Secretin normally ___________ the level of gastrin.

Answer 13

decreases

Thus, an increase in serum gastrin after secretin administration is indicative of Zollinger-Ellison syndrome.

Question 14

What treatment decreases the risk of thyroid storm preoperatively?

Answer 14

Lugol iodine drops

Question 15

What ratio suggests hyperaldosteronism?

Answer 15

Aldosterone:renin >25

Question 16

Cystosarcoma phyllodes should be treated with ______________.

Answer 16

wide local excision

Question 17

The treatment of _____________ is very similar to the treatment of follicular carcinoma.

Answer 17

Hürthle cell carcinoma

Resect and use radioiodine ablation.

Question 18

What is the size cutoff for thyroid lobectomy vs. total thyroidectomy?

Answer 18

4 cm

Question 19

Review the staging of breast cancer.

Answer 19

• 0 = CIS
• 1 = tumor < 2 cm in diameter, no mets or lymph nodes
• 2 = tumor > 2 cm in diameter, no mets or lymp nodes
• 3 = lymph nodes
• 4 = mets