Surgery clinical test prep Flashcards by Jason VanBrunt

Graves disease

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radioiodide scan show diffuse uptake

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Hashimotos thyroiditis

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sx’s= nervousness, insomnia, irritability, wt loss, diaphoresis, palpitations

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test of choice for hyperthyroidism

serum TSH

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should T3 or T4 be evaluated?

T4. this is in excess

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Methimazole

Propylthiouracil= MOA and A.A

ht tx

PTU= inhibits conversion of T3 and T4. A.A agranulocytosis=decrease in WBC’s

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Ddx hyperthyroidism

heart disease, anemia, cirrhosis.

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psammoma bodies

pa. most common thyroid cancer.

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thyroid function test usually normal

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cold nodules found on thyroid scan

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thyroidectomy as tx

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rubbery, encapsulated goiter

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thyroid function tests are usually normal.

cold nodules found

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anaplastic epithelial chords with follicles

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sectreted by the chief cells

pth

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what does parathyroid hormone do?

what does calcitonin do?

pth increases Ca blood conc

calcitonin= decdreases Ca blood conc

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causes rickets, osyeomalacia, hypocalcemia so numbness/tingling in toes + fingers, tetany, muscle cramps

hypo pth

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chvosteks sign (what is how do you get it)

tapping on facial nerve causes contraction of facial muscles

severe=IV Ca gluconate

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trousseaus sign (what is it how do you get it)

inflating b/p cuff to a pressure higher then the pts systolic b/p for 3 minutes and you get carpel spasms. severe=IV Ca gluconate

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prolonged QT interval

hypo pth

severe=IV Ca gluconate

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low serum Ca
High serum phosphate
low urine cAMP
calcifications on x-ray of basal ganglia
whats your dx

hypo pth

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how do yo tx hypoparathyroidism?

mild to moderate= oral Ca+
severe=IV Ca gluconate
vit D=calcitriol

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what should Ca levels be

8.4 to 10

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MCC of hypercalcemia?

hyper pth

Adenoma is cause for 80% of cases

hyper pth

sx's=nephrolithiasis osteitis fibrosa cystica= brown tumors gout pancreatitis

hyper pth

how do you dx? What do you see on x-ray

hypercalcemia with normal PTH level is abnormal due to calcium is suppressing the pth. hypophosphatemia hypercalciuria urine cAMP is elevated.

What do you see on x-ray with hyperparathyroidism?

sub-periosteal bone reabsorption on 2nd and 3rd phalanges | osteopenia

hyperparathyroidism tx?

surgery or furosimde to excrete the Ca+ in the urine (not thiazide diuretics)

cushings syn | whats it from, whats it look like?

due to excess levels og glucocorticoids (cortisol) | central obesity, moon face, hirsutism, buffalo hump, purple striae on abdomen, DM, infertility

MCC of cushings syn? | whats the 2nd MCC?(cushings disease)

iatrogenic=prednisone | ACTH-secreting adenoma of the pituitary

TOC to dx cushings? | and one other test?

overnight low dose dexamethasone test, measure the serum cortisol in the morning. if less then 5=cushingds excluded if more then 5= cushings ACTH level.

test for cushings dz

CRH test=if CRH causes ACTH levels to increase=cushings dz

cushing syn tx?

tapper glucocorticoid | or surgery.

When palpating the breast tissue and a smooth, rubbery mass is located?

fibroadenoma. get a mammogram

A firm tender, irregular mass is usually a?

carcinoma

Other breast cancer finding on PE?

nipple erosion, erythema, eczema like rash, nipple retraction, skin dimpling, differences in breast contour

sx's of (Mammary dysplasia) fibrocyctic dz?

painful, tender mass, fuctuates in size relative to menstrual cycle, usually bilat

Ddx of breast mass?

cyst=non tender fibroadenoma=benign tumor breast abscess=erythem, tender, usually staph from nursing.

mesothelioma sx's dx test? tx?

DOE, cough, FEVER, wt loss dyshagia. labs=CXR shows pleural thickening, effusion, Get tissue sample (chemo does not help) surgery

Which lung cancer has lowest association with smoking? | which has the highest?

adenocarcioma | small cell

``` What do you see on CXR with: small cell CA? Large cell CA? Adenocarcinoma? squamous cell? ```

also called "Oat cell" looks like lymphocyte, centrally located,highly malignant to the brain and cause increase in SAIDH, ACTH"cushings" - LC=large spindle or oval cells, peripherally located, highly anaplastic - Adeno=Maybe Acinar or papillary, most common type found in nonsmokers + women, originale in alveoli tissue - squamous cell= found via sputum culture, associated with hypercalcemia

What other S &S (depending on tumor location)?

small cell=Sperior vena cava syn; obstruction of SVC by mediastinal tumor Horners syn= large cell, adeno Pancoast tumor=squamous cell;upper extremity weakness, pain in arms

pulmonary tumor work up, and tx

everyone gets a CXR, CT scan, tissue biopsy small cell tx=chemo and radiation all others=surgery

what do Q-waves indicate

prior MI (when diagnosing CAD)

what indicates a positive stress test | -what do you do if i is positive

``` chest pain ST segment depression hypotension arrhythmia -cardiac catheterization ```

tell me the ABCDE's of heart health

``` aspirin + antianginal tx blood pressure + beta-blockers cholesterol + cigarettes diet + diabetes exercise + education ```

variant prinzmetal's angina is evidenced by?

vasospasm's with pain at rest hallmark=ST segment ELEVATION coronary angiography is defintive test

3 sx's for MI

substernal chest pain diaphoresis pain lasting longer then 30 minutes.

EKG changes during MI

peaked T-waves ST-segment elevation=acute infarct Q-waves=necrosis ST-segment depression

low-pitched diastolic rumble

S2 is followed by an opening snap

mitral stenosis sx's

``` DOE orthopnea PND palpitations, chest pain hemoptysis ```

whats the most important test to dx mitral stenosis and waht do you see on that test? and how do you tx

echocardiogram= Left atrial enlargement calcified mitral valve tx=diuretics, infective endocarditis prophylaxis, warfarin

harsh crescendo-decrescendo systolic murmur, radiates to carotid arteries

S4 heart sound with precorial thrill

definitve aortic stenosis test? andthe other ones tx?

``` cardiac catheterization CXR=calcified aortic valve ECG=LVH echocardiogram tx=surgery ```

Diastolic decrescendo murmur | with wide pulse pressure

austi flint murmur

displaced PMI and S3 present

tx arotic regurge?

if asymptomatic? salt restriction, diuretics, vasodialators, digoxin surggery in medical emergency

Post MI valvular defect?

acute ar

holosystolic murmur at the apex

a fib is common finding with this valvular defect

S3, gallop, displaced PMI

reduce afterload, salt reduce, diurestics, digoxin | anti coagulate with warfin for a-fib

blowing holosystolic murmur, with pulsatile liver

intensified with inspiration, reduced during valsalva maneuver

test of choice for tricuspid regurge | tx?

echocardiogram | tx=treat left sided heart failure, surgery

midsystolic or late systolic click

mvp

mid to late systolic murmur

mvp

vasalva maneuver increases the murmur

mvp

incomplete relaxation of the LES aperistalsis of esophagus dysphagia

achalasia