Week 4 AFD

Question 1

obstructive jaundice

Answer 1

hx: pale stools and dark urine, itchy ( from bili build up), RUQ symptoms DDX biliary, GI, pancreatic, px: ix: CBC, lytes, Alt, AST, ALP, Bili ( direct and indirect), GGT, U/S Cr, Bun.Amylase, Lipase, PTT/INR/Albumin. After U/S you might need CT or biopsy of a lump (FNA). Tx depends on cause.

Question 2

DDx of jaundice

Answer 2

Prehepatic, Hepatic, and post hepatic. Post hepatic can be spit up into upper 1/3, middle 1/3rd and last 1/4rdof obstruction. Upper 1/3rd is hepatic cysts, HCC, sclerosing cholangitis, trauma. Middle 1/3 = choledochal cysts, cholangiocarcinoma, gallbaladder cancer, sclerosing cholangitis, Mirizzi syndrome. Last 1/3 = pancreatic tumours, sphincter of oddi dysfunction

Question 3

pancreatic cancer

Answer 3

hx : jaundice, wt loss, abdominal pain. Or can be painless jaundice/ Courvoisier’s ( jauncie + painless palpable gallbladder). Px: confirms Ix: U/S + Ct of pancrease. If you see a mass, biopsy it. If operable, you need to plan vansulcar connections so get CT angio. Then can plan surgery, chemo, radiation.

Question 4

breast lump

Answer 4

woman has lump. She comes to you. You do hx - it is unilateral, painful?, does it chagne with menstuation, any d/c from nipple, any skin changes, any fam hx of breast cacner any other cancers? Any OCP or horomone replacement therapy, when did you start period/when ended and any breasfeeding? Px - identify lump , texture, mobiity. Ix: check for organ mets : liver- LEFTs, CXR heading, CT and bone scan. U/s Mammorgrapy + Biopsy. Tx based on core biopsy. stage, then surgery ( lumpectomy/ radiation, masectomy).

Question 5

DDX breast lump

Answer 5

think benign, malignant, infectious/inflammatory.
Infectious/inflam- abscess, mastitis, fat necrosis, Mndors ( pus, fat, veins)
Benign- fibrocystic change, menstrual cycle cysts, breast cysts, fibroadenoma, gynecomastia.
Malignant ( premalig = DCIs, LCIS), infiltrating ductal carcinom ( *0% of all breast cancers), infiltrating lobular carcinoma ( 10% of all breast cansers), pagets , inflammtory carcinoma - blockage of the lymph draining = pea d’orange

Question 6

thyroid surgery. in what situations do we do surgery ( or what is the ddx of thyroid problems)

Answer 6

1) hyperthyroidism presenting as arrhythmia ( graves, toxic multinodular goitre/ thyroid nodule)
2) compressive symptoms when lying down
3) suspiscious for cancer

Question 7

what is the approach to thyroid nodule

Answer 7

hx- nodule, either midline or lateral, painless or not. Ask voice changes, previous radiation to HEENT. Ix : FNAB that lump. The results can either be nondiagnostic, benign, malignant, or betweeen N and M called LUS ( follicular lesion of known source). Image: U/s to see if its cystic r solid. CT if very large. NO Nuclear/Pet.MRI.

Question 8

how do you treat thyroiditis

Answer 8

medical, radioactive iodine ablative therapy, surgery

Question 9

hyperparathyroid story

Answer 9

hx: someone who takes lithium, vitaminD, or no hx. px

Question 10

adrenal disease - what can go wrong?

Answer 10

Adrenal adenoma- can secrete lots of different hormones. Pheo- diaphoretic. Conns : look at aldo: renin ratios.