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46 Cards in this Set
- Front
- Back
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Solitary nodule on thyroid exam - not hard or fixed, next step?
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FNA and send aspirate to cytology
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FNA thyroid biopsies - benign versus indeterminate versus malignant cells? (give percentages)
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2/3 - benign
1/6 - indeterminate 1/6 - malignant cells |
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when is removal indicated for thyroid nodule (3 instances)?
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1. large (>4 cm)
2. recurring several times (post-FNA) 3. + FNA |
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thyroid cysts can be differentiated from nodules how?
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ultrasound
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post-FNA radioactive iodine scanning to determine what? which is more likely to be malignant?
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cold versus hot (takes up iodine)
malignancy risk: cold (15%) verus hot (minimal) |
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two types of thyroid cancer requiring thyroidectomy, and structures on histological exam suggesting each one respectively?
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1. papillary CA (if previous radiation or >1.5cm) (psammoma bodies), 2. medullary ca (amyloid deposits)
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management of follicular thyroid (15-20% of thyroid cancers) cancer if a) microinvasive, well-circumscribed, <4cm? b) >4cm lesion?
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a) if microinvasive, well circumscribed, <4cm --> lobectomy (and isthmusectomy)
b) lesion > 4 cm --> total thyroidectomy Men2A |
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1. MNEMONIC for prognosis for patient with papillary thyroid CA? 2. survival in low risk patients versus high risk at 10 years?
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AGES=
1. age < 40 2. grade 3. extent of dz 4 size of tumor low risk: 100% versus high risk: 20% survival at 10 years |
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common presenting symptoms of parathyroid adenoma (name 3-4)? two surgical options?
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muscle weakness, constipation, mylagias/arthralgias, nephrolitihiasis
1.rsx with idetification of three others 2. sestamibi scan --> shows enlarged parathyroid --> then inisized |
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most common place for missing parathyroid gland (e.g. trying to identify other three and not being able to identify one)
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thymus
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after parathyroid exploration with excision, what sign might be elicited on physical exam? What is suggested if patient has hoarse voice?
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1. Chvostek's sign (twitching of face after tapping on facial nerve) - indicative of hypocalcemia
2. injury to recurrent laryngeal nerve (or superior laryngeal nerve) |
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45 yo M to ED with nausea, fatigue, weight loss, abd pain, altered MS, kidney stones - serum Ca+ is 16 indicating acute hypercalcemia. What is initial treatment (2 components)?
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1. IV fluids (NS) (because of osmotic duiresis and resultant dehydration)
2. furosemide (loops lose calcium) 3. bisphosphonates |
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most common benign cause of acute hypercalcemia?
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parathyroid adenoma
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62 yo woman who has not been routine followed by PCP with acute hypercalcemia - concern for what?
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metastatic breast CA
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why is neck exploration indicated in parathyroidectomy for parathyroid adenoma?
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multiple PTH adenomas 5% of time
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secondary hyperparathyroidism (e.g. in chronic renal failure) - is surgery indicated? what is common operative finding?
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1. indicated if patient having bone pain, frx, pruritis, or calcifications of soft tissue
2. parathyroid hyperplasia |
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what is mechanism of secondary hyperparathyroidism in chronic renal failure?
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decreased vitD resorption and dec phopshorus production ---> formation of insoluble calcium phosphate ---> removed from circulation ---> hypocalcemia and resulting hyperPTH
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Patient becomes uncontrollable hypertensive during operative procedure to 210/160. What is suspected and how would you test for this?
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undiagnosed pheochromocytoma; urinary metanephrines and VMA acid (also MRI and MIBG scan (selectively accum in chromaffin tissue)
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treatment (initial and ultimate) for pheochromocytoma?
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1. alpha- and beta-blockage (e.g. phenoxybenzamine for 10-14 days)
2. adrenalectomy |
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after parathyroid exploration with excision, what sign might be elicited on physical exam? What is suggested if patient has hoarse voice?
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1. Chvostek's sign (twitching of face after tapping on facial nerve) - indicative of hypocalcemia
2. injury to recurrent laryngeal nerve (or superior laryngeal nerve) |
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45 yo M to ED with nausea, fatigue, weight loss, abd pain, altered MS, kidney stones - serum Ca+ is 16 indicating acute hypercalcemia. What is initial treatment (2 components)?
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1. IV fluids (NS) (because of osmotic duiresis and resultant dehydration)
2. furosemide (loops lose calcium) 3. bisphosphonates |
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most common benign cause of acute hypercalcemia?
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parathyroid adenoma
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62 yo woman who has not been routine followed by PCP with acute hypercalcemia - concern for what?
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metastatic breast CA
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why is neck exploration indicated in parathyroidectomy for parathyroid adenoma?
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multiple PTH adenomas 5% of time
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secondary hyperparathyroidism (e.g. in chronic renal failure) - is surgery indicated? what is common operative finding?
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1. indicated if patient having bone pain, frx, pruritis, or calcifications of soft tissue
2. parathyroid hyperplasia |
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what is mechanism of secondary hyperparathyroidism in chronic renal failure?
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decreased vitD resorption and high phosphate (dec elimination) ---> hypocalcemia and resulting hyperPTH
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Patient becomes uncontrollable hypertensive during operative procedure to 210/160. What is suspected and how would you test for this?
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undiagnosed pheochromocytoma; urinary metanephrines and VMA acid (also MRI and MIBG scan (selectively accum in chromaffin tissue)
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treatment (initial and ultimate) for pheochromocytoma?
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1. alpha- and beta-blockage (e.g. phenoxybenzamine for 10-14 days)
2. adrenalectomy |
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pgs not read:
275-276 282-283 |
yayo
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patient with PUD and visual change - what might you suspect?
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MENI: pacnreatic (gastrinoma --> PUD), pituitary adenoma, and parathyroid adenoma
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gastrinoma:
1. diagnosis 2. treatment options depending upon etiology/location (3)? |
1. elevated unstimulated gastrin level (e.g. >1000)
Management: a. part of MEN1- conservative/?surigcally b. solitary - resection c. mass abutting pancreatic duct - Whipple, partial pancreasectomy d. malig/met gastrinoma - gastric rsxn or vagotomy e. |
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what is the landmark where most gastrinomas are found, and what does it include?
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gastrinoma triangle; includes head of pancreas, doeudenum, distal end of stomach
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Patient with fasting, symptomatic hypoglycemia resolved with glucose administration - suspect what?
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insulinoma
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Insulinomas are small/large (<or>1cm), solitary/multi, and low/high incidence of malignancy?
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small (<1cm), solitary (80%), and low risk for malignancy (10%)
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Insulinomas should be resected, but if they can't be, how can they be managed?
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diazoxide (inhibitor of insulin release)
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what other lab value is increase in insulinoma, and actually assists in diagnosis (to rule out exogenous insulin administration)?
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C-peptide
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differentiating men2b from men2a?
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2b has additional marfinoid body habitus plus and ganglioneuromas
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29 yo F with isolated 1cm firm thyroid nodule. What are important elements in H&P to assess to suggest presence of malignancy? name 4-5
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1. family hx of thyroid ca
2. hx of neck radiation 3. hoarseness, dysphagia 4. hard, fixed on palpation 5. cervical lymphadenopathy |
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29 yo F with isolated 1cm firm thyroid nodule and hx of neck radition - next step?
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to OR for thyroidectomy
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postoperative thyroidectomy treatment with thyroid suppression (via thyroid hormone) or with Iodine-131 ablation useful in what thyroid cancers? not useful in which?
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useful in papillary and follicular, not in medullary
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65 yo F with calcium level of 14. she complains of fatigue. radiograph of hand shows bone reabsorption. what other lab values are warranted?
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parathyroid, alk phosph, phosphate levels
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38 yo F with acute onset of swollen, tender thyroid gland.
1. Diagnosis? 2. usually associated with hyperor- or hypothyrdism? 3. lab finding in de Quervain's? 4. therapy? |
1. nful thyroiditis (de Quervains's thyroiditis);hyperthyroid (early from release due to injury) -> hypothyroid (later)
3. elevated ESR 4. conservative (analgesics, aspirin) |
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hypothyroid with painless thyroid mass - low T3, normal-slightly elevated TSH.
1. diagnosis? 2. management (2)? |
1. Hashimoto's thyroiditis
2. thyroid replacement, biopsy of suspicious lesions (higher incidence of papillary CA) |
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40 yo male referred by GI for intractable ulcers in stomach and 3rd prtion of duodeum. He has hx of parathyroidectomy for hypercalcemia. Positive family hx for neck operations. Evaluation (2 important ones)?
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1. test for H. pylor
2. serum gastrin level |
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presenting features of pheochromoctyoma (5)?
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HTN, diaphoresis, pounding headaches, palpitations, anxiety
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Incidental adrenal mass found on CT - should it be resected, and if so, why?
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>5cm should be resected b/c of inc incidence of adrenal cortical carcinoma (also should be resected if active - inc levels of cortisol, catecholamines, potassium)
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