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142 Cards in this Set
- Front
- Back
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MEN 1
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Pituitary, pancreas, parathyroid
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MEN 2A
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Pheo, parathyroid, medullary thyroid
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MEN 2B
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Pheo, medullary thyroid, marfanoid, mucocutaneous neurofibromas
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The recurrent laryngeal nerve innervates all laryngeal muscles except ____
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Cricothyroid (sup. laryngeal n.)
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Thyroid follicles store enough T4 to last ____
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2-3 months
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Tx: Graves’
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Meds, radioiodide ablation
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Dx: tachycardia, diarrhea, lower extremity edema, weight loss, amenorrhea
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Hyperthyroid
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Management of thyroid storm
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Beta blockers, antithyroid meds, corticosteroids, sodium iodide
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Effect of glucocorticoids on thyroid homeostasis
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Block peripheral T4 conversion
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Dx: fatigue, low mood, constipation, neck pain, menorrhagia
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Subacute thyroiditis
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Define: Riedel’s thyroiditis
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Fibrous replacement of thyroid
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Which nodules are likely benign, hot or cold?
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Hot
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__% of thyroid nodule FNAs will show a benign lesion
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65%
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MC presentation of thyroid cancer
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Painless mass
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Possible associated symptoms of thyroid cancer
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Dysphonia, hoarseness, dysphagia, dyspnea
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Amyloid on thyroid FNA is diagnostic of ____ cancer
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Medullary cancer
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Parathyroid embryology
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3rd pouch: Inferior glands; 4th pouch: superior glands
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The only thyroid cancer that undergoes hematogenous metastases
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Follicular
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Principal parathyroid cell
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Chief cell
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Tx: acute hypercalcemia
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Aggressive IVF, Lasix, and bisphosphonates
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GI sx of hypercalcemia
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Nausea, vomiting, constipation, PUD, pancreatitis
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Rare electrolyte cause of hypoparathyroidism
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Chronic hypomagnesemia
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Adrenal arterial supply
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Aorta, inferior phrenic, and renal arteries
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Adrenal venous drainage
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Right drains to IVC, left drains to L renal vein
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¾ of the mass of the adrenals comes from the ___ layer
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Fasciculata
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Categorization of adrenal masses by size
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<6 = observe, >6 resect
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MC paraneoplastic syndrome associated with adrenocortical carcinoma
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Cushings
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Define: Nelson’s syndrome
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Post-adrenalectomy pituitary hyperplasia: hypersecretion of ACTH, mass lesion, hyperpigmentation, amenorrhea
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Dx: weight gain, loss of muscle mass, bruising, acne, fatigue
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Cushing’s
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Suppression with high-dose dexamethasone confirms cortisol of ____ origin
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Adrenal or ectopic
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Classic symptoms of Addisonian crisis
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Abdominal pain, altered mental status
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Sx of Addison’s
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Fatigue, nausea, vomiting, abdominal pain, weight loss, hyperpigmentation
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Dx: diastolic hypertension without edema
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Primary hyperaldosteronism
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Blueberry muffin sign
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Subcutaneous blue tumor nodules in neuroblastoma
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MC extraadrenal site for pheochromocytoma
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Organ of Zuckerkandl (level of aortic bifurcation)
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Intraoperative management of pheochromocytoma
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Alpha blockade FIRST, and then beta blockade
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Size classification: pituitary micro- vs. macroadenoma
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<1 cm: micro-; >1cm macro-
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Two MC indications for splenectomy
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Trauma and ITP
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Conditions associated with splenic rupture
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EBV, malaria, trauma, abscess
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Breast arterial supply
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Internal mammary, axillary, and intercostals
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The majority of venous drainage of the breast is accomplished by the ___ vein
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Axillary
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The smallest breast mass detectable by physical exam is ___
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1 cm
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Damage to the medial and/or lateral pectoral nerves during axillary node dissection will leading to what deficit?
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Pectoral weakness.
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Damage to the thoracodorsal nerve during axillary node dissection will leading to what deficit?
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Latissimus weakness
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Damage to the long thoracic nerve during axillary node dissection will leading to what deficit?
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Scapula winging
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Evaluation of a breast mass in most women
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Diagnostic mammography +/- US +/- FNA
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Evaluation of a breast mass in young women under 30
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US +/- FNA
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Define: hidradenitis suppurativa
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Chronic infection of apocrine sweat glands, often manifesting on the areola in women
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Classic benign breast lesion that feels just like cancer
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Fat necrosis
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Diagnostic evaluation of suspected fibroadenoma
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FNA
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Define: Mondor’s disease
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Superficial thrombophlebitis of lateral thoracic veins
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Presentation of Mondor’s disease
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Acute axillary/lateral breast pain with a palpable tender cord
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Natural history of Mondor’s disease
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Self-limiting over the course of several weeks with NSAIDs
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Typical cause of Mondor’s disease
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Local trauma or surgery
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Most likely diagnosis: 35-year-old woman with bilateral, nodular breast tenderness and straw-colored nipple discharge that is worst during menses
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Fibrocystic change
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Dx: non-cyclic breast pain with lumps under the areolar-nipple complex
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Ductal ectasia
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MCC of bloody nipple discharge
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Intraductal papilloma
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Which breast process is clinically indistinguishable from fibroadenoma but tends to happen in old rather than young women?
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Phyllodes tumor (smooth, well-marginated, mobile, painless)
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Dx: tender, itchy nipple with bloody discharge
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Paget’s disease of the breast
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Three genetic conditions associated with breast cancer
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Li Fraumeni, BRCA, Peutz-Jeghers
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Contraindications to breast lumpectomy
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Previous radiation, multicentric disease, and connective tissue diseases
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Initial lab work for burn patients
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ABG, CBC, electrolytes, carboxyhemoglobin
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Rule of 9s for burns
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9% each arm, 9% head, 18% chest, 18% back, 18% each leg, 1% perineum
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Parkland formula for adult burns
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4 mL/kg/% body surface area burned; five first half over 8 hours, give second half over 16
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When is resuscitation adequate in burn management?
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UOP > .5 cc/kg/hr in adults, 1 in kids
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MC complication of inhalational injury
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Pneumonia
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Key management point for victims of electrical burns
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Continuous cardiac monitoring
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What kind of injury does alkaline material cause?
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Liquefactive necrosis
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What kind of injury does acidic material cause?
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Coagulative necrosis
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Define: Marjolin’s ulcer
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“Burn cancer”; aggressive squamous cell carcinoma with nodal mets
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Define: coronary artery “dominance”
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Which coronary artery gives rise to the posterior descending artery (90% of the time, the RCA)
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Flow through a vessel is significantly impedes when atherosclerotic plaque occupies >__% of the cross sectional area of the lumen
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75%
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Two groups of patients who have “atypical” MI symptoms
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Women, diabetics, and the elderly
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Conduits used for CABG
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Internal mammary artery, radial artery, inferior epigastric artery, saphenous vein,
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Generalized CABG indications by degree of coronary stenosis
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Left main > 60% stenosis, or proximal LAD and circ >70% stenosis.
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MCC of mitral stenosis
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Rheumatic heart disease
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Dx: mid-diastolic murmur with opening snap
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Mitral stenosis
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How can ischemic heart disease cause mitral insufficiency?
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Papillary muscle dysfunction
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MCC of mitral insufficiency
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Mitral valve prolapse (myxomatous degeneration)
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Dx: holosystolic murmur radiating to the axilla
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Mitral insufficiency
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Principles of medical management for mitral insufficiency
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Reduce afterload (lower BP) to reduce the volume of regurgitant blood
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MCC of aortic stenosis
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Calcific changes to native or bicuspid valve
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MCC of aortic insufficiency
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Aortic root dilation, endocarditis
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Dx: decrescendo diastolic murmur on the R
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Aortic insufficinency
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Which worsens with inspiration, tricuspid or mitral stenosis?
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Tricuspid stenosis
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Most small cell lung cancers are ___ located, whereas most non-small cell lung cancers are ___ located
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Centrally; peripherally
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Small cell lung cancers are treated with ___, while non-small cell cancers are treated with ___.
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Chemotherapy, surgery.
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Small cell lung cancer paraneoplastic syndromes
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Cushings, SIADH
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Squamous lung cancer paraneoplastic syndrome
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Hypercalcemia PTH-rP
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Dx: acute, stabbing chest pain and neurologic signs
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Thoracic aortic dissection involving one or more head/neck vessels
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Acute medical management of thoracic aortic dissections
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Labetalol, nitroprusside
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Blood supply to penis
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Internal pudendal artery
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How does management of a torsed appendix epididymis differ from that of a torsed testicle?
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Appendix epididymis is managed with NSAIDs, self-limited.
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What muscle do the ureters lie upon?
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Psoas
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What is the anatomic landmark for where the ureters cross the iliacs?
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Anterior to iliac bifurcation
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Normal red cells per high powered field in urine
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<3
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Classic drug associated with priapism
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Trazadone
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Classic sign of epididymitis in patient with acute scrotum
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Relief of pain with elevation of affected testis
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Classic physical exam for testicular torsion
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High-riding testicle with transverse lie and loss of cremasteric reflex
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Most patients with torsion are ___; the opposite is true of patients with epididymitis
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Afebrile
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__ kidney stones are note visible of plain film
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Urate
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Most kidney stones less than ___ in size will pass spontaneously
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< 5 mm
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Places where a kidney stone might get stuck
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Ureteropelvic junction, pelvic brim, iliac crossing, ureterovesical junction, vesical origin
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Medical management of BPH
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5α reductase inhibitors; α antagonists
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Risk factors: RCC
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Smoking
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Possible paraneoplastic hormones of RCC
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PTH-rP; ACTH; Prolactin; EPO
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MC location for branchial cleft cyst
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Anterior border of sternocleidomastoid
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Define: cystic hygroma
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Congenital lymphangioma
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MC location for cystic hygroma
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Oropharyngeal, particularly floor of the mouth
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MC tracheoesophageal malformation
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Blind esophageal pouch with distal TE fistula
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Dx: baby with excessive drooling and no gastric air bubble
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TE fistula
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VACTERL association
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Vertebral/anal/cardiac/TE fistula/renal/limb
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MC form of congenital diaphragmatic hernia
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Bochdalek (posterolateral)
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Define: Morgagni hernia
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Retrosternal congenital diaphragmatic hernia
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Dx: neonate with respiratory distress and scaphoid abdomen
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Congenital diaphragmatic hernia
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Define: “pulmonary sequestration”
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Nonfunctional cystic pulmonary unit that does not communicate with airways and directly receives its blood supply from the aorta
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Classic CXR for pulmonary sequestration
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Child with pulmonary mass lesion and air-fluid level
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Define: “Congenital Cystic Adenomatoid Malformation”
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Abnormal development of pulmonary tissue, replaced by nonfunctional cystic mass; often an entire lobe
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Presentation of Congenital Cystic Adenomatoid Malformation
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RDS or recurrent pulmonary infections
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On CXR, congenital cystic adenomatoid malformation is often mistaken for ___
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Congenital diaphragmatic hernia
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How can you tell the difference between CCAM and congenital diaphragmatic hernia on CXR?
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NG tube placement
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Define: gastroschisis
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Open midline herniation of abdominal contents
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Common complication of gastroschisis
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NEC
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Define: omphalocele
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Herniation of abdominal contents into umbilical sac
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In addition to bowel, omphalocele often classically involves which organ?
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Liver
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Associated conditions: omphalocele
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Beckwith-Wiedemann; trisomies 13 and 18
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Define: “Littre’s hernia”
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Hernia containing a Meckel’s diverticulum
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MC hernia in children
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Indirect inguinal 2/2 patent processus vaginalis
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Inguinal hernias in kids are more common on the __ side
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R side
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Dx: baby with very acute onset bilious vomiting and distention
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Malrotation with midgut volvulus
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Dx: baby with chronic bilious vomiting and distention
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Duodenal atresia
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The “double bubble sign” is present in which two conditions?
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Midgut volvulus and duodenal atresia
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Classic triad: intussusception
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Intermittent abdominal pain, bilious vomiting, currant jelly stools
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Classic appendicitis mimic in kids
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Meckel’s diverticulum
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Dx gold standard for Meckel’s diverticulum
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Scintigraphy: sensitive to ectopic gastric mucosa
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MCC of lower GI obstruction in neonates
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Hisrchsprung’s
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MC presentation of Hirschsprung’s disease
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Delayed passage of meconium
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Dx: neonate with fever, lethargy, distention, hematochezia
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NEC
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MC intraabdominal malignancy in childhood
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Wilm’s tumor
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MC non-CNS solid tumor of childhood
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Neuroblastoma
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Wilm’s tumor triad
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Flank pain, hematuria, HTN in a child
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Presentation of neuroblastoma
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Abdominal pain, constitutional symptoms, neurologic signs, HTN
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