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FRACS exam > Endo > Flashcards

Endo Flashcards

1
Q

At what size do you start getting symptoms tracheal narrowing from goitre

A

Exertions dyspnoea at less than 8mm

Stridor/wheeze at less than 5mm

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2
Q

indications for surgery in thyrotoxic nodule or TMNG

A 
6 M's
Malignancy
Medical therapy failure
Massive goitre (compressive symptoms)
Mediastinal extension
Menacing consequences of radioactive iodine - pregnancy, allergey, severe orbitopathy
Mechanical compression
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3
Q

advice while taking radioactive iodine

A

Takes 3-5 days to pass through system
Takes upto 12 weeks to work

Dependant on the dose
Need to avoid close personal contact - radioactive iodine can be released in saliva, urine, sweat, no sharing saliva, bed, stay away from children for upto 5 days,
no pregnancy for at least 6 months - probably 12 best

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4
Q

Treatment of thyroid storm

A 
B blocker
Cooling cares (+ paracetamol) 
Icu
Carbimazole
Iodine
Steroids
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5
Q

Amiodarone induced hyperthyroidism types

A

Type 1 - from iodine in amiodaronetype2 from destructive thyroiditis

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6
Q

How is the ti rads comprised

A 
Echogenicity
Margins
Shape
Composition (solid v cyst v spongiform)
Echogenic foci (calcs, peripheral calcs, punctuate echogenic foci)
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7
Q

Ti rads

A

1- benign (0 points)
2 - benign (2 points)
3 - mildly suspicious - fna greater than 2.5cm and follow 1.5cm
4- moderately suspicious (4-6) fna 1.5cm and follow 1cm
5- highly suspicious - fna 1cm follow 0.5cm

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8
Q

What is the implication of negative localisation studies for PHPTH

A

Should do 4 grand exploration
Single gland still most likely
But remember multigland disease/hyperplasia

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9
Q

CT differentiation of incidentaloma

A

<10 HU - benign
<4 cm likely benign (90% malignant tumour >4cm)
< -40 HU myelolipoma
Washout - fast washout is consistent with adenoma. Delayed washout >10 mins in phaeo and ACC
Margins
Increased vascularity in phaeo
High intensity T2 on MRI FOR phaeo
Cystic and haemorrhagic changes in phaeo
>20 HU in malignancy and phaeo

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10
Q

What is the proportion of incidentaloma that are functional

A

90% non funxtuons

  1. 4 Cushing
  2. 1 phaeo
  3. 6 conns
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11
Q

What is mitotaine used for

A

Adrenocortical carcinoma
Incomplete resection or unresectable
High risk disease

Mitotaine is an adrenolytic agent that suppresses the adrenal Cortex and alters the peripheral metabolism of steroids

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12
Q

Commonest sites for neuroendocrine rumours

A 
Small bowel 45%
Rectum 20%
Appendix 16%
Colon 11%
Stomach 7%
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13
Q

Describe the grading of NET

A

G1- mitoses <2, ki67 upto 2%
G2- m 2-20, k 3-20%
G3 - m>20, k >20 (=NEC)

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14
Q

Describe staging of NET

A

generally not for tumour <1-2cm and type 1 and 2 gastric NETs
CT CAP
+ somatostatin receptor based imaging “octreoscan” or Dotate PET scan - important to assess if octreotide would work

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15
Q

cernea classification

A

1 - nerve passes >1cm above superior lobe (60% of normal sized thyroid, 20% of large goitre)
2a - <1cm of superior lobe (20% of large and normal gland)
b - crosses superior lobe (60% large goitre, 20% small)

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16
Q

suspicious USS of involved lymph nodes

A 
loss of fatty hilum
calcifications
non compressible
round vs oval
hyperechoic
>8mm size
17
Q

thyroglobulin measurement post total and hemi thyroidectomy

A

total <5ng/ml

hemi <30ng/ml

18
Q

intermediate/high risk categories of thyroid cancer

A 
>4cm
ETE (microscopic) (macroscopic = high risk)
Clinically lymph node involved
Gross residual tumour (high risk)
Node >3cm (high risk)

follicular cancer with >4 foci of vascular invasion + well differentiated + no capsular invasion

Papillary - high risk variant (tall cell, hurthle cell, hobnail, insular)

19
Q

Outline the roles for RAI

A

Used in adjuvant setting- I-131
Ablate residual thyroid tissue
Adjuvant treatment of subclinical mets
Treatment of residual/metastatic disease

Used in diagnostic purposes - I-123
Staging
Assessment of hyperthyroidism

20
Q

Treatment of metastatic thyroid cancer

A

RAI is curative in a minority of patients
Combination of RAI + TSH helps to minimise disease burden
Kinase inhibitors VEGRF targets can be trialled for non-responsive disease -

21
Q

Genetics of papillary vs follicular

A

papillary - MAPK pathway - RET oncogen

follicular - RAS

22
Q

rates of single vs double vs diffuse hyperplasia for HPTP

A

85% vs 5% vs 10%

23
Q

what age to consider MEN2 a possibility with HPTH

A

<30 year old male

24
Q

what type of pet ct for pth adenoma?

A

methionine PET CT

25
Q

cancer syndromes associated with adrenal cortical carcinoma

A

Li Farumeni

MEN1

26
Q

Histology of Adrenal cortical carcinoma

A 
Weiss histological criteria for cancer
Note its difficult to diagnose cancer in the absence of metastatic disease
5 criteria
>6 mitoses/50 HPF, Ki67%
<25% clear tumour cells
abnormal mitoses
necrosis
capsular invasion
27
Q

phaeo associated familial syndromes

A

MEN2
VHL
NF1
Carney triad

28
Q

when to familial test for phaeo/paraganglioma

A

consider for all paraganglioma
bilateral phaeo
family history
unilateral phaeo <45 years old

29
Q

Phaeo triad

A

Headaches, palpitations sweats (+hypertension on examination)

30
Q

Conn’s triad

A

hypokalemia, alkalosis, hypertension

31
Q

PNET characteristic presentations

A

Insulinoma - whipple’s triad - hypoglycemic symptoms (confusion, visual changes, diaphoresis) + recorded hypoglycemia + symptoms settle with sugar intake
Gastrinoma - zollinger-ellison syndrome (PUD + Diarrhoea)
Glucagonoma - necrolytic migratory erythema, diabetes, diarrhoea, VTE, neuropsych
VIPoma - diarrheoa, hypokalemia, hypochlorhydria
Somatostatinoma - steatorrhoea, cholelithiasis

32
Q

how to confirm ZES

A

Fasting serum gastrin level high
Low stomach pH (<2) (ensure not on acid suppression) - if higher pH and not on suppression consider atrophic gastritis/h.pylori
exclude other causes of high gastrin (e.g. retained antrum syndrome)
secretin suppresion test if FSG<10x increased
if >10 FSG then confirms ZES

33
Q

what is the ASVS

A

arterial calcium stimulation with hepatic venous sampling used to help localised insulinoma + gastrinoma

34
Q

carcinoid syndrome

A

flushing diarrhoea wheezing

35
Q

Bethesda + risk of malignancy

A 
1 - non diagnostic
2- benign - 2%
3- atypia of undetermined significant or follicular lesion of undetermined significance - 5-15%
4 -follicular neoplasm - 15-30%
5- Suspicious for malignancy - 60-75%
6- Malignant - 99%

FRACS exam (13 decks)

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