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General Surgery > Endocrine Glands and Breast > Flashcards

Endocrine Glands and Breast Flashcards

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1
Q

The pituitary gland: affects

A

The pituitary gland: affects bone growth and has growth factors

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2
Q

Which of the following hormones is produced in the anterior lobe of the pituitary gland?

(1) TSH
(2) ACTH
(3) GH
(4) PRI
(5) All of these

A

(5) All of these

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3
Q

T/F: the pituitary gland controls the hypothalamus-pituitary/portal circulation via feedback axis.

A

True.

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4
Q

Treatment of a prolactinoma is:

A

bromocriptine/cabergoline

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5
Q

Treatment of gigantism/acromegaly is:

A

somatostain analogues.

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6
Q

Diagnosis of pituitary tumors is achieved via

A

Diagnosis of pituitary tumors is achieved via elevated hormone levels + CT + MRI**.

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7
Q

Pituitary tumor surgery is indicated if there is:

A

COMPRESSION OF THE OPTIC CHIASMA (transsphenoidal, transnasal or sublabial).

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8
Q
  • SIADH: a generally ectopic hormone that is treated
A

primarily

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9
Q

thyroid gland develops as a

A

thyroid gland develops as a protrusion from the floor of the mouth (base of tongue) and migrates to the lower neck in midline.

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10
Q
  • **Note that the recurrent and superior laryngeal nerves are in close proximity to
A
  • Note that the recurrent and superior laryngeal nerves are in close proximity to the thyroid gland and are at risk during surgery.
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11
Q

Calcitonin levels are elevated in

A

Calcitonin levels are elevated in medullary carcinoma and MEN2

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12
Q

In the developing world, the major cause of hypothyroidism is:

A

iodine deficiency.

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13
Q

In the developing world, the amjor cause of hypothyroidism is:

A

In the developed world, surgery/radiation/genetics/drugs and peripheral hormone resistance are causes of hypothyroidism

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14
Q
  • Cytokines, interferon-alpha, interferon-2, lithium, amiodarone are associated with development of
A

hypothyroidism

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15
Q

A smooth goiter is associated with:

A

hyperthyroidism

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16
Q

A nodular goiter is associated with:

A

Plummer’s disease

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17
Q

Thyroid lab values of hyperthryoidism include:

A

High T3 and T4, low TSH

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18
Q

Hyperthyroidism is treated via:

A

(1) propylthiouracil/methimazole
(2) Radio I-131
(3) Anti-thyroid drugs
(4) beta blockers

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19
Q

A patient with subacute thyroiditis presents with:

A

fever, weight loss, fatigue, swelling with giant cells on spiration.

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20
Q

Treatment of subacute thyroiditis includes:

A

steroids/ACTH.

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21
Q

Treatment of Ridel’s (struma) thryoiditis is:

A

thyroxine and possibly surgery for obstruction.

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22
Q

The type of non-toxic goiter that is LEAST likely to be malignant:

(1) smooth or colloid goiter
(2) Multi-nodular goiter
(3) solitary nodule goiter

A

(1) smooth or colloid goiter is unlikely to be malignant.

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23
Q

A patient with a solitary nodule MOST likely has:

(1) A nodule with 5 - 10% malignancy.
(2) Is most likely to be male
(3) A nodule with 5 - 15% malignancy.

A

A patient with a solitary nodule MOST likely has: (3) A nodule with 5 - 15% malignancy.

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24
Q

A non-toxic goiter workup should include:

A

see if there is a history of MEN-2 and familial polyposis

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25
The best imaging study for non-toxic goiter workup:
- Imaging: ultrasound is the BEST imaging study
26
T/F: - Fine needle aspiration is 80% sensitive/41% specific especially for papillary carcinoma
True.
27
The most common type of thyroid cancer is: (1) follicular cell origin (2) Anaplastic (3) lymphoma (4) metastatic form
The most common type of thyroid cancer is (1) follicular cell origin.
28
The most common type of thyroid cancer is of follicular cell origin. The most common type of follicular cell carcinoma is: (1) Papillary (2) follicular (3) Hurthle cell (4) Medullary
The most common type of follicular carcinoma is (1) Papillary type
29
Calcium has an ______ relationship with phosphate and PTH.
Calcium has an inverse relationship with phosphate and PTH.
30
PRIMARY HYPERPTH can be caused by
adenomas or hyperplasia
31
HyperPTH presents with lab values of:
hypercalcemia and elevated serum PTH
32
Which of the following is a symptom of primary hyperPTH? (1) osteomalacia (2) constipation, peptic ulcers, pancreatitis (3) myalgias (4) kidney stones (5) all of these
(5) All of these
33
The most common symptom of hyper PTH is:
myalgia and muscle weakness
34
Treatment of hyperPTH includes:
saline, diuresis with furosemide, bisphosphonates/calcitonin.
35
Secondary hyperPTH is seen in:
CKD and renal failure.
36
Metastatic calcification is associated with:
tertiary hyperPTH
37
Glucagonoma, Somatostatinoma and pancreatic polygastrinoma have malignancy rates of:
>95%
38
Glucagonoma presents with:
diabetes mellitus and NME
39
Whipple's triad is associated with:
insulinoma and severe hypoglycemia.
40
A somatstatinoma presents with symptoms of:
steatorrhea Diabetes mellitus GB
41
A VIPoma presents with
WDHA | severe diarrhea, hypokalemia, achlorhydria
42
More than half of gastrinomas arise in the:
duodenum
43
__% of gastrinomas are sporadic
75%
44
__% of gastrinomas are associated with MEN-1.
25%
45
Diagnosis of gastrinoma is made via:
serum gastrin > 1000 pg/mL, gastric pH < 2, basal acid > 5 mEq/hr. Diagnosis is via somatostatin receptor scintigraphy (> 95% accurate).
46
Diagnosis of gastrinoma is 95% accurate when the diagnosis is made via:
somatostatin receptor scintigraphy.
47
T/F: the cure rate of gastrinoma is low.
True.
48
VIPOmas present with:
watery diarrhea and hypokalemic achlorhydria. | (2) Patients also have a pancreatic tumor.
49
Treatment of VIPoma includes:
distal pancreatectomy
50
Catecholamines are made in the
inner medullar
51
The zona glomerulosa, zona fasciculata and zona reticulans are faound in the
outer medulla
52
Aldosterone: (1) is made in the zona fasciculata (2) regulates electrolytes/fluid through kidney via the RAAS. (3) produces glucocorticoids and sex hormones.
Aldosterone (2) regulates electrolytes/fluid through the kidney via RAAS
53
The zona fasciculata contains:
glucocorticoids.
54
Glucocorticoid secretion is controlled by:
CRF
55
Glucocorticoid and sex hormone production is controlled by:
CRF and ACTH
56
The majority of Cushing's syndrome is :
ACTH dependent.
57
Aldosteronoma (Conn's syndrome) presents with:
HTN, polyuria, HYPOkalemia.
58
Addison's disease presents with:
HYPOnatremia and HYPERkalemia, as well as weight loss, hypotension, hypoglycemia and bronze pigmentation of the skin.
59
The adrenal medulla contains chromaffin cells which secrete
dopamine, epinephrine and norepinephrine from tyrosine.
60
Pheochromocytoma: results when the adrenal gland produces too much
epinephrine
61
Diagnosis of pheochromocytoma is made via:
elevated plasma and urinary catecholamine and metabolite levels (VMA, metanephrine). Localize by using CT, MRI, MIBG
62
Surgery is indicated for an incidentaloma if:
surgery if functional OR if there is > 6 cm risk of malignancy. **Surgery is not indicated if < 4 cm AND non-functional**.
63
MEN-1 presents with:
pituitary adenoma (2) parathyroid hyperplasia (3) pancreatic tumors
64
MEN-2A presents with:
(1) PTH hyperplasia (2) Medullary thyroid carcinoma (3) Pheochromocytoma
65
MEN-2B presents with:
Muscosal neuromas (2) Marfanoid body habitus (3) MEdullary thyroid carcinoma (4) pheochromocytoma
66
treat parathyroid by near total parathyroidectomy for
MEN-1
67
thyroidectomy is treatment for
thyroidectomy for MEN-2 after removing pheochromocytoma
68
T/F: **Systemic hormone disturbances can cause breast enlargement**.
True
69
Cooper’s ligaments are
Cooper’s ligaments are suspensory ligaments of connective tissue that provide lift to the breast.
70
- Nerves at risk in breast surgery are the
long thoracic, thoracodorsal, medial pectoral, lateral pectoral and intercostobrachial.
71
at birth, the breast is scattered ducts at stroma; at PUBERTY,
hormones cause NEW ducts and lobules to form.
72
- Pregnant breast: has _____influence and enlarges and engorges with milk
- Pregnant breast: has prolactin influence and enlarges and engorges with milk
73
- Lactating breast: evacuates milk due to _____effect on myoepithelial cells
- Lactating breast: evacuates milk due to oxytocin effect on myoepithelial cells
74
The current recommendation of mammorgrams is:
first mammo at 40 y/o, biennially until 50 y/o and annually thereafter.
75
BIRADS-2 indicates:
benign breasts
76
The BIRADS classifications that require a biopsy:
4 and 5
77
Ultrasound: preferred method of imaging in patients
Ultrasound: preferred method of imaging in patients YOUNGER than 40 Y/O
78
MRI: is used when mammogram is
equivocal, for DENSE BREASTS and for some high risk patients.
79
Biopsy: fine needle aspiration is often done under ultrasound imaging for
Biopsy: fine needle aspiration is often done under ultrasound imaging for FNAB. It is 90 – 93% accurate.
80
Core-needle and open biopsies are done for breasts with masses that are
non-palpable.
81
Mastalgia/mastodynia: pain in the breast. This can be
This can be cyclical with menses/ovulation or non-cyclical, which is associated with diseases and cystic change
82
Treatment of mastalgia/mastodynia is:
– treat with analgesics after ruling out more serious disease.
83
A fibroadenoma is MOST common in:
Fibroadenoma: teenage to 30s; low risk of cancer. | *Dx: excision or needle biopsy after age 21.
84
Juvenile and giant fibroadenomas that are > 5 cm may be a
phyllodes tumor (benign or malignant).
85
A patient with a breast hamartoma MOST likely:
Has BENIGN tissue and is over 35 y/o, the patient may also have Cowden syndrome.
86
Fibrocystic changes are seen in:
Fibrocystic change: seen in women 30 – 50 y/o; 90% may manifest as a mass. Needle aspirate if palpable or with sonogram guidance.
87
Breast abscesses often occur during:
lactation
88
A duct papilloma presents with:
bleeding from the nipple.
89
A galactocele causes:
lactation
90
Sclerosing lesions of the breast present as:
microcalcifications/radial scars.
91
A patient presents with bleeding nipple discharge. The patient MOST likely has:
duct papilloma.
92
Which of the following regarding granulomatous mastitis is TRUE? (1) IT is most common in Caucasians (2) It occurs 5 years of lactation. (3) IT does not have to be biopsied to rule out cancer. (4) antibiotics and drainage are not recommended.
(2) Granulomatous mastitis occurs within 5 years of lactation.
93
Breast cancer risk factors include: (1) Lynch syndrome (2) Paternal inheritance (3) typical ductal or lobular hyperplasia.
(1) Lynch syndrome
94
The breast cancer model that ONLY focuses on family history (the number of first-degree relatives and age of onset)
Claus model
95
Chemoprevention is via:
tamoxifen, as well as prophylactic mastectomies
96
T/F: lobular carcinoma in situ is not a cancer, but a risk factor.
True.
97
Phyllodes tumor is considered a
mixed connective/epithelial tumor
98
The current golden standard of treatment for breast cancer is:
- Wide excision with or without sentinel node biopsy/axillary dissection
99
Aromatase inhbitors are breast cancer treatments for:
Aromatase inhbitors are treatments for post menopausal patients.
100
Inflammatory cancers: are warm, erythematous and edematous. They are treated with
Inflammatory cancers: are warm, erythematous and edematous. They are treated with sequential neo-adjuvant chemotherapy/surgery and THEN adjuvant chemo-radiation
101
The risk factors for male breast cancer are
BRCA-2, testicular tumors, Klinefelter syndrome, Jewish or Icelandic heritage. Old age or renal failure.

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