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Surgery Clerkship - De Virgilio COPY > Summary of Essentials Ch. 1- > Flashcards

Summary of Essentials Ch. 1- Flashcards

1
Q

Describe physical exam of a breast mass suspicious for cancer

A

Firm with irregular borders

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2
Q

When is nipple discharge suspicious for breast cancer?

A

Bloody, spontaneous, unilateral, uniductal, associated with a mass, >40 y/o

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3
Q

Most common cause of palpable breast mass?

A

Fibrocystic disease

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4
Q

Most common malignancy neoplasm of the breast?

A

Invasive ductal carcinoma

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5
Q

Most common breast neoplasm in premenopausal women?

A

Fibroadenoma

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6
Q

Work-up of all new breast masses?

A

Triple test -> physical exam, imaging, tissue sample If 30 or younger - U/S If >30 - mammogram + U/S Tissue diagnosis if clinically suspicious regardless of imaging findings Core needle biopsy better than FNA

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7
Q

Drug for HER-2 + breast cancer?

A

Trastuzumab

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8
Q

Drug for premenopausal ER+ breast cancer?

A

Tamoxifen

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9
Q

Rx post-menopausal ER+ breast cancer?

A

Anastrozole (aromatase inhibitor)

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10
Q

Type of calcification suspicious for cancer on mammogram?

A

Fine, linear, branching, pleomorphic microcalcifications

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11
Q

DCIS vs. LCIS in terms of progression?

A

DCIS can progress to invasive cancer if left unresected LCIS is only a marker for the development of future ipsilateral AND contralateral invasive breast cancer

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12
Q

Manage DCIS?

A

Lumpectomy to negative margin

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13
Q

Manage LCIS found on excisional biopsy?

A

Depends on risk factors If low risk -> observation or tamoxifen High risk -> prophylactic bilateral mastectomy

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14
Q

Manage LCIS found on core biopsy?

A

Excision biopsy to rule out adjacent or associated ductal or lobular cancer

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15
Q

Which coronary artery is most commonly affected in ACS? What does it supply and what EKG changes are seen?

A

LAD Anterior wall of left ventricle, anterior 2/3 of intraventricular septum - V2, V3, V4

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16
Q

Initial management of ACS?

A

Aspirin, clopidogrel, Gp2b3a antagonist, heparin, beta-blocker, nitro, statin, orphine

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17
Q

Management of STEMI?

A

Cath suite within 90 minutes for PCI Systemic thrombolysis if PCI not immediately available

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18
Q

Management of NSTEMI?

A

Most do not require PCI Elective cardiac cath on selective basis

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19
Q

Indications for urgent/emergent CABG?

A

Cardiogenic shock Failed PCI Presenting >12 hours after initial insult

20
Q

Indications for elective CABG?

A

Left main CAD Multivessel disease of other coronaries Failed PCI or not amenable to PCI

21
Q

Systolic crescendo-decrescendo murmur loudest at the upper right sternal border + S4?

A

Aortic stenosis

22
Q

What happens to murmur as aortic stenosis worsens?

A

Flow across the valve decreases and the murmur will become quieter and be heard later

23
Q

Rx aortic stenosis?

A

Surgical valve replacement; if poor candidate, valvuloplasty or transcatheter valve replacement

24
Q

Dx aortic dissection?

A

CXR (widened mediastinum) CT chest with IV contrast Unstable - OR with TEE

25
Q

Management of aortic dissection (immediate)?

A

Immediate control of BP - beta-blocker preferred unless suspected tamponade or severe aortic regurgitation

26
Q

Manage type A dissection (involves ascending)

A

Immediate operative repair

27
Q

Manage type B dissection?

A

Admit to ICU for BP control; surgery only if evidence of malperfusion or ongoing pain

28
Q

Work-up of incidental adrenal mass noted on CT?

A

24-hour urine free cortisol level or low-dose dexamethasone suppression test -> hypercortisolism Serum aldosterone/plasma renin ratio >30 -> hyperaldosteronism Catecholamine or metanephrine levels -> pheo

29
Q

Management of functional adenoma?

A

Adrenalectomy

30
Q

Management of non-functional adenoma?

A

<4 cm - observe 4-6 cm - adrenalectomy if good surgical risk >6 cm - adrenalectomy Do NOT biopsy

31
Q

Cause/Dx of primary hyperparathyroidism?

A

Excess PTH secretion -> hypercalcemia and osteopenia Elevated Ca2+ with high or inappropiaitely normal PTH level

32
Q

Cause/Dx of secondary hyperparathyroidism?

A

Decreased serum Ca2+ with increased PTH

33
Q

Indications for parathyroidectomy in asymptomatic patients with primary HPT?

A

Serum Ca2+ level 1.0 mg/dL greater than upper limit of normal Creatinine clearance <60 mL/min T-score

34
Q

Indications for parathyroidectomy in secondary PTH?

A

High PTH despite bmedical management, bone pain, pruritis, progressive renal disease, osteopenic fractures, calciphylaxis

35
Q

What can be done to localize a solitary adenoma?

A

Sestamibi scan + thyroid U/S

36
Q

Manage pheochromocytoma?

A

Medical conditioning with alpha-blockade for at least 2 weeks (phenoxybenzamine) Beta-blockade if tachycardia and/or arrhythmia Adrenalectomy

37
Q

Most important initial test for thyroid mass?

A

TSH

38
Q

Thyroid nodules should be evaluated with ___. If TSH is elevated, get a ___.

A

U/S; radioactive iodine scan

39
Q

What type of thyroid nodules have low risk of malignancy?

A

Iodine-avid and hot

40
Q

Thyroid nodules that should undergo FNA?

A

Size >1 cm or suspicious or increasing in size

41
Q

Management of FNA results if inadequate?

A

Repeat FNA

42
Q

Management of FNA results if benign?

A

Observe

43
Q

Management of FNA results if AUS/FLUS?

A

Repeat FNA

44
Q

Management of FNA results if suspicious for follicular neoplasm?

A

Diagnostic thyroid lobectomy; if malignant, complete thyroidectomy

45
Q

Management of FNA results if suspicious for malignancy?

A

Diagnostic or total thyroidectomy

46
Q

Management of FNA results if malignant?

A

Total thyroidectomy, possible neck dissection

47
Q

What must be excluded prior to surgery in all patients with an FNA diagnosis of medullary thyroid carcinoma?

A

Pheochromocytoma

Surgery Clerkship - De Virgilio COPY (9 decks)

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