Surgery Flashcards
Patient has severe swings of Hypertension during a surgery
What would you do?
continue
pr
don’t start the operation until stabilise
What are causes of hypertension?
Cushing’s
Renal artery stenosis
polycycstic kidney disease
Conn’s syndrome
Phaechromocytoma
Acromegaly
Aortic coarctation
How do you investigate the sever changesin hypertension
renal ultrasound- lookfor renal artery stenosis
Echocardiogram- look for end organ damage
dexomethasone suppression- look for cushing’s
plasma renin/aldosterone- conn’s
plasma metanephrine- phaechromocytoma
What is the first investigation if you supect phaechromocytoma
urine metanephrine
urine catecholamines
how would you investigate connes
plasma renin/ aldosterone
saline infusion
sample from the righ and left adrenal vein and a sample from below the IVC below the renal arteries
How would you investigate cushings intially
MOST appropriats:
Do first: dexamethosone suppression test
Do second: measure the 24h urine cortisol measure
IF they are in clinic you can also do spot serum cortisol ()
What happens to the heart in phaechromocytoma
ECHOCARDIOGRAM
- enlagement of all 4 chambers
how do you treat a phaechromocytoma
alpha blocker!
mortality is 50% if untreated
A patient comes back with an elevated catechomalamine and metanephrines
What do you do as an investagation
- Adrenal CT
- look for metastasis GAD
What are conditions that can cause phaechromocytoma
MEN2a
Paraganglioma syndrome (suxinate dehydrogenase (SDHD
and SHDB)
VHL- von hippel lindau
What are the procedures used to remove a phaechromocytoma
Open
through the back
or front (midline or )
lateral and anterior - minimally invasive (key hole)
persistant hypertension
resistant to hypertension medication
what inestigations?
serum renin aldosterone
RENIN must be suppressed
What medicatoin interfere with renin aldosterone system
supress renin secretion
therefore might fake Conn’s
when you do renin/ aldo ratio
What is the aetiology of breast cancer
Braca 1
braca 2
Lifraumeni syndrome
Hormone:
HRT, oral contraception
early period
nulliparity
late menopause
breastfeeding
late first birth
what is breast screenin program
47 -70 every 3 years
what are normal variant of
multi duct discharge without blood is usually normal
accessory appear during pregnancy
what arethe different types of mastalgia?
cyclical - young womemn around period
non cyclical- menopause
What are conscerning feature on a breast examination
dimpling
lump
nipple inversion
peau d’orange
what could nipple crusting or nipple eczema
padget disease
not itchy, unilateral
someone has padget’s disease of the breast how do you determine it
punch biopsy - padget’s disease
what is a thrombophlebitis of the breast
mondors disease
What are teh different mastitis
lactational mastitis- breast feeeding lady - can progress to a an abcess
periductal mastitis- smokers
granulomatous mastitis- TB, sarcoid
cancerous mastitis-
What is the cause of peau d’orange
lymphoedema
