外科：一般外（內分泌）

30 flashcards · Other · by Wanying Koh

1. follicular cells 分泌什麼

   T3, T4, thyroglobulin

2. parafollicular cells = C cells 分泌什麼

   calcitonin

3. thyroid storm tx

   propylthiouracil (inhibit TPO --> inhibit pdtn of thyroid hormones) B-blockers (decrease SNS s/s, inhibit T4-->T3) iodine (high conc. of iodine to inhibit thyroid hormone pdtn) corticosteroids (inhibit T4 --> T3) dialysis (wash off blood thyroid hormones)

4. hyperparathyroidism tx

   parathyroidectomy subtotal: 切 3.5顆，剩 100mg total: 切 all, transplant to brachioradialis / SCM

5. parathyroid Ca 1) what surgery 2) 切什麼

   1）radical local excision 2）parathyroid tumor, local tissue & LN, 1/2 lobe of thyroid

6. most common pre-operative localization of parathyroid

   Tc-sestamibi scintigraphy

7. 1' 2' 3' PTH PTH/Ca 特性 examples

   1'： PTH inc --> Ca inc (parathyroid adenoma, hyperplasia, carcinoma) 2'：Ca dec --> PTH inc (chronic renal failure pts) 3'：PTH inc --> Ca inc (autonomous hyperplasia of parathyroid after 2' in CKD pts, persists even after renal transplant = 3' hyperPTH)

8. Whipple's triad

   hypoglycemia s/s fasting glucose <50mg/dL resolution of s/s after IV glucose

9. gastrinoma triangle 構造 1) 2) 3)

10. 111In-octreotide scintigraphy diagnoses which pancreatic tumor 最有效

    gastrinoma - 有 somatostatin receptor (insulinoma 比較沒效 - somatostatin receptor 不多)

11. thyroid OP 傷到nerve後引發的問題 1) external branch of superior laryngeal n. 2) recurrent laryngeal n.

    1) loss of high pitch 2) vocal cord palsy (unilateral), airway obstruction (bilateral)

12. thyroid Ca staging N1a: N1b:

    N1a: level 6, 7 N1b: level 1 - 5

13. thyroglossal duct cyst able to cause cancer?

    1% thyroid cancer -- mostly papillary carcinoma

14. thyroid ca lymph node meta most common / least common at which levels

    most common: level 6 (closest to thyroid) least common: level 1 (least connection of LN networks w thyroid)

15. medullary thyroid ca surgical tx post surgery require 131-I?

    total thyroidectomy + central neck dissection 131-I no effect modified radical neck dissection --> only for lateral neck LN meta

16. History of use of propylthiouracil & prednisolone for hyperthyroidism. this time, temp 38.3'C, low BP, weakness after thyroidectomy Dx? blood test for what hormones?

    Addison crisis --> stopping prednisolone after thyroidectomy 造成 secondary adrenal insufficiency check cortisol, ACTH (thyroid storm s/s: BP inc., HR inc.)

17. T4 half-life T3 half-life

    T4 half-life: 1 week T3 half-life: 8-12h

18. cold and hot thyroid nodules 1) seen by what imaging technique? 2) used to differentiate what?

    1) Tc-99m thyroid scan 2) 良性惡性 (cold = more likely to be malignant)

19. FNA & U/S 個別 看什麼?

    FNA: 良性惡性 U/S: solid vs. cystic lesion, 良性惡性

20. post-thyroidectomy hand and face tremors Dx?

    hypoPTH due to 手術中傷到 parathyroid gland / its blood vessels ==> serum Ca dec., P inc. (PTH 應該造成 serum Ca inc, P dec. urine P inc.)

21. primary hyperPTH require parathyroidectomy in which patients x6

    age <50y/o cannot follow-up regularly osteoporosis (T score <-2.5) Ccr decrease > 30% serum Ca >11mg/dL urine Ca > 400mg/24hrs

22. Diagnosis

    renal osteodystrophy --> due to 2' hyperPTH (Rugger-Jersey spine: sclerosis of the vertebral body endplates)

23. most commonly used diagnostic tool for hyperPTH

    MIBI scan (Tc-sestamibi scintigraphy)

24. hyperCa s/s

    stones, bones, abdominal moans, and psychic groans

25. necrolytic migratory erythema seen in which pancreatic NET?

    glucagonoma

26. 1) neuroglycopenia present in which pancreatic NET? 2) definition 3) includes what s/s?

    1) insulinoma 2) shortage of glucose in the brain resulting in alteration of neuronal function 3) dizziness, weakness, drowsiness, delirium, confusion, and, seizures, coma (異常行為，精神混亂，視覺模糊）

27. pheochromocytoma diagnosis

    1) urine total VMA 2) urine total free catecholamines (blood 不用！) 3) abdominal CT scan 4) 131-I MIBG scan (specific for intra/extra-adrenal pheochromocytoma)

28. adrenal zona GFR 分別分泌什麼

    Granulosa: mineralocorticoid Fasciculata: glucocorticoid Reticularis: androgen

29. hyperPTH s/s that is indicative for surgery in dialysis pts calcium levels PTH levels other syndromes

    calcium levels > 11.5mg/dL PTH levels > 800ug/mL other syndromes: osteitis fibrosa cystica calciphylaxis (缺血性皮膚壞死、血管/軟組織廣泛鈣化) bone pain, skin itch

30. sarcoidosis --> hyperCA

    macrophages cause 1-a-hydroxylase overproduction, increase vit D --> small intestine absorbs calcium