I got 99 problems but a thyroid ain't one
What imaging test should be done in a patient w/ suspected parathyroid or thyroid nodule?
Bonus: The internal mammillary artery is a branch of?
Neck Ultrasound
Bonus: Subclavian artery
What lab test is used to diagnose Aldosteronoma?
Bonus: What is the first branch of the internal carotid artery?
Aldosterone:Renin ratio
Bonus: Ophthalmic artery
During a laparoscopic adrenalectomy an injury occurred to the IVC. What is your next step in action?
Bonus: What is the recommended surgical approach for Adrenocortical Carcinoma? Why?
Convert to open
Bonus: Open resection (due to risk of rupture and tumor seeding)
What are the recommended margins for Basal cell carcinoma?
3 mm - 5 mm
What two organism are involved in a Type II necrotizing soft tissue infection?
Streptococcus pyogenes
Staphylococcus Aureus
What protein can you use to monitor recurrence of papillary or follicular thyroid cancer?
Thyroidglobulin
What are the clinical features associated w/ MEN-I syndrome?
Pituitary adenoma
Parathyroid adenoma
Zollinger-Ellison
What is the recurrence rate of medullary carcinoma (general range)?
Bonus: A patient recently diagnosed w/ Medullary CA + unknown past family history. What additional test should you order?
Around 50%
Bonus: Plasma metanephrines (Screen of pheochromocytoma MEN2A & MEN2B)
38 y/o M + has a 1 cm dull red raised plaque on the right side of his face midway between the ear & lateral cantos of the eye. Biopsy shows dermatofibrosarcoma protubens. How should you resect this lesion?
Mohs surgery
Patient develops Necrotizing fasciitis after sustaining a leg wound contaminated w/ soil. What is the pathogen?
Clostridium Perfringens
53 y/o M + has a rapidly enlarging 6.5 cm right thyroid mass w/ irregular features + lateral cervical lymphadenopathy + core need biopsy shows lymphoma. What is the next recommended treatment?
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)
How do you reduce the risk of developing intra-operative thyroid storm in a patient w/ Graves disease?
Lugol's solution (KI)
Propylthiouracil or Methimazole
What drug will case a falsely elevated plasma metanephrines in a patient being evaluated for pheochromocytoma?
Bonus: What antibodies is associated with auto-immune adrenitis?
Phenylephrine
Bonus: 21-Alpha Hydroxylase
What is the management of a 52 y/o M + 1.2 mm melanoma w/ ulceration of his arm + no palpable lymphadenopathy?
Wide excision 1-2 cm margins + Sentinel lymph node biopsy (w/ radioactive tracer and methylene blue)
What is the most definitive treatment options that would minimize morbidity & mortality in a patient w/ necrotizing fasciitis?
Aggressive surgical debridement
What is the recommendation of a thyroid FNA classification of Bethesda 2?
Bonus: What is the best location to stimulate the recurrent laryngeal nerve intra-operatively to check for damage?
Follow-up 1 year w/ ultrasound of thyroid
Bonus: simulate the ipsilateral vagus nn.
What drug do you give to a patient recently diagnosed w/ pheochromocytoma?
Bonus: What is the first branch of the external carotid artery?
Initiate Doxazosin
Bonus: Superior thyroid artery
Zona fasciculata produces what hormone?
Bonus: Where does your right and left adrenal veins drain into? Which one is prone to injury?
Cortisol
Bonus: Right --> IVC | Left --> left renal vv. | Right adrenal vv.
50 y/o M + undergoes sentinel lymph node biopsy (SLNB) for a 1.5 mm melanoma + 2 SLNB are (+) for isolated melanoma + patient states he does not want an extensive lymph node dissection. What is your next best step?
Serial clinical examination & nodal basin ultrasound every 4 month for 2 yrs, followed by 6 months for every 3 yrs, then annually.
What are the 6 components of LIRENC score?
CRP, Hgb, Cr, WBC, Na+, Glucose
Most common site of recurrent laryngeal nerve injury during a thyroid dissection?
Ligament of Berry
35 y/o F + 2cm adrenal mass dx w/ Cushing syndrome + patient is experiencing HTN, Hyperglycemia, and multiple bone fractures. What symptom will most likely persist despite adrenalectomy?
Decrease bone mineral density (DEXA scan -2.5)
What is the first-line BP control intra-operatively in a patient w/ pheochromocytoma?
Nitroprusside
A patient presents w/ a melanoma underneath the right big toenail + biopsy revealed a depth of 4.2 mm. What is the recommended margins and treatment of underlying melanoma?
(Subungual melanoma)
Margins: 2 cm
Tx: toe amputation w/ sentinel lymph node biopsy
What is the most common pathogen in a patient w/ paronychia? What is the recommended treatment?
Staphylococcus Aureus
Incision and drainage w/ lifting of the nail bed +/- antibiotics (Unasyn)