A 45-year-old woman undergoes an uncomplicated thyroidectomy for a goiter. Later that night, she becomes agitated and complains of difficulty breathing. The surgeon notices some neck swelling at the incision site, but the dressing is clean.What should the next step be?
Answer(s): D
One of the most feared complications of neck surgery is postoperative hemorrhage causing airway compromise. Any patient with neck swelling and dyspnea must be assessed for this emergently. The treatment is to immediately open up the neck wound to release the hematoma and relieve the tracheal compression.
A patient presents with a new neck mass. On examination, she has a palpable thyroid nodule and a palpable cervical lymph node on the same side. Needle biopsy of the thyroid nodule shows amyloid in the stroma.The treatment for this patient is which of the following?
Answer(s): A
The needle biopsy revealing amyloid makes the diagnosis of medullary thyroid cancer. Patients often present with a neck mass and palpable lymph nodes (1520%). Because of the aggressive nature of the malignancy and the fact that it is often multicentric, total thyroidectomy is the treatment of choice. Modified radical neck dissection is indicated in patients with palpable lymphadenopathy and in patients with tumors larger than 2 cm (since 60% of these patients will have lymph node involvement). Because medullary carcinoma originates from the thyroid C-cells, they do not respond to thyroxine or radioactive iodine therapy.
Which of the following statements is true about primary hyperparathyroidism?
Answer(s): C
Primary hyperparathyroidism is usually the result of a parathyroid adenoma. It can also be associated with multiglandular hyperplasia. Secondary hyperparathyroidism is associated with the hyperphosphatemia, and resultant hypocalcemia, in chronic renal disease. Tertiary hyperparathyroidism is seen after kidney transplant. Most patients (about 80%) with primary hyperparathyroidism are asymptomatic. Symptoms can include renal stones, bone abnormalities, peptic ulcer disease, and mental status changes. It is more common in females, and the incidence increases with age.
A 45-year-old man presents with suprapubic tenderness, fevers, and nausea. After a thorough evaluation, he is found to have acute cystitis and bladder stones. Which of the following bacteria is most likely responsible for this infection?
E. coli is the most common culprit for acute cystitis, although it is often caused by enterococci, S. aureus, Klebsiella, Pseudomonas, and Streptococcus epidermis. P. mirabilis can split urea, which results in alkaline urine and precipitation of calcium. Patients with this organism often present with bladder calculi.
During laparoscopic abdominal procedures, the abdominal cavity is usually insufflated with carbon dioxide to a pressure of 15 mmHg. Increasing the intra-abdominal pressure to these levels produces which of the following1 physiologic responses?
Increasing abdominal pressures for laparoscopic procedures has several systemic effects. By increasing the carbon dioxide, patients become hypercarbic and acidotic. There is decreased venous return and increased afterload. The peritoneum is distended and the diaphragm elevated. In patients with normal cardiac function, cardiac output is not affected until the abdominal pressures reach about 20 mmHg.
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