• Free medical Books Videos ,lectures ,photos and apps for download at our telegram group

    https://twitter.com/DrATEFAHMED/status/1657105793903218690?s=20


    https://t.me/no1doctors


    #Plastic #Surgery @no1doctors dratef.net lifes1.com

    Share this group Link

    #medical_student #medicalbooks #doctor #surgeon #physcian

    Free medical Books Videos ,lectures ,photos and apps for download at our telegram group https://twitter.com/DrATEFAHMED/status/1657105793903218690?s=20 https://t.me/no1doctors #Plastic #Surgery @no1doctors dratef.net lifes1.com Share this group Link #medical_student #medicalbooks #doctor #surgeon #physcian
    0 Comments 0 Shares 740 Views
  • Acne

    https://twitter.com/DrATEFAHMED/status/1649884825677975553?s=20


    #Acne
    #dermatology
    #plastic
    #shorts
    #medical_notes
    #surgery
    #medicalnotes
    #endoscopy
    #Bariatric
    #sleeve
    #bypass
    #weighloss
    #no1doctor
    ##medical
    #doctor
    #Bariatric #Surgery #Complications
    #bariatricsurgeryjourney #bariatricsurgery #bariatricsurgeon #bariatricsurgeryturkey #bariatricsurgerytestimonial
    #surgery #MCQs #Exam #medical #doctor #medical_exam #medical_student #no1doctor #dratef #Mrcs #frcs #usmle

    Acne https://twitter.com/DrATEFAHMED/status/1649884825677975553?s=20 #Acne #dermatology #plastic #shorts #medical_notes #surgery #medicalnotes #endoscopy #Bariatric #sleeve #bypass #weighloss #no1doctor ##medical #doctor #Bariatric #Surgery #Complications #bariatricsurgeryjourney #bariatricsurgery #bariatricsurgeon #bariatricsurgeryturkey #bariatricsurgerytestimonial #surgery #MCQs #Exam #medical #doctor #medical_exam #medical_student #no1doctor #dratef #Mrcs #frcs #usmle
    0 Comments 0 Shares 11099 Views
  • A 64-year-old woman presents with nephrolithiasis and
    primary hyperparathyroidism. Her family history is
    unremarkable A Tc-99 sestamibi scan demonstrates a focus
    of activity near the left lower pole of the thyroid gland. The
    next step in her management should be


    A. left neck exploration.
    B. confirmatory 24-hour urinary calcium level.
    C. neck ultrasound.
    D. observation with repeat calcium and parathormone levels
    in 6 months.
    E. contrast-enhanced dynamic CT scan of the neck and
    chest (4-dimensional CT).

    https://twitter.com/DrATEFAHMED/status/1645517671960641552?s=20


    ANSWER: C

    The diagnostic workup for primary hyperparathyroidis (pHPTH) is relatively simple biochemically. The serum calcium level will be elevated with a concomitant
    inappropriately elevated parathormone level (PTH).
    Confirmatory testing can include elevated levels of urinary
    calcium excretion, effectively ruling out familial
    hypocalciuric hypercalcemia. A normal Vitamin D level will
    exclude low levels as a cause of the elevated PTH level. Other
    associated biochemical findings can include depressed serum
    phosphate with a serum chloride-to-phosphate ratio of greater
    than 33. Once the biochemical diagnosis of pHPTH is made,
    further testing is unnecessary and the decision for surgery is
    made in concert with a surgeon familiar with endocrine
    surgery. Criteria for surgical intervention are well established
    in pHPT. In general, the symptomatic patient or the patient
    with evidence of organ dysfunction from hypercalcemia
    should have a parathyroidectomy.
    The decision for further imaging is based solely on the
    operative technique planned. If traditional 4-gland neck
    exploration is planned, no further imaging is necessary. In the
    hands of an experienced surgeon, additional imaging only
    increases costs without significant benefit. If a patient is a
    candidate for focused parathyroidectomy, or "minimally
    invasive" parathyroidectomy, imaging techniques to localize
    a solitary adenoma are appropriate. The sensitivity of Tc-99
    sestamibi scan ranges from 65 to 85% and varies across
    institutions widely. More importantly, the relatively low
    specificity of any single imaging test to diagnosis a solitary
    adenoma, as opposed to multiple adenomas or hyperplastic
    disease, is not sufficient to guide focused surgical techniques.
    Most experienced surgeons use a 2-imaging test algorithm,
    and if concordant and confirmatory of solitary adenoma,
    focused exploration may be appropriate. It is inappropriate to
    offer focused parathyroidectomy based on a single positive
    image or discordant imaging results. The most commonly
    used imaging tests to guide exploration options, from least
    expensive to most expensive, are neck ultrasonography, Tc-
    99 sestamibi scanning, and contrast-enhanced CT scan of the
    neck. Ultrasonographic imaging of the neck is inexpensive,reliable in experienced hands, and office based. It has the
    added benefit of ruling out any additional thyroid pathology
    in the setting of planned neck exploration
    A 64-year-old woman presents with nephrolithiasis and primary hyperparathyroidism. Her family history is unremarkable A Tc-99 sestamibi scan demonstrates a focus of activity near the left lower pole of the thyroid gland. The next step in her management should be A. left neck exploration. B. confirmatory 24-hour urinary calcium level. C. neck ultrasound. D. observation with repeat calcium and parathormone levels in 6 months. E. contrast-enhanced dynamic CT scan of the neck and chest (4-dimensional CT). https://twitter.com/DrATEFAHMED/status/1645517671960641552?s=20 ANSWER: C The diagnostic workup for primary hyperparathyroidis (pHPTH) is relatively simple biochemically. The serum calcium level will be elevated with a concomitant inappropriately elevated parathormone level (PTH). Confirmatory testing can include elevated levels of urinary calcium excretion, effectively ruling out familial hypocalciuric hypercalcemia. A normal Vitamin D level will exclude low levels as a cause of the elevated PTH level. Other associated biochemical findings can include depressed serum phosphate with a serum chloride-to-phosphate ratio of greater than 33. Once the biochemical diagnosis of pHPTH is made, further testing is unnecessary and the decision for surgery is made in concert with a surgeon familiar with endocrine surgery. Criteria for surgical intervention are well established in pHPT. In general, the symptomatic patient or the patient with evidence of organ dysfunction from hypercalcemia should have a parathyroidectomy. The decision for further imaging is based solely on the operative technique planned. If traditional 4-gland neck exploration is planned, no further imaging is necessary. In the hands of an experienced surgeon, additional imaging only increases costs without significant benefit. If a patient is a candidate for focused parathyroidectomy, or "minimally invasive" parathyroidectomy, imaging techniques to localize a solitary adenoma are appropriate. The sensitivity of Tc-99 sestamibi scan ranges from 65 to 85% and varies across institutions widely. More importantly, the relatively low specificity of any single imaging test to diagnosis a solitary adenoma, as opposed to multiple adenomas or hyperplastic disease, is not sufficient to guide focused surgical techniques. Most experienced surgeons use a 2-imaging test algorithm, and if concordant and confirmatory of solitary adenoma, focused exploration may be appropriate. It is inappropriate to offer focused parathyroidectomy based on a single positive image or discordant imaging results. The most commonly used imaging tests to guide exploration options, from least expensive to most expensive, are neck ultrasonography, Tc- 99 sestamibi scanning, and contrast-enhanced CT scan of the neck. Ultrasonographic imaging of the neck is inexpensive,reliable in experienced hands, and office based. It has the added benefit of ruling out any additional thyroid pathology in the setting of planned neck exploration
    0 Comments 0 Shares 10850 Views