Last-Minute Review Sheet

BIRADS—used to classify mammography findings and determine next steps based on risk of malignancy

• 0 – insufficient → need more imaging

• 1 – negative → routine follow-up

• 2 – benign → routine follow-up

• 3 – likely benign → short interval follow-up

• 4 – suspicious → CNB

• 5 – highly suspicious for malignancy → CNB

• 6 – biopsy proven malignancy → treat accordingly

Per Dr. Hayes: BIRADS 3, you need to see (get follow-up imaging)! BIRADS 4, you need a core (CNB)!

Bethesda Classification—standardized thyroid cytopathology reporting for FNA of thyroid nodules

• 1 – nondiagnostic → repeat FNA

• 2 – benign → follow-up imaging in 12 mo

• 3 – AUS/FLUS → repeat FNA or obtain molecular testing

• 4 – follicular neoplasm → diagnostic lobectomy vs molecular testing

• 5 – suspicious for malignancy → lobectomy vs total thyroidectomy

• 6 – malignant → treat malignancy accordingly

Types of choledochal cysts and their treatment:

• 1 – dilation of the CBD → cyst excision with Roux-en-Y hepaticojejunostomy

• 2 – diverticulum off of the CBD → resection of diverticulum off of the CBD

• 3 – choledochocele → endoscopic sphincterotomy vs trans-duodenal excision and sphincteroplasty

• 4a – intrahepatic and extrahepatic cysts → cyst excision followed by Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy, consider partial hepatectomy if cysts are limited to one lobe

• 4b – extrahepatic cysts → cyst excision followed by Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy

• 5 – intrahepatic cysts (Caroli’s disease) - partial hepatectomy (if cysts limited to one lobe) vs liver transplant

Biochemical work-up for adrenal mass:

• - To evaluate for aldosteronoma—BMP, aldosterone, renin

• - To evaluate for hypercortisolism—24 h urine cortisol, ACTH, low-dose dexamethasone suppression test

• - To evaluate for pheochromocytoma—plasma/urine metanephrines

• - DHEA-sulfate—can be elevated with adrenal cortical carcinoma

Concerning imaging findings for an adrenal mass:

• - >4 cm

• - >10 HFU

• - Delayed washout

• - Irregular borders

Anticoagulation reversal agents

• - Heparin—protamine

• - Enoxaparin—protamine

• - Warfarin—Vit K, PCC, FFP

• - Xa inhibitors—Xarelto (rivaroxaban), Eliquis (apixaban)

  • Andexanet alfa—recombinant factor Xa

  • PCC

• - IIa inhibitors—Pradaxa (dabigatran)

  • Praxbind (idarucizumab)—monoclonal antibody

  • Dialysis