SherryT_SurgeonSimulator

(enchant: ?page, (text-colour: black) + (background: white)) ''Surgeon Simulator'' By Sherry Tariq [[Begin]]

The patient comes in and starts detailing his symptoms: * swelling in the neck * pain in the neck * hoarseness * trouble breathing and swallowing * constant cough On top of all these symptoms you notice a big, fat //lump// in their neck. You're starting to form an idea of what is going on; it is centered around the ''thyroid''. "Do you even know what the thyroid is?" asks Nurse Sally. [["Yes!"]] (enchant: ?page, (text-colour: black) + (background: white))

"Smart move!" exclaims Nurse Sally. You don't know whether to take that as sarcasm or a genuine comment. Now, you know there is a problem with the thyroid, but how will you further investigate the problem? [[Blood Test]] [[Imaging Test]] (enchant: ?page, (text-colour: black) + (background: white))

You prescribe anti-thyroid hormone drugs to the patient in an effort to reduce the overproduction of thyroid hormones. Time goes by... [[How is the patient doing now?]] (enchant: ?page, (text-colour: black) + (background: white))

THE PATIENT HAS ''DIED''! It seems you did not treat the true problem he was dealing with. [[Try again->"Yes!"]] (enchant: ?page, (text-colour: white) + (background: red))

With this blood test, you want to figure out if there are abnormal levels of thyroid hormone being produced by the body. The patients results return and indicate that there are about normal levels of thyroid hormone. "Of course, this may be enough information to diagnose," says Nurse Sally. "Or would you like to run some more tests?" [[Diagnose a thyroid nodule]] (Pretty common problem where lumps form on an otherwise normal-functioning thyroid gland) [[Perform an imaging test->Imaging Test]] (enchant: ?page, (text-colour: black) + (background: white))

You decide to perform a //radioiodine scan//. For this, a small quantity of radioactive iodine is consumed by the patient. This iodine is absorbed by the thyroid gland and a camera is used later to see where the radioactivity is. You find an abnormality - a //cold nodule//. This means that a form of ''cancer'' is present; however, it is uncertain if it is benign or cancerous. Nurse Sally tells you that, in her experience, these are usually benign ''cancers'' and that it is best to leave them alone. Will you heed Nurse Sally's advice or do some further investigating? [[Nurse Sally must be right]] [[Check patient history]] (enchant: ?page, (text-colour: black) + (background: white))

You know that to treat a //thyroid nodule// you must perform hormone therapy on the patient. These hormones simply attack the extra thyroid tissue and prevent the symptoms from manifesting in the patient. Some time passes... [[Check up on the patient]] (enchant: ?page, (text-colour: black) + (background: white))

THE PATIENT HAS ''DIED''! It seems you did not treat the true problem he was dealing with. [[Try again->Blood Test]] (enchant: ?page, (text-colour: white) + (background: red))

You tell the patient that there is nothing to worry about and he will be okay. You prescribe some medicine to ease the symptoms and send him on his merry way. Some time passes... [[How is he doing?]] (enchant: ?page, (text-colour: black) + (background: white))

Further investigating the patient seems like the right move. You discover that the patient has a family history of (text-style: "shudder")[THYROID CANCER]! It is all clear what the problem is now. Nurse Sally asks if you would like to treat the ''cancer'' or further make sure if the ''cancer'' is even present. [[Let's just do this]] [[One more check can't hurt]] (enchant: ?page, (text-colour: black) + (background: white))

THE PATIENT HAS ''DIED''! It seems you did not treat the true problem he was dealing with. [[Try again->Imaging Test]] (enchant: ?page, (text-colour: white) + (background: red))

"Woah!" exclaims Nurse Sally. "Let's not get ahead of ourselves and let's take a sample." You decide to heed her words. [[Yes, ma'am->One more check can't hurt]] (enchant: ?page, (text-colour: black) + (background: white))

You decide to remove a sample of thyroid tissue from the patient. This is the most invasive procedure to diagnose the patient with, so you have saved it for last. You perform a //fine needle aspiration// (FNA) of the thyroid. Here, you inject a needle into an anesthsized area of the thyroid to take out some cells into a syringe. These cells were sent to a lab and came back positive for containing (text-style: "shudder")[CANCER]. Time to treat this bad boy, but you have a few options. Nurse Sally looks at you for guidance. [[Radioactive iodine treatment]] (destroys thyroid tissue) [[Targeted drug therapy]] (shoot drugs at the thyroid)) [[Thyroid lobectomy]] (partial removal of the thyroid) [[Thyroidectomy]] (full removal of the thyroid) (enchant: ?page, (text-colour: black) + (background: white))

This is a good option for a less serious issue. However, Nurse Sally reminds you that thyroid cancer calls for a more heavy removal of thyroid tissue. Try again, doctor, you got this! [[Try again->One more check can't hurt]] (enchant: ?page, (text-colour: black) + (background: white))

This therapy is used only in advanced thyroid cancer. Nure Sally reminds you that it helps clear out any remaining tumor, but only after a sizeable amount has been removed. Try a procedure that targets more of the tumor! [[Try again->One more check can't hurt]] (enchant: ?page, (text-colour: black) + (background: white))

This procedure would take out a bit of the thyroid in order to resume normal functioning, but disrupt the ''cancer'' from spreading. Nurse Sally commends you on this excellent choice! The drugs kick in to sedate the patient as you begin the procedure. You quickly realize that not enough anesthetic was administered so you must (text-style: "rumble")[ACT QUICK]! [[Hurry up!]] [[Slow and steady wins the race]] (enchant: ?page, (text-colour: black) + (background: white))

This is a full removal of the thyroid gland. Nurse Sally tells you that it is particularly useful for severe cases of thyroid cancer, but we caught this cancer pretty early on. Try a less intense procedure to start with and if further complications arise you can take out more of the thyroid. [[Try again->One more check can't hurt]] (enchant: ?page, (text-colour: black) + (background: white))

You begin to do the procedure very quickly. All is well until you ''hit the parathyroid gland'' on accident! This causes the patients calcium levels to drop which is hazardous to normal bone development. Nurse Sally looks to you for what to do next! [[Power on in the short time window]] [[Take care of the patient and move on]] (enchant: ?page, (text-colour: black) + (background: white))

The patient wakes up near the end of the surgery and experiences the procedure! He is shocked and appalled. He files a ''medical malpractice lawsuit'' against you! [[Try the procedure again->Thyroid lobectomy]] (enchant: ?page, (text-colour: white) + (background: red))

The operation is a semi-success, but the patient has bone weakness for the rest of their life. They need constant calcium influx to survive. Also, they file a ''medical malpractice lawsuit'' and win. Nurse Sally is disappointed. [[Try again->Hurry up!]] (enchant: ?page, (text-colour: white) + (background: red))

The surgery is a ''SUCCESS''! Both the patient and Nurse Sally thank you for your help and quick-thinking skills. Nurse Sally asks if you want to do some follow-up treatment. [[No follow-up]] [[Follow-up treatment]] (enchant: ?page, (text-colour: black) + (background: white))

The patient goes in ''remission'' with no medication to take care of their recovering thyroid. They will need to come to the hospital again to take care of their condition. [[Try again->Take care of the patient and move on]] (enchant: ?page, (text-colour: white) + (background: red))

"What follow-up treatment?" asks Nurse Sally. [[Thyroid hormones]] [[Radioactive iodine->Thyroid hormones]] [[Both of these]] (Nurse Sally recommends this one) (enchant: ?page, (text-colour: black) + (background: white))

The patient needs more than just this to keep from going into remission. ''Try again!'' (P.S. Listen to Nurse Sally) [[Follow-up treatment]] (enchant: ?page, (text-colour: white) + (background: red))

Congratulations! You successfully treated and followed up on your first patient. Your skill as a medical surgeon is apparent and you have proved your worth within your first week as a resident! (enchant: ?page, (text-colour: white) + (background: blue)) ''The End!'' [[References]]

“Tests for Thyroid Cancer.” American Cancer Society, www.cancer.org/cancer/thyroid-cancer/detection-diagnosis-staging/howdiagnosed.html. “Thyroid Cancer.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 Mar. 2018, www.mayoclinic.org/diseases-conditions/thyroid-cancer/diagnosis-treatment/drc-20354167. “Thyroid Cancer Misdiagnosis - What Causes This Devastating Disease.” Paul & Perkins, paulandperkins.com/thyroid-cancer/. (enchant: ?page, (text-colour: black) + (background: white))

(enchant: ?page, (text-colour: black) + (background: white)) You are a bright-eyed, new attending resident surgeon from ''Harvard Medical School''. Your focus is more on helping those in need, rather than making money so you decided to do your residency at a low funded hospital. Today is your first day and the attendings trust in your medical school education so much that they leave you alone with just ''Nurse Sally'' to tend to your patients. [[Continue]]

You are nervous, but eager to show your ability to the attending doctors and to better peoples lives. "//This is not for you//," says Nurse Sally. Her doubt drives you to prove her wrong. You go to meet your first patient. Good luck, doctor! [[I got this]] (enchant: ?page, (text-colour: black) + (background: white))

"The thyroid is responsible for making hormones that regulates the body's metabolic rate and various other regulatory systems," you reply. Nurse Sally looks in acknowledgment and asks what you want to do. [[Further Testing]] [[Diagnose Graves Disease]] (Very common disorder that causes an overproduction of thyroid hormones) (enchant: ?page, (text-colour: black) + (background: white))