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SURGERY > Head, Neck, Thyroid, Parathyroid, Breast > Flashcards

Head, Neck, Thyroid, Parathyroid, Breast Flashcards

1
Q

Painless, mandibular mass commonly assoc w/ impacted tooth

Xray: multilocular radioluscent appearance, “soap bubble”

Dx:
Tx:

A

Ameloblastoma (Adamantinoma)

Tx: resection with 1-2cm margin

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2
Q

Radical neck dissection vs Modified radical neck dissection

A

Both: Removes levels I-V cervical lymphatics

RND: removes spinal accessory n, IJV, SCM

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3
Q

Auriculotemporal nerve damage resulting to post gustatory sweatinf

A

Frey Syndrome

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4
Q

Most common malignant salivary gland tumor

A

Mucoepidermoid CA

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5
Q

Injury results to difficulty hitting high notes and voice fatigue

A

External branch of superior laryngeal n.

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6
Q

Serum calcitonin is sensitive to what type of thyroid cancer?

A

Medullary thyroid CA

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7
Q

Most common benign epithelial salivary gland tumor

A

Pleomorphic adenoma

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8
Q

Indications of anti-thyroid drugs as tx for Grave Dse

A

Small goiters (<40g)
Mildly elevated thyroid hormones
Rapid inc in gland size

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9
Q

Painless, hard, woody anterior neck mass that progress to compressive sx in weeks

Dx?
Diagnostic?
Tx?

A

Reidel thyroiditis (invasive fibrous thyroiditis)

Open thyroid biopsy

Wedge excision of thyroid isthmus
L-thyroxine
Steroids

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10
Q

Criteria for optimum FNAB cytology

A

Atleast 6 follicles each containing at least 10-15 cells from at least 2 aspirates

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11
Q

Orphan Annie nuclei - large nuclei cleared out in the center

A

Papillary CA

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12
Q

Malignant thyroid diseases cannot be diagnosed by FNAB

A

Follicular Carcinoma

Hurthle Cell Carcinoma

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13
Q

Most common malignancy that metastasize to the thyroid

A

Renal cell CA

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14
Q

Pentad of Primary hyperparathyroidism

A 
Kidney stones
Painful bones
Abdminal groans
Pyschic moans
Fatigue overtones
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15
Q

Tx for parathyroid
…Adenoma
…Hyperplasia
…CA

A

Adenoma: Resection of involved gland
Hyperplasia: 3 1/2 parathyroidectomy or total parathyroidectomy + autotransplantation

CA: en bloc resection + ipsilateral thyroid lobe

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16
Q

Indication for surgery for thyroid cysts?

What surgery?

A

> 3 aspiration attempts
Cysts > 4 cm
Complex cysts

Unilateral Lobectomy

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17
Q

Indication for surgery for thyroid colloid adenoma?

What surgery?

A

Size > 3 cm

Lobectomy plus Isthmusectomy

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18
Q

Poor prognostic factors for Papillary Thyroid Ca

A 
Age: <15, >45 (most impt)
Male, Metastasis
Extrathyroidal extension
Size > 4 cm
Good radioiodine concentration
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19
Q

Sites of breast CA mets (in order of frequency)

A 
Bone
Lung
Pleura
Soft tissue
Liver
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20
Q

Tumor marker for post operative surveillance in Differentiated Thyroid Malignancies?
Normal level?
Frequency?

A

Thyroglobulin
<2 ng/ml if taking LT
<5 ng/ml if hypothyroid
Taken at 6 mos then annually

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21
Q

Thyroid malignancy that may occur sporadically or part of multiple endocrine neoplasia syndromes

A

MTC

22
Q

Surgical management of Papillary Thyroid Ca

A 
High risk/bilateral: TT/NTT
Minimal papillary (<1 cm): Lobectomy + Isthmusectomy
23
Q

Surgical Management of Follicular Ca

A

Adenoma: Lobectomy + Isthmu
Carcinoma: TT/NTT
Old, >4 cm: TT/NTT

24
Q

Surgical Management of Hurthle Cell Ca

A

Adenoma: Lobectomy plus Isthmusectomy
Carcinoma: TT/NTT + routine central LND

25
Q

Surgical Management of MTC

A

TT + Bilateral central LND
>1 cm: plus prophylactic MRND
LN(+): staged bilateral MRND

26
Q

Prophylactic Thyroidectomy recommendations for ret mutation carriers

A

MEN2A: TT before age 6
MEN2B: TT before age 1
If calcitonin (-): no Central LND

27
Q

Postoperative follow up for MTC

A

Annual Calcitonin and CEA

28
Q

Rank MTC variants accdg to prognosis

A

Non MEN familial MTC
MEN 2A
Sporadic MTC
MEN 2B

29
Q

Appearance of Anaplastic Carcinoma on FNAB

A

Giant Multinucleated Cells

30
Q

Acute pain at the lateral aspect of the breast with tender, firm cord following the distribution of the veins

Dx?
Tx?

A

Mondor Dse

Supportive- warm compress
Anti-inflammatory meds
Restriction of motion
Brassiere support
Sx- excision of the involved vein segment
31
Q

Age to start baseline mammogram
Low risk
High risk

A

Low risk- 35 yo

High risk- 25 yo

32
Q

Chromosome involved in

BRCA 1
BRCA 2

A

BRCA 1- chr 17

BRCA 2- chr 13

BRCA 2 mutations are associated with well differentiated tumors that express hormone receptors. Hence, better prognosis

33
Q

Regarded as a true anatomic precursor of invasive breast CA

A

DCIS

34
Q

Chronic, eczematous eruption of the nipple with histologic finding of large, pale, vacuolated cells in the rete pegs of epithelium

(+) CEA

A

Paget disease of the breast

35
Q

Peri/post menopausal with a solitary, firm mass, poorly defined margins, central stellate configuration with chalky-white or yellow streaks

Dx?

A

Invasive ductal breast CA

36
Q

BRCA1 (+)
Soft, hemorrhagic and bulky mass

Histo: dense lmyphoreticular infiltrate of lymphocytes and plasma cells
Large pleomorphic nuclei that are poorly differentiated sheet-like growth pattern

A

Medullary breast CA

37
Q

70s/F with small breast mass

Histo: papillae with fibrovascular stalks

A

Papillary breast CA

38
Q

Multifocal, multicentric, bilateral breast mass

  1. Small cells arranged in single file orientation -
  2. Intracytoplasmic mucin that may displace that nucleus -

Dx?

A
  1. Indian file configuration
  2. Signet ring cell CA

DX: Invasive lobular breast CA

39
Q

BIRADS Category Assessment with recommendation

A

0-incomplete- additional imaging
1-negative-routine screening
2-benign-routine screening
3-probably benign-follow up after 6 mos
4a-low suspicion for malignancy-biopsy
4b-intermediate risk for malignancy-biopsy
4c-moderate risk for malignancy-biopsy
5-highly suggestive of malignancy-appropriate action
6-biopsy proven malignancy-assure tx is completed

40
Q

Breast

Diagnostic technique of choice for patients who will receive systemic therapy

A

Core needle biopsy

41
Q

Absolute contraindications to Breast Conserving Surgery

A 
Prior RT
Pregnant (1st-2nd trimester)
Persistently positive margins
Multicentric lesions
Diffuse microcalcifications
CT d/o (scleroderma)
42
Q

Structures removed in radical neck dissection

A

Levels I-V cervical lymphatics
Spinal accessory n.
IJV
SCM ms.

43
Q

Most frequent metastatic site of breast Ca

A

Bones (vertebral column via Batson’s plexus)

44
Q

T1, N3, M0
Stage?
Tx?

A

Stage IIIC

Neoadjuvant chemo plus
BCS or MRM plus
Adjuvant Chemo RT
Antiestrogen Tx if ER+

45
Q

What is N3 status for Breast Ca?

A

Ipsilateral axillary AND internal thoracic lymph node, or
Supraclavicular node, or
Infraclavicular node

46
Q

N2 status for breast Ca?

A

Ipsilateral axillary node, fixed or matted, or

Internal Thoracic lymph node

47
Q

T2 status for Breast Ca?

A

Tumor size >2 cm but <5 cm

48
Q

Management of inflammatory breast Ca?

A 
Treat as Stage IIIB
Neoadjuvant chemo
MRM
Adjuvant Chemo RT
Hormone Tx
49
Q

Screening Mammography for Average Risk Women

A

Baseline mammogram at age 35
Annual starting at age 40

For high risk:
10y earlier
Biannual

50
Q

What breast cancer stages may be offered BCS?

A

Stage I, IIA and IIB

SURGERY (8 decks)

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