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Surgery Revision > Breast and Endocrine > Flashcards

Breast and Endocrine Flashcards

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1
Q

What does ANDI stand for?

A

Abnormalities of normal development and involution

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2
Q

4 reproductive phases of a woman’s life

A
  • development
  • cyclical change
  • pregnancy
  • involution
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3
Q

Benign breast issues by age

A

15-30: fibroadenoma
20s + 30s: mastalgia and lumpiness
30s + 40s: cystic changes
65+: cancer

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4
Q

Object of aspirating a breast cyst

A
  • excluding a solid lesion

- relieve pain

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5
Q

Worrying features after cyst aspiration

A
  • blood stained fluid
  • residual mass

(no cytology needed unless blood stained)

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6
Q

Definition of mastalgia

A

Any pain (tenderness, fullness, aching) felt in the breast

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7
Q

2 types of mastalgia

A
  • cyclical bilateral

- non-cyclical focal

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8
Q

Possible anti-oestrogen meds for severe cases of mastalgia

A
  • danazol 100mg
  • tamoxifen 10mg

for 3 months

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9
Q

Treatment of post partum breast infection

A

Flucloxacillin or erythromycin

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10
Q

Clinical features of periductal mastitis

A
  • retro and peri-areolar inflammation
  • oedema
  • nipple retraction
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11
Q

Treatment of periductal mastitis

A
  • co-amoxiclav for 2 weeks
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12
Q

What are fibroadenomas?

A

NOT NEOPLASMS

- fibrous overgrowths of a single lobule

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13
Q

What are giant fibroadenomas?

A

> 5cm

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14
Q

Clinical features of fibroadenomas

A
  • painless
  • well defined
  • very mobile
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15
Q

How does treatment of fibroadenoma change with age?

A
  • over 25, need triple testing

- over 35, need histological diagnosis

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16
Q

What is triple testing?

A
  • clinical exam
  • cytology
  • mammogram/US
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17
Q

Susupicious features of a nipple discharge

A
  • spontaneous
  • single duct
  • blood stained
  • unilateral
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18
Q

What to do if a nipple discharge is suspect

A
  • microdocotomy
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19
Q

Causes of gynaecomastia

A

Physiological

  • neonatal
  • puberty
  • old age

Drugs

  • oestrogen
  • digoxin
  • steroids

Liver failure

Rare tumours (testes, adrenal)

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20
Q

Risk factors for breast cancer

A
  • female
  • advancing age
  • family history
  • irradiation
  • BRCA1/2
  • wide ostrogen window
  • few/no children
  • late birth of first child
  • HRT
  • OCP
  • smoking
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21
Q

Symptoms of breast cancer

A
  • painless lump
  • change in appearance
  • nipple discharge
  • Paget’s
  • extramammary mets
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22
Q

Signs of breast cancer

A
  • mammographic lesion
  • nipple discharge
  • thickened area/ shelving mass
  • overlying skin dimpling/ ulceration
  • nipple retraction
  • visible mass
  • fixity to underlying msucle
  • skin oedema
  • palpable axillary nodes
  • supraclavicular glands
  • symptomatic mets
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23
Q

Features of breast malignancy on mammogram

A
  • microcalcifications
  • density with surrounding spiculation
  • distortion of breast architecture
  • tethering
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24
Q

Indications for mammography in patients with proven cancer

A
  • to exclude multi-centric/contralat disease
  • to exclude DCIS
  • follow up
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25
Indications for mammography in patients with clinical problems
- discrete mass in women >30 - vague thickening in women <30 - single nipple discharge - focal mastalgia - unexplained nipple retraction
26
3 categories of primary breast cancers
- non-invasive epithelial cancers (carcinoma in situ) - invasive epithelial cancers - mixed connective and epithelial
27
Most common breast cancer
Infiltrating ductal carcinoma
28
Met screen in breast cancer
All patients: - CSR - LFTs If LFTs abnormal - liver US If >T3 - bone scan
29
Hormone modifying drugs used in breast cancer
- tamoxifen | - Herceptin
30
Therapy option in breast cancer
- surgery - radiotherapy - chemotherapy - endocrine manipulation - biological treatment
31
Surgical options for breast surgery
- total mastectomy | - wide local excision
32
Patients suitable for a WLE
- tumour size <5cm, single lesion - large breast (only 10% should be removed) - outer quadrants - no family history - no multifocal disease - willing to receive 6 weeks of adjuvant radiotherapy
33
Options for axillary lymph node surgery
- axillary nodal clearance | - sentinel lymph node biopsy
34
Patients suitable for sentinel lymph node biopsy
- T1/2 - no palpable lymph nodes - no prior axillary surgery, irradiation or chemo
35
How is sentinel node biopsy done?
- want to remove first draining node - technetium injected around the tumour 24 hours prior - detected with gamma rays - node is detected and sent for frozen section
36
Endocrine manipulation options for pre-menopausal women
- tamoxifen (ER receptor competitor) - LHRH agonist (Zoladex) - progesterones - oopherectomy (rare)
37
Endocrine manipulation options for post-menopausal women
- aromatase inhibitors - tamoxifen - pregesterones
38
What is a biological modifiers used in breast cancer?
Trastuzumab | - for Her-2-neu positive patients
39
What is Pagets?
Intraductal carcinoma which invades the skin - mimics eczema - always involves the nipple and then moves to areola - diagnose with punch biopsy
40
What is inflammatory breast cancer?
- locally advanced carcinoma which mimics cellulitis/ abscess - red, hot, with rapid course - dermal lymphatic invasion - needs aggressive neoadjuvant chemo
41
Causes of a goitre
- multinodular - physiological - throiditis - thyroid carcinoma
42
Causes of a solitary nodule
- hyperplastic/adenomatous nodule - simple cyst - follicular adenoma - thryoid carcinoma
43
Bethesda classification
``` 1 = non- diagnostic 2 = benign 3 = indeterminate 4 = suspicious for follicular neoplasm 5 = suspicious for malignancy 6 = malignant ```
44
Modes of investigation for nodular thyromegaly
- US - apiration cytology - radio-isotope scanning - CT scan
45
US features of thyroid malignancy
- hypoechogenic - increased vascularity - local lymphadenopathy - microcalcification
46
Tumour marker for thyroid medullary carcinoma
- calcitonin
47
Features of a malignant thyroid mass
- asymmetrical goiter/ solitary nodule in children/men - rapid onset - progressive increase in size - pain - local invasion - lymphadenopathy - hoarseness
48
Types of thyroid carcinoma
- well differentiated - medullary - anaplastic - lymphoma
49
Types of well-differentiated thyroid carcinoma
- papillary - follicular - mixed
50
How does papillary thyroid carcinoma spread?
Lymph node spread
51
How does follicular thyroid carcinoma spread?
Haematogenous
52
Components of MEN2 syndrome
- Medullary thyroid carcinoma - phaeochromocytoma - hyperparathyroidism - neurofibromatosis
53
Common causes of thyrotoxicosis
- Graves disease - Toxic multinodular goitre (Plummers) - Toxic solitary nodule (toxic adenoma)
54
Rare causes of thyrotoxocosis
- Excess TSH (pituitary) - Excess T4 (iatrogenic) - Excess iodine (Jod Basedow) - transient during thyroiditis
55
Options for the management of thyrotoxicosis
- Neomercazole - Propanolol - I131 - surgery
56
Complications of thyroid surgery
Structural - laryngeal nerve damage - laryngeal oedema - haemorrhage - thracheomalacia Endocrine - hypoparathyroidism - hypothyroidism - thyroid crisis
57
Function of the parathyroid glands
To maintain the body's calcium and phosphate levels within a very narrow range so that the muscles and nerves can function properly
58
Hormones that control calcium
PTH increases | Calcitonin decreases
59
Causes of hypercalcaemia
- disorders of the parathyroid glands - malignancy - vit D disorders - high bone turn over - renal disorders
60
Clinical presentation of hypercalcaemia due to hyperparathyroidism
- recurrent renal calculi - progressive bone density loss - pathological fractures - ill-defined musculo-skeletal complaints - neurocognitive impairment - unexplained abdo pain (bones, stones, moans and groans)
61
How does a hypercalcaemic crisis present?
- rapidly rising calcium levels - polyuria - dehyrdration - confusion, coma, death
62
Diagnosis of | primary hyperparathyroidism
- elevated serum calcium - elevated parathyroid hormone - sestaMIBI scan - US
63
Cause of secondary hyperparathyroidism
- chronic renal failure - GIT malabsorption states Phosphate retention and calcium deficiency stimulate glands to secrete PTH Chronically depletes bone calcium stores
64
Diagnosis of secondary hyperparathyroidism
Normal serum calcium levels | High levels of PTH
65
Cause of tertiary hyperparathyroidism
Successful renal transplant with ongoing hypercalcaemia
66
Features suggestive of Zollinger-Ellison Syndrome
- recurrent ulcer - refractory ulcer - multiple ulcers - ulcers in unusual sites - ulcer and diarrhoea - ulcer and MEN syndrome
67
Suggestive features of insulinoma
- hypoglycaemia - neuroglycopenia - catecholamine release (sweating, palpitations)
68
Other name of MEN1
Wermer's Syndrome - pituitary - pancreas - hyperparathyroidism
69
Other name of MEN 2a
Sipple syndrome - medullary thyroid cancer - phaeochromocytoma - hyperparathyroidism
70
Other name of MEN2b
mucosal neuroma syndrome - medullary thyroid cancer - phaeochromocytoma - marganoid habitus - mucosal neuromas
71
Causes of Cushing's syndrome
- steroids - pituitary - ectopic ACTH - adrenal (Adenoma/carcinoma)
72
Clinical features of Cushing's syndrome
- central obesity - weakness, proximal myopathy - hypertension - skin changes - psych changes - amenorrhoea/impotence - osteoporosis - thirst/ polyuria - glucose intol
73
What are phaechromocytomas?
Tumours of the adrenal medulla | - produce adrenalin and noradrenaline
74
Syndromes that phaeochromocytoma is associated with
- MEN2 - neurofibromatosis - Von Hippel-Lindau syndrome
75
Test for phaeochromocytoma
Urinary catecholamine
76
Features of phaeochromocytoma
- hypertension in the young - rapidly progressive hypertension - poorly controlled hypertension - paroxysmal attacks
77
Treatment of phaeochromocytoma
- alpha blockade with phenoxybenzamine or prazocin | - removal of the tumour
78
What is Conn's syndrome
An aldosterone secreting adenoma of the adrenal cortex
79
When to suspect Conn's syndrome
- hypertension | - weakness (from hypokalaemia)
80
Investigation of Conn's syndrome
- hypokalaemia and excessive urinary potassium secretion - excessive aldosterone secretion (blood and urine levels) - depressed renin levels - localization of the adenoma by CT scanning
81
Surgically correctable hypertension
- coarctation of the aorta - renovascular hypertension - phaeochromocytoma - Conn's syndrome - Cushing's syndrome
82
What is adrenogenital syndrome
Increase in pituitary ACTH production - adrenocortical hyperplasia - inappropriate adrenal androgen secretion
83
What is Addison's disease
Desctruction of the adrenal gland by: - TB - autoimmune adrenalitis - metastatic disease - mineralocorticoid and glucocorticoid insufficiency
84
Symptoms of Addison's disease
- fatigue - weight loss - anorexia - nausea and vomiting - abdo pain - diarrhoea
85
Management of Addison's disease
- immediate administration of 4mg dexamethasone

Surgery Revision (8 decks)

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