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Breast & Thyroid Flashcards

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1
Q

List manifestations of Poland $

A

It is athelia or amastia associated with absence of the sternal portion of pectoralis major, absence of ribs 2-5, deformities of hand or vertebrae

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2
Q

Inv & ttt of traumatic fat necrosis

A

Fine or true cut needle biopsy shows the ccc foamy fat laden macrophages. Mammography gives similar features to cancer
Ttt: excision

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3
Q

MC type of mastitis is….., its causative org is….

A

Acute lactational mastitis
Staph

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4
Q

Describe surgical management of breast abscess (acute/chronic)

A

Acute: GA, radial incision, +counterincision if non-dependent area, destroy loculi by finger, Abx & dressing, remove drain when drainage stops. If non-lactating breast, Multiple biopsies should be taken from wall to exclude inflammatory carcinoma
If chronic abscess: incision

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5
Q

Retromammary abscess may be caused by…..

A

Infected hematoma, rib osteomyelitis, empyema necessitans

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6
Q

MC breast disorder is…., ccc cyst of this disease is….

A

Fibroadenosis
Blue-domed cyst of Bloodgood

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7
Q

Describe CP of fibroadenosis

A
  1. Asymptomatic
  2. Pain; PMT, dull aching pain, cyclic (premenstrual) & non-cyclic (perimenopausal) mastalgia. If postmenopausal cancer should be suspected
  3. Lump mc in upper outer quadrant, painful, firm, diffuse felt by tip of finger
  4. Discharge: clear, yellow, usually bilateral, greenish if retention cyst
  5. LNs: enlarged elastic tender mobile
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8
Q

Mention complications of fibroadenosis

A
  1. Inc risk of bc esp in atypical epithelial hyperplasia
  2. Infection & hge of cyst of bloodgood
  3. Anxiety
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9
Q

Mention inv in cases of fibroadenosis or fibroadenoma

A
  1. Mammography: breast is dense & nodular
  2. US: cysts can by detected
  3. Aspiration cytology of cyst guided by sonography
  4. True cut needle biopsy in solid doubtful masses
  5. Open biopsy if not conclusive
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10
Q

Describe ttt of LCIS

A

Strict follow-up: self-exam every 5th day postmenstrual, exam every 6 months, mammography every 2 yrs by oblique lateral view.
Prophylactic tamoxifen
In +ve family Hx: MRM + reconstructive surgery

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11
Q

MC cause of bleeding per nipple is….

A

Ductal papilloma

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12
Q

List inv & ttt of duct papilloma

A

For discharge: benzidine test, for papilloma: galactography & US, for breast: mammogram
Ttt by micro-dochectomy & histopathology as 10% precancerous

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13
Q

MC cause of breast mass in young females

A

Fibroadenoma

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14
Q

List inv of gynecomastia

A
  1. Blood tests according to suspected cause: thyroid, estrogen, testosterone, LFT & KFT
  2. Mammogram of bc is suspected
  3. Chest, abdomen & pelvis CT & X-ray if tumor is suspected
  4. Testicular US if testicular tumor suspected
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15
Q

Mention complications of large breast weight

A
  1. Breast pain; more w/menses
  2. Bach-ache & lower neck pain ass w/ hypertrophic arthritis of cervical vertebrae
  3. Lordosis & compensatory kyphosis
  4. Grooving & irritation of shoulders from bra strap pressure
  5. Sub-mammary intertrigo
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16
Q

List the major risk factors of breast cancer

A

Age, sex, genetic factors (BRCA 1&2), nulliparity, breast feeding (dec), first live birth (younger age less risk), past history of BC, family Hx, Hx of other cancer (ovarian/endometrial), benign breast disease (multiple papillomatosis)

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17
Q

Mention intermediate & minor RF of BC

A

Int: obesity, age of menarche & menopause, hyperplasia w/ severe atypia, irradiation
Minor: high social class, western diet, estrogen exposure in OCP & HRT, high intake of alcohol

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18
Q

MC type of BC is…

A

Invasive ductal carcinoma NOS

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19
Q

In case of acute lactational mastitis, if there is no Abx response within 1 wk, what to do next & why?

A

Biopsy for fear of mastitis carcinomatosis

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20
Q

Encephaloid carcinoma is ccc by….

A

Prominent lymphocytic reaction (good prognostic factor)

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21
Q

The type of BC that tends to metastasize to unusual sites is…..

A

Signet ring carcinoma

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22
Q

Describe the Manchester system for classification

A

Stage 1: confined to breast skin involvement in direct continuity w/tumor not exceeding its size
Stage 2: as 1, but w/ involvement of LNs from one group ipsilateral
Stage 3: as 2 but w/ one of the following:
1. Skin invaded larger area than tumor size
2. Ipsilateral LNs affection more than one
3. Tumor fixed to underlying fascia or muscle
Stage 4: tumor of any size with one or more of following features:
1. Marked skin involvement
2. Fixed ipsilateral axillary LNs
3. Ipsilateral supraclvaicular LNs
4. Tumor fixed to chest wall
5. 2ry deposits in other breasts or contralateral axilla
6. Evidence of distant metastasis

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23
Q

List skin signs of breast cancer on inspection & classify them according to cause

Study These Flashcards
A

1.Infiltration of cooper’s ligament: tethering, dimpling, puckering
2. Lymphedema: peau d’orange (obstruction of dermal lymphatics), brawny edema (arm swelling due to axillary infiltrates)
3. Skin changes due to retrograde lymphatic spread: skin nodules, skin ulceration, cancer en cuirrasse.

24
Q

List indications of mammography

Study These Flashcards
A
  1. Screening in high risk groups
  2. Evaluation of sound breast
  3. Detect impalpable BC
  4. Useful in detecting bilateral or multifocal lesions, & in detecting early cases of non-invasive lesions in screening programs
25
Mention mammographic signs of malignancy
1. Clustered microcalcifications: in ductal 2. Star shaped mass 3. Distorted contour 4. Inc skin thickness
26
Mention role of US in BC
1.Detect impalpable breast lumps 2.Can differentiate cystic from solid swelling & do aspiration if cystic 3.Exam of dense breasts in young age group 4. Can’t detect microcalcifications 5. Basis of BIRADS classification
27
List criteria of malignant cyst
Irregular wall, hemorrhagic fluid, rapid refilling, residual mass after aspiration, malignant cells in aspirate. If solid FNABC
28
List indications of MRI in BC
Gold standard w/ breast prosthesis Differentiate fibrous sacrring from recurrence following surgery Monitor response of neoadjuvant therapy
29
List CI of BCS
1. Tumor larger than 4 cm 2. Extensive LN involvement (more than N1) 3. Distant mets 4. Centrally located retro-areolar tumors 5. Tumor invading underlying muscle 6. Poor diffierentiation high histologic grade (III) 7. Multicenricity 8. Pregnancy 9. Collagen vascular diseases
30
List indications of radiotherapy in BC ttt
1. To chest wall after mastectomy if extensive local disease 2. To remaining breast tissue in case of BCS 3. To supraclavicular & internak mammary LNs in medial quadrant & central tumors 4. Whole axillary irradiation if axillary clearance (1&2) was not complete& in case of +ve LN mets 5. Whole axillary irradiation in case of bad pathological nodal features as capsular invasion or more than 3 LNs involved 6. Irradiation of level 1 LNs in case of free sentinel LN
31
Mention complications of BC tted by radiotherapy
Bone pain, cerebral mets, SVC obstruction
32
List inv of mammary duct ectasia
If presented w/ subareolar mass: triple assessment, mammography shows coarse calcifications, US shows dilated ducts, cytological exam shows inflammatory cells, biopsy to exclude cancer If presented w/ nipple discharge, benzidine test + cytology
33
TTT of breast sarcoma
Palliative simple mastectomy + radiotherapy
34
List causes of diffuse goiter
1. Physiological 2. Endemic 3. Sporadic 4. Drug-induced: antithyroid drugs, lithium, aminoglutethimide 5. Dyshormogenesis
35
Mention indications of surgery in nodular goiter
1. Large goiters or those causing disfigurment 2. Retrosternal extension 3. Development of complications
36
What is preoperative assessment if thyroidectomy
1. Laryngoscopy to demonstrate vocal cord function, medico-legal importance 2. Thyroid function should be normalized
37
List complications of thyroidectomy
1. Hge: 1ry or reactionary 2. Nerve injury: a. RLN: if bilateral actual injury (not neuralraxia) pt requires surgery to widen slit between vocal cords OR permenant tracheostomy. If unilateral, causes difficulty in breathing, hoarseness of voice impaired cough b. ELN: loss of high pitched voice, choking due to loss of sensation of laryngeal mucosa above vocal cords 3. Functional complications: hypoparathyroidism, hypothyroidism, recurrence, thyrotoxoc crisis 4. Others as tracheal or esophageal injury
38
List complications of SNG
1. 2ry thyrotoxicosis 2. Malignancy: follicular type 3. Hge: ttt:urgent aspiration & subtotal thyroidectomy 4. Pressure symptoms on trachea 5. Retrosternal extension 6. Infection
39
TTT of toxic nodule
1. Radioactive iodine if age more than 45 2. Hemithyroidectomy in younger pts
40
Describe ttt of thyrotoxic crisis
1. Ice bath & fanning + antipyretics (not aspirin) 2. IV inderal drip to achieve beta blockade 3. IV hydrocortisone 4. IV K iodide 5. Antithyroid drugs 6. Supportive ttt as O2, morphia, IV fluids
41
Mention indications of each line of ttt in Graves disease
1. Medical: 1ry thyrotoxicosis (>45), recurrence after surgery, refusal of surgery, small gland 2. Surgery: young pts, failure of medical ttt when radioiodine is unsuitable, retrosternal or huge goiters bec size is likely to inc with antithyroid drugs 3. Irradiation: pts more than 45, failed medical ttt, RAI could be used for recurrence after subtotal thyroidectomy
42
Mention disadv of irradiation of thyroid
1. Overdose: thyroid insuffieciency 2. MC comp of RAI is myxedema 3. Low dose: recurrence 4. Teratogenici 5. . Carcinogenicity
43
Mention CI of thiourea group
Toxic nodular goiter & RSG
44
Mention a special sign in RSG
+ve Pemberton sign pt elevates arm above level of head—> facial plethora due to venous congestion
45
Mention inv for RSG
1. CT scan: investigation of choice 2. Isotope scan: to differentiate from tumor 3. Plain X-ray or neck US: shadow in sup mediastinum or calcification 4. Flow volume loop pulmonary function test
46
Describe ttt of RSG
1. Surgery is always indicated, cervical approach is usually sufficient (if congenital from chest) 2. If toxic: subtotal thyroidectomy after preparation with inderal only 3. Avoid injury of RLN, fragmentation if malignancy is suspected
47
List DD of dysphagia w/ thyroid
1. RSG 2. Riedle’s thyroiditis 3. Malignancy 4. Myopathy of striated muscle of esophagus
48
Mention DD of shadow in the superior mediastinum
1. RSG 2. Thymoma 3. Lymphoma 4. Aortic aneurysm 5. LN enlargement
49
Describe ttt of Hashimoto
L-thyroxin + cortisone Surgery: thyroidectomy, indications: larger goiter w/ rapid inc in size. Suspicion of malignancy: pain, ulceration, LN++
50
Describe CP of riedle’s
CP: simulates cancer, hard nodule, asymmetrical enlargement, fixed, adherent & sticky to skin producing pressure manifestations. May be associated w:p/ retroperitoneal fibrosis, mediastinal fibrosis, hypothyroidism DD: anaplastic carcinoma by FNABC or open biopsy TTT: LAHEY operation isthmusectomy to relieve pressure
51
Inv of choice for benign follicular adenoma vs carcinoma
Hemithyroidectomy & paraffin section
52
Describe spread of follicular carcinoma
Mainly blood to skull: solitary, painful, osteolytic, pulsating
53
List PDFs for papillary & follicular carcinoma
P: external irradiation of the neck in childhood, papillary adenoma, genetic factors Godwin $, ret/PTC3 oncogene F: SNG & follicular adenoma
54
TTT of anaplastic carcinoma
Debulking or isthmusectomy to relieve compression of the trachea. Tracheal stenting also be done to relieve tracheal obstruction while avoiding surgery. Thyroidectomy is almost never possible. No radio iodine uptake, radiotherapy or chemo response.
55
The highly radiosensitive thyroid tumor is….
Thyroid lymphoma
56
List complications of thyroid malignancies
1. Spread 2. Other: A. General: cachexia & mets B. Local: infiltration of RLN, sympathetic chain, trachea, esophagus
57
List causes of post-thyroidectomy stridor
Due to: 1. Bilateral RLN injury 2. Laryngeal edema & tracheal collapse 3. Deep neck hematoma

General Surgery (5 decks)

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