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General Surgery > Breast & Thyroid > Flashcards

Breast & Thyroid Flashcards

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

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

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
Q

Mention mammographic signs of malignancy

A
  1. Clustered microcalcifications: in ductal
  2. Star shaped mass
  3. Distorted contour
  4. Inc skin thickness
26
Q

Mention role of US in BC

A

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
Q

List criteria of malignant cyst

A

Irregular wall, hemorrhagic fluid, rapid refilling, residual mass after aspiration, malignant cells in aspirate. If solid FNABC

28
Q

List indications of MRI in BC

A

Gold standard w/ breast prosthesis
Differentiate fibrous sacrring from recurrence following surgery
Monitor response of neoadjuvant therapy

29
Q

List CI of BCS

A
  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
Q

List indications of radiotherapy in BC ttt

A
  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
Q

Mention complications of BC tted by radiotherapy

A

Bone pain, cerebral mets, SVC obstruction

32
Q

List inv of mammary duct ectasia

A

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
Q

TTT of breast sarcoma

A

Palliative simple mastectomy + radiotherapy

34
Q

List causes of diffuse goiter

A
  1. Physiological
  2. Endemic
  3. Sporadic
  4. Drug-induced: antithyroid drugs, lithium, aminoglutethimide
  5. Dyshormogenesis
35
Q

Mention indications of surgery in nodular goiter

A
  1. Large goiters or those causing disfigurment
  2. Retrosternal extension
  3. Development of complications
36
Q

What is preoperative assessment if thyroidectomy

A
  1. Laryngoscopy to demonstrate vocal cord function, medico-legal importance
  2. Thyroid function should be normalized
37
Q

List complications of thyroidectomy

A
  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
Q

List complications of SNG

A
  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
Q

TTT of toxic nodule

A
  1. Radioactive iodine if age more than 45
  2. Hemithyroidectomy in younger pts
40
Q

Describe ttt of thyrotoxic crisis

A
  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
Q

Mention indications of each line of ttt in Graves disease

A
  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
Q

Mention disadv of irradiation of thyroid

A
  1. Overdose: thyroid insuffieciency
  2. MC comp of RAI is myxedema
  3. Low dose: recurrence
  4. Teratogenici
  5. . Carcinogenicity
43
Q

Mention CI of thiourea group

A

Toxic nodular goiter & RSG

44
Q

Mention a special sign in RSG

A

+ve Pemberton sign pt elevates arm above level of head—> facial plethora due to venous congestion

45
Q

Mention inv for RSG

A
  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
Q

Describe ttt of RSG

A
  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
Q

List DD of dysphagia w/ thyroid

A
  1. RSG
  2. Riedle’s thyroiditis
  3. Malignancy
  4. Myopathy of striated muscle of esophagus
48
Q

Mention DD of shadow in the superior mediastinum

A
  1. RSG
  2. Thymoma
  3. Lymphoma
  4. Aortic aneurysm
  5. LN enlargement
49
Q

Describe ttt of Hashimoto

A

L-thyroxin + cortisone
Surgery: thyroidectomy, indications: larger goiter w/ rapid inc in size. Suspicion of malignancy: pain, ulceration, LN++

50
Q

Describe CP of riedle’s

A

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
Q

Inv of choice for benign follicular adenoma vs carcinoma

A

Hemithyroidectomy & paraffin section

52
Q

Describe spread of follicular carcinoma

A

Mainly blood to skull: solitary, painful, osteolytic, pulsating

53
Q

List PDFs for papillary & follicular carcinoma

A

P: external irradiation of the neck in childhood, papillary adenoma, genetic factors Godwin $, ret/PTC3 oncogene
F: SNG & follicular adenoma

54
Q

TTT of anaplastic carcinoma

A

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
Q

The highly radiosensitive thyroid tumor is….

A

Thyroid lymphoma

56
Q

List complications of thyroid malignancies

A
  1. Spread
  2. Other:
    A. General: cachexia & mets
    B. Local: infiltration of RLN, sympathetic chain, trachea, esophagus
57
Q

List causes of post-thyroidectomy stridor

A

Due to:
1. Bilateral RLN injury
2. Laryngeal edema & tracheal collapse
3. Deep neck hematoma

General Surgery (5 decks)

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