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Case of Abnormal mammogram Flashcards

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1
Q

national breast screening service

A

every 3 years between 50-70 registered as female

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2
Q

images are read by?

A

2 readers

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3
Q

outcome of mammogram?

A

routine recall, technical recall ( blurry), clinical recall female waited until appointement despite mammogram being normal, abnormal mammogram

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4
Q

xrays of breast?

A

4 standard views
craniocaudal view
mediolateral oblique

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5
Q

what biopsy do you take imaging for microcalcification?

A

stereotactic biopsy

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6
Q

ductal cell in situ is?

A

malignant proliferation of epithelial cell in terminal duct lobular unit without invasion of basement membrane

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7
Q

grading by surgery p, imaging m/u, pathology b?

A
  1. normal
  2. benign
  3. indeterminate/ likely benign small
  4. suspicious of malignancy
  5. malignant
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7
Q

grading by surgery p, imaging m/u, pathology b?

A
  1. normal
  2. benign
  3. indeterminate/ likely benign small
  4. suspicious of malignancy
  5. malignant
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8
Q

if you are less than 40 you dont get?

A

mammogram only ultrasound

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9
Q

if benign would you biopsy?

A

if over 30 just in case

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10
Q

which 2 conditions can present the same?

A

abscess, inflammatory breast cancer

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11
Q

symptomatic referral through GP would be?

A

2 week wait

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12
Q

breast biopsy diagnosis

A

b5a- intraepithelial neoplasia- excision but no sentinel lymph node biopsy necessary
b5b- invasive neoplasm - excise and sentinel lymph node biopsy always necessary

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13
Q

neoplastic proliferation will lose?

A

basal cells

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14
Q

fibroadenoma is

A

stromal proliferation

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15
Q

orientating wide local excision

A

blue- anterior
2 long- lateral
2 short- superior

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16
Q

Where does calcification happen?

A

necrosis areas

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17
Q

grading of tumour?

A

presence of ducts
cytonuclear pleomorphism
mitotic count

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18
Q

ductal neoplasia retains?

A

e-cadherin- cell adhesion molecule
whereas lobular neoplasia loses e-cadherin, single cells

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19
Q

lobular neoplasia is usually?

A

bilateral, multifocal- spreads everywhere

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20
Q

her2 expression?

A

to see if herceptin can be treatment if 3 plus
if 2 plus equivocal then requires further testing FISH

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21
Q

if equivocal then what do you perform?

A

in situ hybridization

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22
Q

which classification is associated with BRCA mutations?

A

ER , PR and hER2 negative basal-like

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23
Q

luminal A or B subtypes are?

A

60%- ER/PR positive HER2 variable

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24
HER2/ neu rich subtype?
15% ER/PR negative, HER2/neu positive
25
sentinel lymph node?
first lymph node that drains the breast, if negative for metastases in an invasive tumour then reassure other lymph node after will be ok
26
sentinel lymph node involved by metastasis?
axillary dissection
27
case defintion?
criterion/ set for criteria for the determination of whether someone has the disease
28
case identification?
the operationalisation of the case definition how we identify who is/ not a case
29
sensitivity of breast cancer?
proportion of women who correctly test positive
30
specificity of breast screening?
proportion of women without breast cancer who correctly test negative
31
positive predictive value?
likelihood patient with positive test result actually has the disease
32
negative predictive value?
likelihood patient with negative test result does not have the disease
33
as prevalence increase?
PPV will increase and NPV will decrease
34
case control study?
groups with different outcomes (disease), useful for low prevalence conditions
35
case control study strengths weakness?
evidence of cause-effect relationship can identify multiple exposure retrospective- cheaper/ shorter good when disease is rare weakness-cannot calculate prevalence incidence relative risk less suitable for rare exposure hard to ensure exposure occurred before onset of disease retrospective data availability/quality difficult to find suitable control group
36
risk?
outcome of interest/ total number of all possible outcomes
37
odds?
outcome of interest/ outcome not of interest
38
odds ratio?
odds in exposed/ odds in non exposed
39
why use odds ratio not relative risk?
starting population already is selected for disease, whereas relative risk noone started with the disease OR will always overestimate RR
40
what is chlorpromazine used to treat?
psychosis and sometimes anti-emetic
41
antipsychotics are used for?
nausea vomiting, choreas and motor tics
42
what can haloperidol be used for?
retractable hiccups
43
if you introduce agonist with competitive antagonist?
you push the curve to the right so you need more drug for same amount of response
44
naloxone binds to?
mu receptors antagonises morphine
45
non competitive antagonist and agonist change curve?
decreasing max, lower curve
46
why would you not give antipsychotic iv?
risk of infections
47
in an emergency antipsychotic should be given?
intramuscular, lower dose due to avoiding first pass metabolism
48
side effects of antipsychotics?
dyskinesia, make heart race
49
antipsychotics in schizophrenia will help with?
positive psychotic symptoms (hallucination, delusions), but not negative apathy social withdrawal
50
antipsychotics work by?
block d2 receptors mesolimbic dompamine pathways- pleasure and reward mesocortical dopamine- prefrontal cortex cognition working memory and decision making nigrostriatal dopamine- purposeful movement tubero infundibular dopamine- dopamine function inhibit prolactin release
51
antipsychotic drug reactions include?
parkinsonian symptoms, dystonia, akathisia tardive dyskinesia hyperprolactinaemia, sexual dysfunction, cardiovascular side effects hyperglycaemia and weight gain, hypotension and interference with temperature regulation, neuroleptic malignant syndrome, blood dyscrasias
52
in mild/moderate psychotic symptoms elderly patients should?
not be given antipsychotics
53
if you need to give an antipsychotic to elderly then?
reduce dose to half of adults
54
chlorpromazine is indicated for?
schizophrenia, mania, severe anxiety, intractable hiccups, psychomotor agitation violence, relief of acute symptoms of psychoses, nausea and vomiting in palliative care
55
blockade of d2 receptors leads to?
movement disorders
56
blockade of cholinergic receptors leads to?
dry mouth
57
blockade of alpha adrenergic receptors leads to?
tachycardia, arrhythmias,
58
blockade of histaminergic receptors lead to?
pruritus itching
59
blockade of histaminergic receptors lead to?
pruritus itching
60
blockade of seretonergic receptors leads to issues with?
temperature, mood
61
chlorpromazine is?
extensively bound to proteins and first pass metabolism
62
anticholinergics help with?
reducing tremor, rigidity and sialorrhoea
63
routine administration of antimuscarinics is inappropriate as it may worsen?
tardive dyskinesia
64
dystonia?
neurological movement disorder with involuntary muscle contractions that cause slow repetitive movements or abnormal postures
65
dykinesia?
involuntary, erratic writhing movements of face arms legs and trunk, fluid and dance like
66
akathisia?
restlessness, inability to remain still, may think it is the condition
67
tardive dykinesia?
rhythmic involuntary movement of tongue face and jaw, develops on long term therapy or high dose
68
1st generation usually cause?
hyperprolactinaemia whereas 2nd generation are partial agonist so reduce prolactin
69
chlorpromazine works by?
depressant actions on CNS, alpha adrenergic blocking anticholinergic activities, inhibit dopamine, anti seretonin and weak anti histamine

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