Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

General Surgery > Head, Neck And Breast Surgery > Flashcards

Head, Neck And Breast Surgery Flashcards

(56 cards)

Start Studying
1
Q

List the non-hereditary risk factors for breast cancer

A

Older patient >50 years

Females

Alcohol and smoking

Early menarche

Late menopause

Late first pregnancy/few or no pregnancy

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the hereditary risk factors for breast cancer

A

BRCA 1 or BRCA 2 mutation
* BRCA 1 mutation - 85% chance of developing breast ca

Family history of breast cancer

Family history of ovarian cancer

Personal history of breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What patients are considered high risk for breast cancer?

A

> 1 first line relative with unilateral breast ca

1 first line relative with bilateral breast ca

1 male relative with breast ca

1 relative with breast or ovarian ca

Previous biopsy showing

  • CIS
  • Proliferative disease with atypia
  • complex fibroadenoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is breast cancer diagnosed?

A

Triple Test!!

  1. Clinically
    * History - Risk factors
    * Exam - Lump/mass and LN
    * Metastases
  2. Mammogram
    * 2 views - CC and MLO
    * Suspicious lesion
  3. FNA and Cytology
    * ER/PR status
    * Pathological type
    * Inconclusive > Core biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the importance of ER/PR status of a breast carcinoma

A

ER/PR (+) must NOT get hormone Replacement therapy because it feeds the tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the features of a suspicious lesion on mammogram?

A

Hyperdense

Spiculated

Pleomorphic microcalcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the most common pathological types of breast cancer?

A

Infiltrating ductal (75%)

Infiltrating lobular (10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the management guidelines for a Stage I-II breast cancer?

A

Breast conservtaion therapy with adjuvant radiotherapy

Systemic therapy depending on prognostic factors of the tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the indications for Neo-adjuvant chemotherapy in breast cancer?

A

All locally advanced disease - Stage IIb; IIIa and IIIb

> 4cm mass

To downstage a tumor

If increased risk of micrometastases

To decrease tumour size

HER (+)/(-)

Triple negative - ER/PR/HER (-)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the indications for Adjuvant chemotherapy in breast cancer?

A

Age <40 years

ER / PR (-)

> 3 LN involvement

High grade tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the indications for hormone therapy in breast cancer?

A

ER (+)

Soft tissue metastases

Bone metastases

Pleural effusion (lung metastases)

Local reccurrance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the indications for a mastectomy (contraindications for BCT) in breast cancer?

A

High breast : tumour ratio

Previous irradiation to the breast

Multifocal/multicentric tumour

Wide spread microcalcifications on mammography

Tumor > 4cm

BRCA (+)

Patient preference

Collagen vascular disease - coz’ radiotherapy C/I

  • SLE
  • Scleroderma

2 Recurrence of carcinoma

Males

Poor socio-economic circumstances

Pregnancy / Lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What hormone therapy would you use in a post-menapausal woman with breast cancer?

A

Tomoxifen

  • Inhibits oestrodiol binding
  • Especially effective in ER/PR (+) patients

Anastrozole (Arimidex)
* Aromatase inhibitor - inhibits the conversion of androgens to oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the side-effects of tomoxifen?

A

Menopausal symptoms:

  • Hot flushes
  • Mood changes
  • Altered menses / amenorrhoea
  • Dry vagina
  • Thrush

Thromboembolism

  • Stroke
  • DVT

Fatty liver changes

Increased risk of endometrial cancer

Vaginal atrophy and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the side-effects of Arimidex?

A

MSK pain

Bone pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What hormone therapy would you use in a pre-menapausal woman with breast cancer?

A

Ovarian ablation

  • Surgical
  • GnRH antagonist - Temporary, better for younger patients

Tomoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What receives biological therapy in breast cancer and biologic would they receive?

A

HER-2 (+) patient

Herceptin - monoclonal antibody against HER-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Discuss regional therapy in breast cancer

A

Palpable Axillary LN
* Axillary dissection via Modified radical mastectomy

Impalpable Axillary LN
* Sentinal LN biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Discuss BRCA

A

Autosomal dominant inheritance

Associated with breast, ovarian, fallopian tube, colon and prostate carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What stage breast cancers would you do a CT scan and bone scan for?

A

Stage IIb and up

To look for Metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the histological indications for axillary dissection in breast cancer?

A

Large tumour

Soft tissue invasion

3 or more LN had tumour in it

Extranodal extension of disease

Micrometastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What special investigations would you do in a patient with thyroid pathology and why?

A

Serum TSH

  • Raised in hypothyroidism
  • Decreased in hyperthyroidism and euthyroidism

Total T4, free T4 and free T3
* Function of the thyroid

Serum Calcitonin
* Increased in MEN 2 syndrome

Thyroid Antibodies
* Increased in autoimmune thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Discuss the use of thyroid function tests (TFT)

Study These Flashcards
A

Elevated TSH and low FT4 = Primary hypothyroidism due to disease in the thyroid gland

Low TSH and low FT4 = Hypothyroidism due to a problem involving the pituitary gland

Low TSH with an elevated FT4 and FT3 = Hyperthyroidism.

24
Q

Discuss Radioactive Iodine (RAI) Uptake testing

Study These Flashcards
A

Provides a function-anatomical correlation of thyroid lesion

Provides information on risk of malignancy

Cold nodule = High risk of malignancy (20%)

Hot nodule = Lower risk of malignancy (5%)
* Hot nodule + hyperthyroidism = benign

25
What imaging would you do in a patient with thyroid pathology and why?
RAI uptake * Provides information of risk of malignancy FNA * Diagnoses/excludes malignancy Ultrasound * Evaluation of thyroid nodules for suspicious signs of malignancy CT scan * Metastases
26
What are the suspicous signs of thyroid cancer on ultrasound?
Calcification Increased vascularity Irregular borders Absent halo sign
27
What is the most common thyroid malignancy?
Papillary cell adenocarcinoma
28
What is the origin of a Papillary cell adenocarcinoma of the thyroid?
Arises from follicular epithelial cells
29
What are the risk factors for a Papillary cell adenocarcinoma of the thyroid?
Genetic mutation of BRAF gene Previous irradiation Family history of thyroid cancer Familial syndromes: * Familial papillary carcinoma * Familial non-medullary thyroid carcinoma * Familial adenomatous polyposis coli (FAP) * Gardner syndrome (Familial colorectal polyposis) * Turcot syndorme (multiple adenomatous polyps in the colon)
30
What is the clinical presentation of a Papillary cell adenocarcinoma of the thyroid?
Most common (80%) 2:1 female:male ratio 20-30 years Solitary nodule * Firm on palpation * Solid on ultrasound * Cold on RAI Dysphagia (invasive) Dyspnoea (invasive) Dysphonia (invasive) Palpable LN
31
What is the route of spread of a Papillary cell adenocarcinoma of the thyroid?
Lymphatic
32
Where does a a Papillary cell adenocarcinoma of the thyroid metastasize to?
Lungs Bone
33
What investigations would you do for a papillary cell adenocarcinoma of the thyroid??
Thyroid function tests * Increased TSH * Normal FT3 and FT4 Ultrasound * Look for suspicious signs * Solid FNA and cytology * Papillary projections of columnar epithelium * Psammoma bodies (60%) RAI * Cold
34
What is the management of a Papillary cell adenocarcinoma of the thyroid?
Surgical <1 cm - Lobectomy/Isthmustectomy (Younger patients) >1 cm - Total thyroidectomy with central node dissection Adjuvant * Thyroid hormone suppression and radioiodine therapy * External beam radiotherapy for >45 years and had locally invasive disease. Post-Total thyroidectomy Life-long thyroid hormone replacement therapy
35
What are the indications for a Total thyroidectomy?
(Also contraindications to RAI) Large/Multinodular goitre with poor RAI uptake Compression symptoms Suspicious malignant nodule/ confirmed thyroid cancer Pregnancy/children Patients who wish to fall pregnant Amioderone induced hyperthyroidism Adverse effects of antithryoids Unable to follow long term follow-up
36
What are the complications of thyroidectomy?
Thyroid storm Neck haematoma Recurrent laryngeal nerve injury Injury to the external branch of the superior laryngeal nerve Injury to the oesophagus Injury to to the great vessels/cervical sympathetic trunk Hypoparathyroidism
37
Provide a DDx for a solitary nodule of the thyroid
Cyst Colloid nodule Papillary cell adenocarcinoma Follicular cell adenocarcinoma
38
What is the origin of a medullary carcinoma of the thyroid?
Arises from the parafollicular cells | *Secretes calcitonin and CEA
39
What are the risk factors for medullary carcinoma of the thyroid?
RET oncogene on chromosome 10 MEN syndrome 2A and 2B
40
What is the presentation of medullary carcinoma of the thyroid?
Sporadic type * Unilateral, solid, hard, nodular neck mass Familial type * Bilateral/multicentric hard, nodular neck mass
41
What is the route of spread for medullary carcinoma of the thyroid?
Haematogenous * LN * Bone * Lung
42
Where does a medullary carcinoma of the thyroid metastasize to?
Early * Adjacent muscle * Trachea * Local and mediastinal LN Late * Bones * Lungs * Liver * Adrenals
43
How would you diagnose a medullary carcinoma of the thyroid?
Bloods * Raised Calcitonin * Raised CEA FNA RAI * Cold
44
How would you manage a medullary carcinoma of the thyroid?
(If present, phaeochromocytoma should be managed first) Total thyroidectomy + modified neck dissection if cervical LN affect
45
Define MEN syndrome
It is a group of autosomal dominant disorders characterized by the growth of benign and malignant endocrine tumours
46
What are the clinical features of MEN-1 syndrome?
Hyperparathyroidism Pancreatic tumours Pituitary adenomas Adrenal adenoms Carcinoid tumours
47
What is the management of MEN-1 syndrome?
Hyperparathyroidism * Medical - Calcimimetics * Surgical - Parathyroidectomy with thymectomy Gastrinomas * Medical - PPI's (omeprazole)
48
What are the clinical features of MEN-2A syndrome?
Medullary carcinoma of the thyroid (80-100%) Phaeochromocytoma (40%) * HPT * Headaches * Palpitations * Diaphoresis
49
How would you diagnose MEN-2A syndrome?
Genetic testing - RET mutation Serum calcitonin after 3 days of omeprazole
50
What is the management of MEN-2A/2B syndrome?
Medullary carcinoma of the thyroid * Prophylactic thyroidectomy in kids with RET mutation Phaeochromocytoma * alpha-blockers + beta-blockers * Unilateral/bilateral adrenalectomy
51
What are the clinical features of MEN-2B syndrome?
Medullary carcinoma of the thyroid Mucosal neuromas * Bumpy, enlarged lips and tongue Phaeochromocytoma * HPT * Headaches * Palpitations * Diaphoresis Skeletal abnormalities Marfanoid habitus
52
What is the most common salivary gland neoplasm?
Parotid tumours - Benign pleomorphic adenoma
53
What is the clinical presentation of a malignant parotid mass?
Rapid growth Pain Paraesthesia Facial nerve (CN VII) weakness/palsy Skin invasion and fixation to mastoid tip
54
How would you diagnose a salivary gland tumour?
FNA Surgical excision * Provides a definite histopathological diagnosis MRI * Better soft-tissue visualization * Can see soft tissue extension and involvement of adjacent structures
55
How would you manage a benign pleomorphic adenoma of the parotid gland?
Superficial parotidectomy with preservation of the facial nerve
56
What are the indications for adjuvant radiation therapy in salivary gland tumours?
Extraglandular disease Perineural invasion Direct invasion of regional structures Regional metastases High-grade histology

General Surgery (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions