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Medicine > Introduction To Clinical Application > Flashcards

Introduction To Clinical Application Flashcards

1
Q

Define abuse and neglect

A

Abuse and neglect are forms of maltreatment

Somebody may abuse or neglect by inflicting harm or by failing to act to prevent harm

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2
Q

What piece of legislation and guidance was released around safeguarding in 2018?

A

Working together to safeguard children 2018

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3
Q

What 3 areas are included in the assessment framework triangle for a child’s needs?

A

Childs development needs

Parenting/ carer capacity

Family and environmental factors

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4
Q

What age does a child need to be and have unexplained bruising to have an automatic referral to social care?

A

Children under 2

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5
Q

What are the 4 categories of abuse?

A

Physical
Sexual
Emotional
Neglect

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6
Q

What is syncope and how does it happen?

A

Transient loss of consciousness characterised by fast onset and spontaneous recovery

Caused by a reduced perfusion pressure in the brain
Syncope is usually self limiting being horizontal will fix low blood pressure due to the baroreceptor reflex

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7
Q

What is pre-syncope?

A

Symptoms preceding a syncopal episode includes:

Light headed ness
Sweating
Pallor
Blurred vision

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8
Q

What are a few broad categories for syncope?

A

Reflex syncope - baroreceptor reflex not working as quickly
Orthostatic hypotension - some as above but commonly in elderly
Cardiac/ cardiopulmonary disease - serious cause

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9
Q

What is the mechanism causing reflex syncope?

A

Disorder of the autonomic regulation of postural tone
Activation of part of the medulla leads to decrease in sympathetic output and increase in parasympathetic
Fall in cardiac output and BP leads to reduced cerebral perfusion

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10
Q

What are 3 examples of reflex syncope?

A

Vasovagal - simple faint - from prolonged standing, stress, sight of blood, pain

Situational syncope - e.g. coughing, straining, lifting heavy weight

Carotid sinus massage

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11
Q

How much of a blood pressure drop is defined as orthostatic hypotension?

A

20 mmHg on SBP

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12
Q

What is the pathophysiology with standing causing syncope?

A

Standing causes 500-800ml of blood to pool in legs

Reduction in end diastolic volume

Reduced cardiac stretch therefore reduced stroke volume and cardiac output

Normally managed by the baroreceptor reflex

If this fails then cerebral perfusion will drop and syncope occurs

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13
Q

Why would the baroreceptor reflex fail?

A

Baroreceptor become less sensitive with age and hypertension

Medications such as antihypertensives can impair this response or venous return

Dehydration - hypovolaemia is common in elderly

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14
Q

What is cardiac syncope?

A

Syncope caused by cardiac disease

Any patient who presents with a fall should have an ECG done

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15
Q

What are the 3 broad categories of cardiac syncope?

A

Electrical problem - bradycardia or tachycardia

Structural - aortic stenosis or hypertrophic obstructive cardiomyopathy

Coronary - MI/ IHD

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16
Q

Why does aortic stenosis cause syncope?

A

Narrowing of aortic valve - harder to push blood through the valve - heart has to work harder then in exercise it can fail to adequately perfuse the brain

Syncope with AS have a mean survival of 2-5 years untreated

Also ejection systolic murmur

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17
Q

What are risk factors of cardiac syncope?

A

FHx of cardiac disease or sudden cardiac death

Preceding chest pain or palpaitations

PMHx of IHD or ASD repairs

Abnormal ECG

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18
Q

What is important to note about the elderly cardiovascular and respiratory systems?

A

CVS - cardiac output falls by 3% per decade - arm-brain circulation time for drugs therefore reduces.
Decreased cardiac conducting cells therefore more arrhythmias and AF present.
Large and medium sized blood vessels become less elastic and compliant - therefore raised TPR and HTN therefore LV strain and hypertrophy

Respiratory system -
Lung and chest wall have decreased compliance.
TLC, FVC, FEV1 and VC all reduced. Reduction in elastic support of airways.
Atelectasis, PE and pneumonia are common post-op complications in elderly. Increase with smokers and chronic lung disease.
Upper airways tissues lose elasticity too and result in partial or complete obstruction of the airways in sleep or sedative states.
Increase incidence of arterial desaturation during sleep with rising age

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19
Q

With respect to pharmacology what are the changes seen in elderly people?

A

Reduced CO therefore delayed onset of IV anaesthesia

Reduced total body water and increased adipose tissue therefore leads to altered VD of some drugs

Plasma proteins also reduced therefore reduced drug binding and increased free drug

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20
Q

What is the malnutrition screen tool used in leicester?

A

MUST - malnutrition universal screening tool

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21
Q

What is phimosis?

A

Inability to retract the foreskin (prepuce)

Incidence 1% adult non-circumcised population

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22
Q

When is the prevalence of physiological phimosis in the age ranges?

A

50% at 1 year
10% at 3 years
1% at 17 years

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23
Q

What is balanitis xerotica obliterans?

A

Scarring and oedema of the prepuce causing phimosis

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24
Q

What is paraphimosis?

A

When the foreskin is too taught that it cant be pulled over the head of the penis.
It can lead to the head of the penis not getting blood

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25
Q

What is the most common penile cancer?

A

Squamous cell carcinoma

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26
Q

What are risk factors for penile cancer?

A

Phimosis - hygiene - smegma

HPV 16 and 18

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27
Q

What are indications for circumcision?

A

Paediatric - religious or recurrent balanitis/ UTIs

Adult - recurrent balanitis
Phimosis
Penile cancer
BXO
Recurrent paraphimosis
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28
Q

What is a common testicular torsion presentation?

A

Young patient
Sudden onset - woke from sleep and short duration
Unilateral pain; may be nauseated/ vomit, often no LUTS

OE= Testis is very tender
Lying high in scrotum with horizontal lie - may even lie vertical or have undone the torsion by the time of presentation

Surgery indicated ideally within 6 hours - no point >18hours

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29
Q

How does epididymo-orchitis present usually?

A

STI/ UTI
Gradual onset
Unilateral usually
Recent Hx of UTI/ unprotected sex/ Catheter/ check for mumps history

OE= pyrexial can be septic
Scrotum erythematous
Testis/ epididymis enlarged, tender
Fluctuate areas may represent abcess
May have reactive hydrocoele
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30
Q

What is fournier’s gangrene?

A

Necrotic area of scrotal skin

High mortality rate - approx 50%

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31
Q

What are 4 presentations of painless scrotal lumps that are not tender?

A

Testis tumour - >90% painless
Epididymal cyst
Hydrocoele
Reducible inguino-scrotal hernia

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32
Q

What is one potential presentation of a painless/ aching at end of the day - not tender scrotal lump?

A

Varicocoele

- Bag of worms - chronic aching

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33
Q

What are 3 acute presentations with scrotal lumps that are painful and tender?

A
  • Epididymitis
  • Epididymo-orchitis
  • Strangulated inguino-scrotal hernia - emergency
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34
Q

What is the reason for hydrocoele formation?

A

Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis

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35
Q

Why can varicocoeles cause infertility?

A

Bilateral varicocoeles have the greatest risk of infertility

Due to reduced blood drainage and therefore perfusion the testis may die and become non-functional

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36
Q

Define urinary retention

A

Inability to pass urine rather than inability to make urine

Common in males, rare in females

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37
Q

What are 5 causes of urinary retention

A

Prostatic enlargement - BPH/ cancer

Phimosis/ urethral stricture/ meatal stenosis

Constipation

UTI

Drugs - anticholinergic

Over distension - too much fluids

Following surgery - anaesthetics, colorectal surgery could destroy nerves in the process

Neurological - cauda equina - painless retention

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38
Q

What are the 3 types of urinary retention?

A

Acute

Chronic

Acute on chronic

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39
Q

What is a treatment for acute urinary retention?

A

Catheterisation

Trial without catheter after addressing exacerbating factors

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40
Q

How much fluid is held in the urinary retention types?

A

Acute - residual volume <1L

Chronic - Residual volume >300ml

Acute on chronic - Residual volume >1L

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41
Q

How would you treat chronic urinary retention?

A

Patient would have to learn to self catheterise and this would have to be done regularly

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42
Q

How would you treat acute on chronic urinary retention?

A

TWOC (not usually successful and no place if kidney insult)

Long term catheter or surgical intervention

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43
Q

Which types of urinary retention are painful?

A

Acute - painful

Chronic - painless/ less painful

Acute on chronic - painful

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44
Q

Which of the urinary retention types have kidney insult?

A

Acute - no kidney insult

Chronic - may have kidney insult

Acute on chronic - usually have kidney insult

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45
Q

What is the medical term for bed wetting?

A

Nocturnal enuresis

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46
Q

What two areas can LUTS be predominant?

A

Voiding phase

Storage phase

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47
Q

What are voiding phase LUTS?

A

Suggestive of bladder outflow obstruction

Hesitancy
Poor flow
Post micturition dribbling

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48
Q

What are storage phase LUTS?

A

Frequency
Urgency
Nocturia

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49
Q

How much urine has to be produced to be classed as nocturnal polyuria?

A

> 1/3 of total 24hour urine

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50
Q

Where does tamsulosin work in terms of receptors and anatomically in the urinary system?

A

Alpha 1 receptors

Sympathetic smooth muscle of the prostate and bladder neck

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51
Q

What are the treatments for male LUTS - BPH?

A

Reduce caffeine intake, fizzy drinks and don’t drink more than 2.5L a day

Alpha blockers

5alpha- reductase inhibitors

Surgical intervention - Transurethral resection of prostate

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52
Q

How does finasteride work?

A

5alpha - reductase inhibitor

Acts by shrinking the prostate by means of androgen deprivation

Symptoms relief slower than alpha blockade

Slows progression

Reduces the risk of retention

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53
Q

What tool is used for evaluation of CVS risk?

A

QRISK3

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54
Q

What things are taken into account when stratifying someone’s CVS risk?

A 
Migraines
Corticosteroid use
SLE
Atypical antipsychotics
Severe mental illness
Erectile dysfunction
CKD stage 3 and beyond
Postcode
BMI
Rheumatoid arthritis
Total and HDL cholesterol
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55
Q

What is a normal voiding frequency?

A

4-8 times per day and once at night

56
Q

What is erythroderma?

A

Intense and widespread reddening of the skin usually attributed to inflammation

> 90% of body surface area is affected - erythematous and exfoliatitive

  • caused by psoriasis, eczema, drugs, cutaneous T cell lymphoma

Symptoms - pruritus, fatigue, anorexia, feeling cold

Signs - erythematous, thickened, inflamed, scaly, no sparing

57
Q

What are complications of erythroderma?

A

It is total skin failure
- hypothermia - loss of thermoregulation

  • infection - loss protective barrier
  • renal failure - insensible losses
  • high output cardiac failure - dilated skin vessels
  • protein malnutrition - high turnover of skin
58
Q

What are 4 major cell types of the epidermis?

A

Keratinocytes - protective barrier

Langerhan cells - antigen presenting cells

Melanocytes - produce melanin which provides pigment to the skin and protects cell nuclei from UV DNA damage

Merkel cells - contain specialised nerve endings for sensation

59
Q

What are the 4 layers of the epidermis?

A

Stratum corneum

Stratum Lucidum

Stratum Granulosum

Stratum Spinosum

Stratum Basale

Dermis

60
Q

What is the normal epidermal turnover time?

A

30 days

61
Q

Pathology of the epidermis causes what 3 things?

A

Change in epidermal turnover

Change in surface of the skin

Change in pigmentation of the skin

62
Q

What is the dermis composed of?

A

Collagen, elastin and GAG

63
Q

What is dermographia?

A

Scratching of the skin causes release of histamine in the dermis and therefore local oedema

64
Q

What is granuloma annulare?

A

Raised ring-shaped patch of skin

Local inflammation in dermis

Causes are unknown but goes away on its own

65
Q

What is the condition called when glands on the skin become colonised by bacteria?

A

Acne vulgaris

Stimulated by conversion of androgen to dihydrotestosterone

66
Q

What are the 3 main types of hair?

A

Lanugo hair

Vellum hair - short hair all over the body

Terminal hair - coarse long hair

67
Q

What are the 3 main phases of hair follicle growth?

A

Anagen - growth phase of hair growth of 1cm/month and lasts for 3-5 years

Catagen - transitional stage where hair follicle renews and lasts for 2 weeks

Telogen - shedding phase lasting for 4 weeks of no growth

68
Q

What is the difference between alopecia areata and genetic alopecia?

A

Alopecia areata is an autoimmune condition that causes hair to fall out by prematurely moving hair follicles from anagen to telogen

Genetic alopecia is where there is increased levels of androgens around the hair follicles causing decreased hair growth cycle length and shorter and thinner hair

69
Q

What is the anatomy of the nail?

A

Nail plate which arises from the nail matrix at the posterior nail fold and rests on the nail bed
Nail bed contains blood capillaries

Nail root is where the nail grows from

Lunula is white area at the base of the finger nail

Eponychium - cuticle protects the proximal nail and epidermis from bacteria

70
Q

What is Lichen planus?

A

Inflammatory disorder that can appears as purplish flat-topped bumps. Bumps may appear in clusters or lines on the skin but in the nails appears as white areas

Swelling and irritation of the skin

71
Q

What is melanonychia?

A

Familial
Mole in the nail bed that extends into the nail
Potentially a sign of melanoma

72
Q

What is the Fitzpatrick skin types chart?

A

Type 1 to 6 getting darker skin at each stage

Burn level and tan level

Type 1 is the whitest skin that always burns and never tans

Type 6 is the darkest skin (black) which does not burn but tans very easily

73
Q

What mnemonic would be used to describe abnormal skin?

A

SCAM

S - site, distribution (rash) or size and shape (lesion)

C - colour (and configuration)

A - associated changes e.g. surface features

M - morphology

74
Q

What mnemonic is used for pigmented lesions?

A

ABCD

A - asymmetry

B - border (irregular or blurred)

C - colour

D - diameter

75
Q

What 4 things are used to describe site and distribution?

A

Generalised

Flexural

Extensor

Photosensitive region

76
Q

What 4 terms are used to describe configuration of skin lesions?

A

Discrete - small and few of them

Confluent

Linear - psoriasis

Target - concentric rings with a little blister in the middle. Causes = erythema multiforme, reactive rash post cold sore

77
Q

4 terms used to describe the colour of a lesion?

A

Erythematous - red and blanching

Purpuric - red or purple and non-blanching = Lower limbs with papules- vasculitis - meningitis can be a cause
Non-blanching because red cells are outside of the vessels

Brown or black - pigmented or hyperpigmented - post rash skin colour different

Hypopigmented - depigmented if total loss of colour - in vitiligo the immune system attacks melanocytes

78
Q

4 words used to describe surface features of skin lesions?

A

Scale - built up keratin

Crust - dried exudate
Impetigo

Erosion/ ulceration - partial or full thickness loss of skin. Deep = ulceration. Topical = erosion.

Excoriation = erosion from scratching = pruritis

79
Q

12 words to describe the morphology of skin lesions?

A

Macula - flat and different colour, e.g. freckles

Paulette - raised small erythematous. E.g. acne/ psoriasis

Patch - flat to skin e.g. vitiligo

Plaque - Raised, under plaque is active and thick under layers. Plaque is patch that is erythematous

Nodule - from under the skin. E.g. telangiectasia, skin cancer - BCC

Vesicle - fluid comes out and blisters fill with fluid but are small in size

Pustule - Pus filled blisters that can be small in size - signs of infection

Bulla - large vesicles that are fluid filled

Annular - ring shaped e.g. eczema discoid

Wheal - urticaria - transient raised areas e.g. stinging nettles

Discoid/ nummulite - discoid eczema

Come done - open (black head) or close (white head)

80
Q

4 words for hair findings in dermatology?

A

Alopecia - patchy loss of hair areata/ genetic. Not itchy but is autoimmune

Alopecia diffuse - commonly in women later in life

Hypertrichosis - excess hair over a mole

Hirsuitism - male pattern hair in females

81
Q

4 words for nail findings

A

Koilonychia- iron deficiency severe - nail spooning

Pitting - indicative of psoriasis

Only holy sis - separation post sun exposure where the white nail has separated from the nail bed

Clubbing - lung cancer, bronchiectasis, heart failure, lung fibrosis, CF, ILD, sarcoidosis, tetralogy of fallot, subacute bacterial endocarditis

82
Q

What does frailty mean?

A

Accumulation of deficits.

People who are off their baseline in terms of ADL’s.

Needing help to do things they previously didn’t need help with.

Manifestations - delirium, falls and fractures, immobility and pressure sores, incontinence, iatrogenesis

83
Q

What is the clinical frailty scale?

A

A scoring system used to identify frail people

Scored from 1 to 9
1 being very fit and 9 being severely frail

Score 8/9 - 50% mortality at one year
Score 1/2 - 2-3% mortality at one year

84
Q

What is the progression from treatment to feeling fully normal after pneumonia?

A

1 week - fever resolved
4 weeks - chest pain and sputum reduced substantially
6 weeks - cough and breathlessness reduced
3 months - most symptoms resolved by fatigue may still be present
6 months - most people feel back to normal

85
Q

What is the goal of CURB scoring?

A

Prognostic of risk of death

0 low risk <1% mortality risk
1 or 2 intermediate risk 1-10% mortality risk
3 or 4 high risk >10% mortality risk

86
Q

How does frailty link with response to stressors?

A

The more frail the patient the worse their response to stress is.

Severely frail people never come back to their baseline they always end up worse and more in need of care than they previously did

87
Q

What are the component parts of the comprehensive geriatric assessment?

A
  • Social networks
  • Environment
  • Medical
  • Psychological/cognitive
  • Functional

Coordinated , communicated, patient centred care

88
Q

What is the adult definition of sepsis?

A

Infection
Dysregulation host response
Life threatening organ dysfunction

89
Q

What is a q-SOFA score and what does it include?

A

Risk scoring system for prognosis outside of ITU

Takes into account
Altered GCS
RR >22
SBP <100

90
Q

What is the paediatric definition of Sepsis?

A

SIRS- systemic inflammatory response

+

Suspected/ proven infection

91
Q

What features make sepsis into severe sepsis?

A

SIRS + suspected/ proven infection

+ organ dysfunction - CV/ Resp/ 2 or more other organs

92
Q

What is SIRS?

A

Inflammation throughout the whole body

Broad categories - infectious or not-infectious

Trauma, pancreatitis, haemorrhage, anaphylaxis, burns, infection

Marked by - tachycardia, hypotension, hyper/hypothermia, leukopenia/ leukocytosis

93
Q

What are the basic principles of sepsis management in paediatrics?

A

A-E assessment

Hypotension - give fluids IO/IV

Tachypnea - high flow oxygen to improve sats

Hypoglycaemia/ hypocalcaemia- correct accordingly

Adrenaline (ionotropic) continuous infusion peripherally

94
Q

How do we calculate mean arterial pressure?

A

[SBP + (2x DBP)] / 3

95
Q

For peripheral inotropes which is best for cold shock and for warm shock?

A

Cold shock - adrenaline

Warm shock - noradrenaline

96
Q

What is more likely to cause mortality - giving IV fluid boluses or giving the same amount of fluid in a continuous IV drip?

A

Fluid boluses

97
Q

In a neonate age <1 month what antibiotics would be used to treat sepsis?

A

Gentamicin

Amoxicillin

Cefotaxime

98
Q

In a child aged 1 -3 months what antibiotics would be given to treat sepsis?

A

Amoxicillin

Ceftriaxone

99
Q

In a child aged 3 months and over what antibiotics would be given to treat sepsis?

A

Ceftriaxone

100
Q

What factors are included in the assessment of breast disease?

A

Physiological swelling and tenderness

Modularity

Breast pain (not usually associated with malignancy)

Palpable breast lumps

Nipple discharged including galactorrhoea

Breast infection and inflammation - usually associated with lactation

101
Q

What is the medical term for breast bud development?

A

Thelarche

102
Q

30 year old women with pain leading up to and during periods in the breast could have a benign cause - what is the differential?

A

Fibrotic changes is benign - fibroadenoma

Usually ages between 20-50 (menstruation) - therefore hormonal aetiology

Pain and nodularity

103
Q

Asymmetrical nodularity, symptoms one week before menstruation and decreases when it starts, OE - area of nodularity or thickening in the upper outer quadrant of the breast.

What would you do?

A

Refer on as asymmetrical after a review after 1-2 menstrual cycles and seeing her mid-cycle

Bilateral would be commonly normal but unilateral is abnormal

104
Q

What is cyclical mastalgia?

A

Tenderness and nodularity in premenstrual phase is common - affecting up to 2 thirds of all menstruating women

105
Q

A palpable benign breast lump can usually be 2 things which are and what are the features of them?

A

Cysts

Fibroadenomas

3 dimensional, mobile and smooth regular borders

solid or cystic in consistency

106
Q

What is intraductal papilloma and what is it caused by?

A

Benign growth in single milk duct - makes breast sore as prevents breast milk from passing through the duct

Multiple milk ducts not just one - duct ectasia (blockage)

107
Q

What is mastitis and how does it present?

A

Infection of the breast

Point tenderness, erythema and fever

Generalised cellulitis of the breast

Treated with antibiotics or I&D

108
Q

What bacteria cause mastitis?

A

Staph or strep

109
Q

What age of the patient and features of the breast would require referral on a suspected cancer pathway?

A

Aged >30 and unexplained breast lump with or without pain

Aged >50 with any of the following symptoms in one nipple only:
Discharge, retraction, other changes of concern (lymph nodes), skin changes

110
Q

What is the journey of grief?

A

Immobilisation

Denial

Anger

Bargaining

Depression

Testing

Acceptance

111
Q

What happens to the breast lobules and interlobular stroma as age increases?

A

Prepubertal breast - few lobules - before puberty male and female breasts are identical)

Menarche - increase in the number of lobules, increase volume of interlobular stroma

Menstrual cycle - follicular phase lobules quiescent, after ovulation cell proliferation and stromal oedema, with menstruation see decrease in size of lobules

Pregnancy - increase in size and number of lobules, decrease in stroma, secretory changes

112
Q

What physiological changes are seen in breast tissue on the cessation of lactation in terms of lobules?

A

Atrophy of lobules but not to former levels

113
Q

What physiological changes are seen in breast tissue on increasing age in terms of lobules?

A

Terminal duct lobular units decrease in number and size, interlobular stroma replaced by adipose tissue - mammograms easier to interpret

114
Q

Non-cyclical and focal pain in the breast could be an indicator of what?

A

Ruptured cysts, injury, inflammation

115
Q

What type of features of a palpable mass would be worrying?

A

Hard, craggy and fixed

116
Q

What age range would fibroadenomas occur most often at?

A

<30years

Can occur at any age during reproductive period though

117
Q

What age does a phyllodes tumour usually present?

A

6th Decade

Stromal tumour

118
Q

What is the most common breast lesion?

A

Fibrotic changes

May present as a mass or mammographic abnormality

Mass often disappears after fine needle aspiration - cysts refill once aspirated and then patient represents

119
Q

Why does transient gynaecomastia affect boys in puberty?

A

Oestrogen production peaks earlier than that of testosterone

120
Q

What type of cancers are >95% of all breast cancers?

A

Adenocarcinoma

121
Q

What area of the breast are most commonly associated with breast cancer?

A

Upper outer quadrant - approx 50%

122
Q

Apart from age and gender what are risk factors related to breast cancer?

A

Uninterrupted menses

Early menarche (<11 years)

Late menopause

Parity and age at first full term pregnancy

Breast -feeding

Obesity and high fat diet

Exogenous oestrogen (HRT increases risk by 1.2-1.7times)

Breast density

Geographic influence - diet, physical activity, breast feeding

123
Q

What is the hereditary risk factors to breast cancer?

A

10% breast cancers are hereditary

3% of all breast cancers and 25% of familial cancers attributed to mutations in BRCA1 or BRCA2 - both are tumour suppressor genes - proteins repair damaged DNA

124
Q

How do we classify breast carcinoma?

A

Carcinomas are divided into insult and invasive

Carcinomas can be ductal or lobular

125
Q

What is in situ breast carcinoma?

A

Neoplastic population of cells limited to ducts and lobules by basement membrane, myoepithelial cells are preserved

Does not invade into vessels and therefore cannot metastasise or kill the patient

126
Q

Why are ductal carcinoma in situ (DCIS) a problem?

A

Non-obligate precursor of invasive carcinoma

Most often presents as mammographic calcification (clusters or linear and branching) but can present as a mass

Can spread through ducts and lobules and be very extensive

Histologically often shows central (comedo) necrosis with calcification

127
Q

What is Paget’s disease of the breast?

A

Adenocarcinoma of the beast that extend to nipple skin without crossing the basement membrane

Unilateral red and crusting nipple

Eczematous or inflammatory conditions of the nipple should be regarded as suspicious and biopsy performed

128
Q

How does invasive carcinoma differ from DCIS?

A

Neoplastic cells invaded beyond basement membrane into the stroma

Can invade vessels and therefore metastasise to lymph nodes and other sites

By the time a cancer is palpable more than half of the patients will have a ill arm lymph node metastases

Peau d’orange - involvement f lymphatic drainage of skin - yellowing of the skin

129
Q

How is invasive breast carcinoma classified?

A

Invasive ductal carcinoma - 70-80% prognosis

Invasive lobular carcinoma - 5-15% prognosis

130
Q

What are the most frequent locations of breast cancer metastases?

A

Bone
Lung
Liver
Brain

Invasive lobular carcinoma can spread to odd sites - peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries, uterus

131
Q

How do we stage breast cancer?

A

TNM

132
Q

What is the 10 year survival of grade 1/2/3 breast cancer?

A

Grade 1 - 80%

Grade 2 - 50%

Grade 3 - 40%

133
Q

What would be the molecular classifications of breast cancer?

A

Oestrogen receptor positive or negative

HER2 positive or negative

134
Q

What is the worst molecular classification for breast cancer?

A

Oestrogen receptor negative

HER2 negative

Basal-like phenotype

Most BRCA1 tumours have this phenotype

135
Q

What is tamoxifen used for?

A

Oestrogen receptor positive breast carcinoma

136
Q

What is Herceptin used for?

A

HER2 receptor positive breast carcinoma

137
Q

What is HER2?

A

Member of the human epidermal growth factor receptor family

Encodes a transmembrane tyrosine kinase receptor

Humanised monoclonal antibody against the HER2 protein

Medicine (15 decks)

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