book 1 Flashcards
1
Q
where can you palpate the ischial spines?
A
4 and 8 oclock
2
Q
where can you palpate the ischial spines?
A
4 and 8 oclock
3
Q
2 ligaments of the pelvis?
A
sacrospinous and sacrotuberous
4
Q
if you get life threatening haemorrhage after pelvic fracture, which vessels are likely affected?
A
common iliac artery/vein
5
Q
do you want the station to be positive or negative
A
positive
6
Q
describe medulla of ovary?
A
highly vascularised, connective tissue, nerves, lymphatics
7
Q
what is the name of the group of arteries that enter hilum from broad ligament and supply blood to the ovary?
A
helicine
8
Q
dense connective tissue in the penis?
A
tunica albuginea
9
Q
name for the development of oocytes?
A
oogenesis
10
Q
growth of follicle term?
A
folliculogenesis
11
Q
loss of oogonia and oocytes by apoptosis?
A
atresia
12
Q
what happens to folic if it fails to associate with pregranulosa cells?
A
die
13
Q
what are pregranulosa cells like? what happens to them if the follicle enters growth phase?
A
squamous, become cuboidal
14
Q
what do you call cuboidal granulosa cells?
A
zona granulosa
15
Q
layer of specialised extracellular matrix between oocyte and granolas cells?
A
zona pellucida
16
Q
what cells associate with the outside of the folic?
A
stroma cells
17
Q
what do they go on to become?
A
theca (interna and externa)
18
Q
which layer of the theca secrete oestrogen precursors?
A
inner
19
Q
which cells convert the precursors to esrogen?
A
granulosa cells
20
Q
name of strucure, filled with follicular fluid which starts to form?
A
antrum
21
Q
after ovulation, follicle transforms into?
A
CL
22
Q
which cells of the corpus lute secrete oestrogen and progesterone?
A
theca and granulosa
23
Q
if no implantation, CL becomes?
A
corpus albicans
24
Q
what colour is the corpus albicans?
A
white
25
if implantation occurs, placenta secretes HCG. what is the effect of this?
prevents CL degeneration
26
the corpus lute maintains progesterone levels, and so maintains the pregnancy
ie corpus lute needs HCG
27
name sites of uterine tubes (fun to as it is)
infundibulum, ampulla, isthmus, interstital part
28
where does fertilisation usually occur?
ampulla
29
how many layers of smooth muscle are in the ampulla? isthmus?
2 in the ampulla, 3 in the isthmus
30
which layer of the endometrium contains 3 layers of smooth muscle, with collagen and elastic tissue?
myometrium
31
which layer shed during menstruation?
endometrium
32
2 layers of endometrium?
striatum basalis and stratum functionalis
33
which part is grown and shed?
f
34
during secretory phase, describe the appearance of the glands? what do they secrete?
coiled with corkscrew appearance. glycogen
35
what is glycogen converted into in the vagina? by what?
lactic acid by commensal bacteria
36
describe mucus in proliferative phase and following ovulation?
thin and watery in proliferative phase, thick and viscous following ovulation
37
4 layers of the vagina?
NLFA - i hop - non keratinised stratified squamous epithelium, lamina propria, fibromuscular layer, adventitia
38
vagina lubricated by cervical mucous and ?
fluid from thin walled vessels in lamina propria
39
contains 2 tubes of erectile vascular tissue?
clitoris
40
minora, which has only sebacsous glands, wad which has both sebaceous and apocrine
minora only s, majora has s and a
41
what does FSH stimulate?
follicle development and granolas cells to produce oestrogen
42
dominant follicles release what substance which inhibits FSH?
inhibin
43
decline in FSH causes?
atresia of all but dominant follicle
44
term for degeneration of corpus luteum?
luteolysis
45
estrogen induced growth of endometrial glands, which phase?
proliferative phase
46
what happens in L phase?
secretory activity
47
which process inhibits scar formation in menstruation?
fibrinolysis (breakdown of clots)
48
how many days does bleeding usually last ?
4-6
49
should there be clots?
no
50
variation of days in normal cycle?
21-35 days
51
menorrhagia?
prolonged and increased menstrual flow
52
RAGE PI
y
53
metrorrhagia
regular intermenstrual bleeding
54
increased bleeding and frequent cycle?
polymenorrhagia
55
polymenorrhoea - menses occurring at?
56
menometrorrhagia?
prolonged menses and intermenstrual bleeding
57
oligomenorrhoea?
menses at intervals of more than 35 days
58
how long do you need absence of periods to be amennorheic?
6 months
59
DUBs are all to do with?
corpus luteum
60
what percentage of women with abnormal uterine bleeding have DUB?
50
61
both anovulatory and ovulatory have a deficiency of?
prog
62
85% are an/ov?
anovulatory
63
which one more common in obesity?
anovulatory
64
what ages do you expect to get anovulatry?
extremes of fertility, 20 and 40
65
management of DUB? (pro foo, dan, pillh, NSAID, GnRH analogues, capillary wall stabilisers)
PROGESTERONE
66
2 alternatives that release progesterone?
IUCD or IUS
67
which hormone converts endometrium to secretory stage to prepare for implantation?
pro
68
can also do resection or ablation for DUB
y
69
infertility - female should take 0.4mg folic acid for how long before conception?
12 weeks
70
mild or moderate endometriosis, what fertility treatment can be offered? also for unexplained fertility?
IUI
71
Indications for IVF?
unexplained 2 year duration, pelvic disease, anovulatory, male factor infertility
72
which drug used to down regulate GnRH?
buretin
73
side effects?
hot flushes, mood swings, nasal irritation, headaches
74
what should endometrium look like following this?
thin
75
how is ovary stimulated?
gnrh
76
side effects of ovarian stimulation?
mild allergic reactions and ovarian hyperstimulation syndrome (OHSS)
77
what is injected to mimic LH surge 36 hours before egg collection?
HCG
78
no more than 2 embryos to be transferred in women less than 40. however, 3 can be transferred in special circumstances
y
79
after the transfter, what hormone is given?
prog
80
what complications can arise from sperm aspiration?
abdominal pain/bloating/nausea, diarrhoea, breathless
81
what is the chance of success in a woman under 35?
37%
82
over 41
0.5%
83
pathway of IVF?
down regulation using bretin (menopausal symptoms) - ovarian stimulation - scan - oocyte retrieval - embryo transfer - luteal support (progesterone)
84
complications of IVF?
ectopic pregnancy, OHSS, multiple pregnancies
85
in breast, i larger ducts, epithelial lining is?
columnar
86
in smaller i.e. acini, its?
columnar or cuboidal
87
keratinised stratified squamous epithelium with a curve of dense irregular connective tissue mixed with bundles of smooth muscle?
nipple
88
in absence of pregnancy, what happens to lumina of ducts and epithelial cells in luteal phase?
lamina increases, epithelial cells increase in height
89
if pregnancy occurs, you get elongation and branching of the smaller ducts
y
90
also proliferation of the epithelial cells of the glands and the myoepithelial cells
y
91
in pregnancy, 2nd trimester, which cells infiltrate the connective tissue?
plasma and lymphocytes
92
during pregnancy, E and P stimulate proliferation of secretory tissue. what happens to fibrofatty tissue
becomes sparse
93
composition of breast milk?
88% water, 7% carb, 3.5% fat, 1.5% protein
94
also contains?
vitamins, ions, IgA
95
what sort of secretion for lipids?
apocrine, takes a bit of cytoplasm with it
96
proteins in milk made by ?
rER
97
packaged in ?
the golgi
98
which type of secretion for proteins?
merocrine, secretion, merge with the apical membrane
99
following menopause, the secretory cells of TDLU degenerate leaving only ducts. in connective tissue there is reduced ______ and _______? fewer of which cell type
collagen and elastic fibres, fibroblasts
100
histopathology - tissue
| cytology cells
B1-b5
| c1 - c5
101
what would you do to establish hormone receptor status?
biopsy
102
causes of gynaecomastia?
hormones, cannabis, prescription drugs, liver disease, hyperthyroid, renal disease, puberty, idiopathic
103
describe the growth?
ductal growth with no lobular growth?
104
lumpy rope like change?
fibrocystic change
105
pain, tenderness, lumpiness in pre menopausal woman. sudden pain, both breasts, cyclical pain, smooth discrete lumps?
FCC
106
describe cysts?
1mm blue domed with pale fluid, sisal multiple. cysts are thin walled but may have fibrotic wall. lined by apocrine epithelium
107
management?
exclude malignancy, reassure, excise if necessary (aspirate)
108
what percentage of cysts are associated with malignancy?
1-2 percent
109
circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribtion/
hamartoma
110
black woman in 20s, solitary painless firm discrete mobile mass?
fibroadeoma. circumscribed, rubbery, grey white colour.
111
management of fibroadenoma?
diagnose, reassure, excise
112
when do you excise it?
if it is abnormal shape, enlarging or don't know what it is
113
type of sclerosis. benign disorderly proliferation of acini and stroma. pain, tenderness, lumpiness, may cause calcification?
sclerosing adenosis
114
radial scar - buzzwords?
stellate architecture, central puckering, fibroelastic core, radiating, epithelial proliferation, distorted ductules, fibrocystic change
115
what may develop within these lesions?
cancer
116
are these types of sclerosis pre malignant?
no
117
fat necrosis - path?
trauma, damage to adipcytes, foamy macrophage infiltration - scarring and fibrosis
118
duct ectasia - which ducts does it affect?
sub areolar
119
pain?
yes
120
most common cause of?
green discharge
121
acute episodic inflammatory changes
y
122
associated with? what can happen to the nipple?
smoking, retraction and distortion
123
what happens to the sub areolar ducts?
dilation, also become inflamed and fobrosed
124
management?
treat infections, exclude maignancy, stop smoking. can excise if necessary
125
2 main aetiologies of abcess/mastitis
duct ectasia and breast feeding
126
management
CONTINUE BREAST FEEDING, antibiotics (flucloxacillin/co amoxixillin) drainage or incision and drainage
127
management
CONTINUE BREAST FEEDING, antibiotics (flucloxacillin/amoxixillin) drainage or incision and drainage
128
what is storm of breast?
connective tissue and fat, not glandular tissue
129
unilateral breast mass, doesn't metastasis, benign, prime to local recurrence, leaf shaped?
phyllodes tumour
130
papillary lesions, can they cause blood nipple discharge?
yes
131
painful?
usually no, asymptomatic at screening
132
nodules may be calcified
core is fibrovascular, may show proliferative activity, myoepithelium and epithelium
133
pathway of intraduct papilloma?
none, usual type hyperplasia, atypical hyperplasia, dcis
134
breast carcinoma arises from which epithelium?
glandular
135
metastatic tumours to breast come from?
kidneys, lungs, ovaries
136
in situ carcinomas can be lobular or ductal
arise in the glandular epithelium of the terminal duct lobular unit
137
2 types of lobular neoplasia?
atypical lobular hyperplasia, lobular carc in sit (>50%)
138
describle neoplasia
er positive, e cad negative, intracytoplasmic lumens/vaculoes, small/intermediate sized nuclei. MULTIFOCAL AND BILATERAL.
139
DCIS tends to be unicentric
involvement of the nipple in DCIS is known as pagets
140
what nipple symptoms do you get in pagets?
redness, scaling and flaking of nipple
141
lobular neoplasia, palpable? calcium?
not palpable, but visible grossly. may calcify
142
why is lobular neoplasia significant?
8 x rr of invasive carcinoma, 15-20 percent when you investigate them they have higher grade lesion than diagnostic biopsy
143
high grade DCIS can extend along the ducts to reach the epidermis of nipple
pagets
144
most common invasive breast cancer?
ductal 80 percent, lobular 10 percent
145
risk factors for breast cancer/
age, age at first menarche, age at first birth, age at menopause, hrt, cocp, alcohol , obesity, smoking, BRACA 1 and 2
146
BRACA 1 and 2 - lifetime risk of breast cancer?
45 - 64 percent lifetime risk
147
DCIS management?
excise and radiotherapy
148
what staging system is used in breast cancer?
TNM t = local invasion
149
pathological assessment breast cancer?
TGSPP (prognostic and predictive)
150
well differentiated - good prognosis - cells similar
poorly differentiated - cells different - bad prognosis
151
3 grading parts?
tubular differentiation 1-3 nuclear polymorphism 1-3 mitotic activiy 1-3
152
drug that blocks oestrogen receptor in breast?
tamoxifen
153
how can you reduce amount of oestrogen?
gnRH antagonists, aromitast inhibitors (TAG OOPH) also oophrectomy
154
name an aromatase inhibitor?
letrozole (aroma to let)
155
gnrh antagonists
go zo
156
percentage of breast cancers that are er positive?
80
157
HER 2?
14
158
scoring used in prognostic/predict?
nottingham
159
nottingham eqn?
0.2 x tumour diameter x grade x lymph node status
160
first degree relative with breast cancer doubles risk
why does obesity predispose to breast cancer? adipocytes convert androgens to oestrogens
161
radiotherapy treatment for what pre disposes to breast cancer
hodgkins lymphoma
162
presentation of breast cancer ?
LMNN - lump, mastalgia, nipple pain, nipple changes
163
why sensitivity of mamography reduced in young women?
presence of more glandular tissue
164
us good to differentiate between ?
solid and cystic lumps
165
which t would a tumour be if it was over 5 cm?
t3
166
distant mets of breast cancer?
other breast, liver, lungs, bone
167
benefits of chemo better in who?
young women
168
who gets radiotherapy after excision?
WLE, mastectomy if local spread, large tumour, lymph node mets (extensive)
169
who gets radiotherapy after excision?
WLE, mastectomy if local spread, large tumour, lymph node mets
170
side effects of radio?
telangactasia, pneumonitis, dysphagia, osteonecrosis
171
tamoxifen - action?
blocks estrogen receptor in breast
172
effective in what age group?
all
173
less or more effective in her 2 positive?
less
174
more effective when?
when given after chemo
175
aromatase inhibitors - name 1
letrozole
176
action?
inhibit estrogen synthesis
177
side effect?
osteoperosis
178
side effect?
osteoperosis
179
2 ligaments of the pelvis?
sacrospinous and sacrotuberous
180
if you get life threatening haemorrhage after pelvic fracture, which vessels are likely affected?
common iliac artery/vein
181
do you want the station to be positive or negative
positive
182
describe medulla of ovary?
highly vascularised, connective tissue, nerves, lymphatics
183
what is the name of the group of arteries that enter hilum from broad ligament and supply blood to the ovary?
helicine
184
dense connective tissue in the penis?
tunica albuginea
185
name for the development of oocytes?
oogenesis
186
growth of follicle term?
folliculogenesis
187
loss of oogonia and oocytes by apoptosis?
atresia
188
what happens to folic if it fails to associate with pregranulosa cells?
die
189
what are pregranulosa cells like? what happens to them if the follicle enters growth phase?
squamous, become cuboidal
190
what do you call cuboidal granulosa cells?
zona granulosa
191
layer of specialised extracellular matrix between oocyte and granolas cells?
zona pellucida
192
what cells associate with the outside of the folic?
stroma cells
193
what do they go on to become?
theca (interna and externa)
194
which layer of the theca secrete oestrogen precursors?
inner
195
which cells convert the precursors to esrogen?
granulosa cells
196
name of strucure, filled with follicular fluid which starts to form?
antrum
197
after ovulation, follicle transforms into?
CL
198
which cells of the corpus lute secrete oestrogen and progesterone?
theca and granulosa
199
if no implantation, CL becomes?
corpus albicans
200
what colour is the corpus albicans?
white
201
if implantation occurs, placenta secretes HCG. what is the effect of this?
prevents CL degeneration
202
the corpus lute maintains progesterone levels, and so maintains the pregnancy
ie corpus lute needs HCG
203
name sites of uterine tubes (fun to as it is)
infundibulum, ampulla, isthmus, interstital part
204
where does fertilisation usually occur?
ampulla
205
in over 40s?
mammogram
206
which layer of the endometrium contains 3 layers of smooth muscle, with collagen and elastic tissue?
myometrium
207
which layer shed during menstruation?
endometrium
208
2 layers of endometrium?
striatum basalis and stratum functionalis
209
which part is grown and shed?
f
210
during secretory phase, describe the appearance of the glands? what do they secrete?
coiled with corkscrew appearance. glycogen
211
what is glycogen converted into in the vagina? by what?
lactic acid by commensal bacteria
212
describe mucus in proliferative phase and following ovulation?
thin and watery in proliferative phase, thick and viscous following ovulation
213
4 layers of the vagina?
NLFA - i hop - non keratinised stratified squamous epithelium, lamina propria, fibromuscular layer, adventitia
214
vagina lubricated by cervical mucous and ?
fluid from thin walled vessels in lamina propria
215
contains 2 tubes of erectile vascular tissue?
clitoris
216
minora, which has only sebacsous glands, wad which has both sebaceous and apocrine
minora only s, majora has s and a
217
what does FSH stimulate?
follicle development and granolas cells to produce oestrogen
218
dominant follicles release what substance which inhibits FSH?
inhibin
219
decline in FSH causes?
atresia of all but dominant follicle
220
term for degeneration of corpus luteum?
luteolysis
221
estrogen induced growth of endometrial glands, which phase?
proliferative phase
222
what happens in L phase?
secretory activity
223
which process inhibits scar formation in menstruation?
fibrinolysis (breakdown of clots)
224
how many days does bleeding usually last ?
4-6
225
should there be clots?
no
226
variation of days in normal cycle?
21-35 days
227
menorrhagia?
prolonged and increased menstrual flow
228
RAGE PI
y
229
metrorrhagia
regular intermenstrual bleeding
230
increased bleeding and frequent cycle?
polymenorrhagia
231
polymenorrhoea - menses occurring at?
less than 21 day intervals
232
menometrorrhagia?
prolonged menses and intermenstrual bleeding
233
oligomenorrhoea?
menses at intervals of more than 35 days
234
how long do you need absence of periods to be amennorheic?
6 months
235
DUBs are all to do with?
corpus luteum
236
what percentage of women with abnormal uterine bleeding have DUB?
50
237
both anovulatory and ovulatory have a deficiency of?
prog
238
85% are an/ov?
anovulatory
239
which one more common in obesity?
anovulatory
240
what ages do you expect to get anovulatry?
extremes of fertility, 20 and 40
241
management of DUB? (pro foo, dan, pillh, NSAID, GnRH analogues, capillary wall stabilisers)
PROGESTERONE
242
2 alternatives that release progesterone?
IUCD or IUS
243
which hormone converts endometrium to secretory stage to prepare for implantation?
pro
244
can also do resection or ablation for DUB
y
245
infertility - female should take 0.4mg folic acid for how long before conception?
12 weeks
246
mild or moderate endometriosis, what fertility treatment can be offered? also for unexplained fertility?
IUI
247
Indications for IVF?
unexplained 2 year duration, pelvic disease, anovulatory, male factor infertility
248
which drug used to down regulate GnRH?
buretin
249
side effects?
hot flushes, mood swings, nasal irritation, headaches
250
what should endometrium look like following this?
thin
251
how is ovary stimulated?
gnrh
252
side effects of ovarian stimulation?
mild allergic reactions and ovarian hyperstimulation syndrome (OHSS)
253
what is injected to mimic LH surge 36 hours before egg collection?
HCG
254
no more than 2 embryos to be transferred in women less than 40. however, 3 can be transferred in special circumstances
y
255
after the transfter, what hormone is given?
prog
256
what complications can arise from sperm aspiration?
abdominal pain/bloating/nausea, diarrhoea, breathless
257
what is the chance of success in a woman under 35?
37%
258
over 41
0.5%
259
pathway of IVF?
down regulation using bretin (menopausal symptoms) - ovarian stimulation - scan - oocyte retrieval - embryo transfer - luteal support (progesterone)
260
complications of IVF?
ectopic pregnancy, OHSS, multiple pregnancies
261
in breast, i larger ducts, epithelial lining is?
columnar
262
in smaller i.e. acini, its?
columnar or cuboidal
263
keratinised stratified squamous epithelium with a curve of dense irregular connective tissue mixed with bundles of smooth muscle?
nipple
264
in absence of pregnancy, what happens to lumina of ducts and epithelial cells in luteal phase?
lamina increases, epithelial cells increase in height
265
if pregnancy occurs, you get elongation and branching of the smaller ducts
y
266
also proliferation of the epithelial cells of the glands and the myoepithelial cells
y
267
in pregnancy, 2nd trimester, which cells infiltrate the connective tissue?
plasma and lymphocytes
268
during pregnancy, E and P stimulate proliferation of secretory tissue. what happens to fibrofatty tissue
becomes sparse
269
composition of breast milk?
88% water, 7% carb, 3.5% fat, 1.5% protein
270
also contains?
vitamins, ions, IgA
271
what sort of secretion for lipids?
apocrine, takes a bit of cytoplasm with it
272
proteins in milk made by ?
rER
273
packaged in ?
the golgi
274
which type of secretion for proteins?
merocrine, secretion, merge with the apical membrane
275
following menopause, the secretory cells of TDLU degenerate leaving only ducts. in connective tissue there is reduced ______ and _______? fewer of which cell type
collagen and elastic fibres, fibroblasts
276
histopathology - tissue
| cytology cells
B1-b5
| c1 - c5
277
what would you do to establish hormone receptor status?
biopsy
278
causes of gynaecomastia?
hormones, cannabis, prescription drugs, liver disease, hyperthyroid, renal disease, puberty, idiopathic
279
describe the growth?
ductal growth with no lobular growth?
280
lumpy rope like change?
fibrocystic change
281
pain, tenderness, lumpiness in pre menopausal woman. sudden pain, both breasts, cyclical pain, smooth discrete lumps?
FCC
282
describe cysts?
1mm blue domed with pale fluid, sisal multiple. cysts are thin walled but may have fibrotic wall. lined by apocrine epithelium
283
management?
exclude malignancy, reassure, excise if necessary (aspirate)
284
what percentage of cysts are associated with malignancy?
1-2 percent
285
circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribtion/
hamartoma
286
black woman in 20s, solitary painless firm discrete mobile mass?
fibroadeoma. circumscribed, rubbery, grey white colour.
287
management of fibroadenoma?
diagnose, reassure, excise
288
when do you excise it?
if it is abnormal shape, enlarging or don't know what it is
289
type of sclerosis. benign disorderly proliferation of acini and stroma. pain, tenderness, lumpiness, may cause calcification?
sclerosing adenosis
290
radial scar - buzzwords?
stellate architecture, central puckering, fibroelastic core, radiating, epithelial proliferation, distorted ductules, fibrocystic change
291
what may develop within these lesions?
cancer
292
are these types of sclerosis pre malignant?
no
293
fat necrosis - path?
trauma, damage to adipcytes, foamy macrophage infiltration - scarring and fibrosis
294
duct ectasia - which ducts does it affect?
sub areolar
295
pain?
yes
296
most common cause of?
green discharge
297
acute episodic inflammatory changes
y
298
associated with? what can happen to the nipple?
smoking, retraction and distortion
299
what happens to the sub areolar ducts?
dilation, also become inflamed and fobrosed
300
management?
treat infections, exclude maignancy, stop smoking. can excise if necessary
301
2 main aetiologies of abcess/mastitis
duct ectasia and breast feeding
302
which bacteria are involved in both?
mixed organisms anaerobes in duct
| strep pyogenes in breast feeding
303
management
CONTINUE BREAST FEEDING, antibiotics (flucloxacillin/amoxixillin) drainage or incision and drainage
304
what is storm of breast?
connective tissue and fat, not glandular tissue
305
unilateral breast mass, doesn't metastasis, benign, prime to local recurrence, leaf shaped?
phyllodes tumour
306
papillary lesions, can they cause blood nipple discharge?
yes
307
painful?
usually no, asymptomatic at screening
308
nodules may be calcified
core is fibrovascular, may show proliferative activity, myoepithelium and epithelium
309
pathway of intraduct papilloma?
none, usual type hyperplasia, atypical hyperplasia, dcis
310
breast carcinoma arises from which epithelium?
glandular
311
metastatic tumours to breast come from?
kidneys, lungs, ovaries
312
in situ carcinomas can be lobular or ductal
arise in the glandular epithelium of the terminal duct lobular unit
313
2 types of lobular neoplasia?
atypical lobular hyperplasia, lobular carc in sit (>50%)
314
describle neoplasia
er positive, e cad negative, intracytoplasmic lumens/vaculoes, small/intermediate sized nuclei. MULTIFOCAL AND BILATERAL.
315
DCIS tends to be unicentric
involvement of the nipple in DCIS is known as pagets
316
what nipple symptoms do you get in pagets?
redness, scaling and flaking of nipple
317
lobular neoplasia, palpable? calcium?
not palpable, but visible grossly. may calcify
318
why is lobular neoplasia significant?
8 x rr of invasive carcinoma, 15-20 percent when you investigate them they have higher grade lesion than diagnostic biopsy
319
high grade DCIS can extend along the ducts to reach the epidermis of nipple
pagets
320
most common invasive breast cancer?
ductal 80 percent, lobular 10 percent
321
risk factors for breast cancer/
age, age at first menarche, age at first birth, age at menopause, hrt, cocp, alcohol , obesity, smoking, BRACA 1 and 2
322
BRACA 1 and 2 - lifetime risk of breast cancer?
45 - 64 percent lifetime risk
323
DCIS management?
excise and radiotherapy
324
what staging system is used in breast cancer?
TNM t = local invasion
325
pathological assessment breast cancer?
TGSPP (prognostic and predictive)
326
well differentiated - good prognosis - cells similar
poorly differentiated - cells different - bad prognosis
327
3 grading parts?
tubular differentiation 1-3 nuclear polymorphism 1-3 mitotic activiy 1-3
328
drug that blocks oestrogen receptor in breast?
tamoxifen
329
how can you reduce amount of oestrogen?
gnRH antagonists, aromitast inhibitors (TAG OOPH) also oophrectomy
330
name an aromatase inhibitor?
letrozole (aroma to let)
331
gnrh antagonists
go zo
332
percentage of breast cancers that are er positive?
80
333
HER 2?
14
334
scoring used in prognostic/predict?
nottingham
335
nottingham eqn?
0.2 x tumour diameter x grade x lymph node status
336
first degree relative with breast cancer doubles risk
why does obesity predispose to breast cancer? adipocytes convert androgens to oestrogens
337
radiotherapy treatment for what pre disposes to breast cancer
hodgkins lymphoma
338
presentation of breast cancer ?
LMNN - lump, mastalgia, nipple pain, nipple changes
339
why sensitivity of mamography reduced in young women?
presence of more glandular tissue
340
us good to differentiate between ?
solid and cystic lumps
341
which t would a tumour be if it was over 5 cm?
t3
342
distant mets of breast cancer?
other breast, liver, lungs, bone
343
benefits of chemo better in who?
young women
344
3 chemos?
taxane, CMF, anthra cycline CAT
345
who gets radiotherapy after excision?
WLE, mastectomy if local spread, large tumour, lymph node mets
346
side effects of radio?
telangactasia, pneumonitis, dysphagia, osteonecrosis
347
tamoxifen - action?
blocks estrogen receptor in breast
348
effective in what age group?
all
349
less or more effective in her 2 positive?
less
350
more effective when?
when given after chemo
351
aromatase inhibitors - name 1
letrozole
352
action?
inhibit estrogen synthesis
353
more effective in which group?
her 2 positive
354
side effect?
osteoperosis
355
premenopausal, discomfort, fulness, cyclical pain, classically outer half of breast?
cyclical pain
356
does cycle pain have to be bilateral?
no can be unilateral
357
older woman, post m, burning pain, can arise from chest wall, breast or outside breast?
non cyclical
358
management of duct papilloma?
microdochectomy or full duct excision
359
mastalgia initial management?
reassure, well fitted bra, nsaids
360
if severe?
consider primrose oil, gamolenic acid, or DANAZOL - best
361
side effects of danazol?
weight gain, acne and hirsutism. can also use bromocriptine and tamoxifen
362
if bilateral milky discharge?
galactorrhoea, chceck prolactin levels for pituitary tumour
363
what can cause symtomatic improvement in gynaecomastia?
tamixifen and danazol
364
persistent breast access?
incise and drain
365
periductal mastitis - hot to the touch, skin may appear reddened, breast is tender. treatment?
aspirate and antibiotics or incision and drainage
366
common in who?
female smokers
367
breasts lie between which ribs?
2 and 6
368
lower part of breast overlies?
serratus anterior
369
only technique that reliably shows micro calcifications?
mamography
370
mamography - maximal contrast with minimal radiation dose
digital is much clearer, also better for dense breasts
371
how should lymph nodes look?
oval/horseshoe with fatty hilum
372
craniocaudal?
horizontal
373
MLO, magnification views fr?
microcalcification
374
scoring system used for fat in breasts?
BIRADS
375
internal echo suggestive of?
malignancy
376
hypoechoic - malignant cells absorb the radiation and there are no echoes back
benign can be hypo or hyper echoic
377
wider than tall, well circumscribed, homogenous, no vascularity?
benign
378
malignant?
poorly circumscribed, heterozygous, fat/oedema, speculated, hypoechoic
379
why is MRI good?
no ionising radiation
380
what imaging is used for screening in high risk?
MRI
381
in younger women what is best imaging?
US
382
in over 40s?
mammogram
383
chemo can shrink tumour, some overall survival advantage for younger patients if chemo pre surgery
y
384
radiotherapy reduces risk of local recurrence by?
2/3
385
cardiac damage can be a late effect of radio)
chemo side effects - nausea and vomiting, infertility, alopecia, neutopaenia, mouth ulcers, lassitude (tired, no energy)
386
what can be given in her 2 positive?
trastuzamab
387
bony mets?
biphosphonates
