Breast and Endocrine Flashcards
indications of mastectomy
multifocal tumor
central
large lesion small breast
dcis >4cm
patient choice
wide local excision indications
solitary tumor
peripheral tumor
small lesion large breast
dcis <4cm
pt choice
post thyroidectomy sudden dyspnoea
tracheomalacia ( long standing very large goitre)
contained hematoma (reactionary hemprrhage)
mx of contained hematoma
urgent wound decompression in all layers before return to theatre
breast lump inv in order
examination
uss/mammogram
core biopsy if indeterminate excision biopsy
mx of breast ca axillary disease
fnac positive
axillary nodal clearance
if negative
sentinal lymph node biopsy
mc breast ca
invasive ductal ca
ioc for breast implant
mri
linguini sign in rupture
thyroid ca spread
papillary- lymphatics
follicular- hematogenous
medullary- lymphatics
anaplastic- locally invasive
men 1
3 p
parathyroid hyperplasia
pituitary tumour
pancreatic tumour ( ze syndrome, insulinoma)
men 2a
sipple syndrome
2pm
parathyroid hyperplasia
pheochromocytoma
medullary thyroid cancer
men 2b
3mp
marfanoid habitus
medullary thyroid cancer
mucosal neuroma
pheochromocytoma
radiation in breast cancer
wide local excision
large lesion
high grade vascular invasion
chemo in breast ca
downstaging in bcs
axillary nodal disease
grade three breast ca
sick euthyroid sx
h/o of hospital stay/icu/major surgery
tsh low t4 low
mx of thyroid ca
papillary ca- total thyroidectomy with nodal clearance
follicular lesion - hemi
follicular ca - completion thyroidectomy
anaplastic - palliative radiotherapy
lymphoma - core biopsy, radiotherapy
persistent refilling cyst - hemithyroidectomy
graves- total if with eye signs
radioactive iodine or surgery if without eye signs
familial hypocalciuric hypercalcemia
ca high
pth high
urine ca low
mg high
nipple discharge and breast disease
cheesy - duct ectasia
blood stained- papilloma
milky- galactorrhoea
incidentaloma
adrenal adenoma
benign non functioning
hormonal assay and surveillance
if malignant adrenalectomy
drugs causing gynaecomastia
disco afmc
digitalis
isoniazid
spironolactone
cimetidine
oestrogen
anabolic steroids
finasteride
methyldopa
cannabis
waterhouse friderichesen syndrome
adrenal gland failure
menningococcal septicemia
mammogram breast cyst
halo sign
ductal papilloma surgery
microdochectomy
ductal atresia surgery
hadfields procedure
her 2 receptor positive
trastuzumab
estrogen therapy for breast ca
pre menopausal - tamoxifen
post menopausal - anastrazole
chrons disease biological agent
tnf alpha inhibitor
recurrence of papillary ca thyroid
anti thyroglobulin antibodies
thyroid peroxidase antibodies
anti microsomal antibodies
hashimotos thyroiditis
tsh receptor antibodies
graves disease
calcitonin
medullary thyroid ca
hot nodule
toxoc adenoma
identification of parathyroid glands intra operatively
methylene blue dye
ct scan finding of benign adrenal adenoma
lipid rich core
brca
brca 1 - 17 chromosome
brca 2 - 13 chromosome
cah
21 hydroxylase deficiency
pseudohermaphroditism in female
precocious puberty in male
whipples triad
insulinoma
symptoms broght on by fasting
hypoglycemia
improve with glucose administration
breast lymph nodes
1- inferior and lateral to pectoralis minor
2- posterior
3- medial (full clearance)
nelson syndrome
bilateral adrenalectomy for cushings
acth secreting pituitary adenoma
symptoms vision loss, hypopituitarism, headache
lymphatic drainage of breast
cross the midline and empty into c/l side
75% axillary lymph nodes
25% internal mammmary
left breast- thoracic duct - left subclavian
right- internal mammary
pheochromocytoma inv
1st - 24 hr urinary vma
2nd line - clonidine supression test
mibg very specefic
extra adrenal or recurrence
brca testing
all women <50 with triple negative breast ca
acromegally test
1st igf 1
2nd oral glucose tolerance and growth hormone
conns syndrome
1 hyperaldosteronism
adrenal adenoma
adrenal hyperplasia
adrenal carcinoma
features harps
htn
high aldosterone
low renin
high potassium
high sodium
gitelmans syndrome
hyperkalemia without hypertension
hypokalemic metabolic alkalosis
hypocalciuria
hypokagnesemia
increased plasma renin activity
liddle syndrome
hypokalemia with hypertension
decreased plasma renin activity
tnm staging breast ca
tis- cis
T1 - <2 cm
T2- >2cm but <5cm
T3- >5cm
T4- chest wall
N0 - no nodes
N1- axillary
N2-N3 nodes around breast
M0- no mets
M1- other organs
nottingham prognostic criteria
npi= 0.2x tumour diameter in cm + tumour grade + ln stage
migratory necrolytic erythema
glucaganoma
pedicled myocutaneos flap
diep gold standard
tram
ld- thoracodorsal is blood supply
