Breast and Endocrine

Question 1

indications of mastectomy

Answer 1

multifocal tumor
central
large lesion small breast
dcis >4cm
patient choice

Question 2

wide local excision indications

Answer 2

solitary tumor
peripheral tumor
small lesion large breast
dcis <4cm
pt choice

Question 3

post thyroidectomy sudden dyspnoea

Answer 3

tracheomalacia ( long standing very large goitre)
contained hematoma (reactionary hemprrhage)

Question 4

mx of contained hematoma

Answer 4

urgent wound decompression in all layers before return to theatre

Question 5

breast lump inv in order

Answer 5

examination
uss/mammogram
core biopsy if indeterminate excision biopsy

Question 6

mx of breast ca axillary disease

Answer 6

fnac positive
axillary nodal clearance

if negative
sentinal lymph node biopsy

Question 7

mc breast ca

Answer 7

invasive ductal ca

Question 8

ioc for breast implant

Answer 8

mri
linguini sign in rupture

Question 9

thyroid ca spread

Answer 9

papillary- lymphatics
follicular- hematogenous
medullary- lymphatics
anaplastic- locally invasive

Question 10

men 1

Answer 10

3 p

parathyroid hyperplasia
pituitary tumour
pancreatic tumour ( ze syndrome, insulinoma)

Question 11

men 2a
sipple syndrome

Answer 11

2pm

parathyroid hyperplasia
pheochromocytoma
medullary thyroid cancer

Question 12

men 2b

Answer 12

3mp

marfanoid habitus
medullary thyroid cancer
mucosal neuroma
pheochromocytoma

Question 13

radiation in breast cancer

Answer 13

wide local excision
large lesion
high grade vascular invasion

Question 14

chemo in breast ca

Answer 14

downstaging in bcs
axillary nodal disease
grade three breast ca

Question 15

sick euthyroid sx

Answer 15

h/o of hospital stay/icu/major surgery
tsh low t4 low

Question 16

mx of thyroid ca

Answer 16

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

Question 17

familial hypocalciuric hypercalcemia

Answer 17

ca high
pth high
urine ca low
mg high

Question 18

nipple discharge and breast disease

Answer 18

cheesy - duct ectasia
blood stained- papilloma
milky- galactorrhoea

Question 19

incidentaloma

Answer 19

adrenal adenoma
benign non functioning
hormonal assay and surveillance
if malignant adrenalectomy

Question 20

drugs causing gynaecomastia

Answer 20

disco afmc

digitalis
isoniazid
spironolactone
cimetidine
oestrogen

anabolic steroids
finasteride
methyldopa
cannabis

Question 21

waterhouse friderichesen syndrome

Answer 21

adrenal gland failure
menningococcal septicemia

Question 22

mammogram breast cyst

Answer 22

halo sign

Question 23

ductal papilloma surgery

Answer 23

microdochectomy

Question 24

ductal atresia surgery

Answer 24

hadfields procedure

Question 25

her 2 receptor positive

Answer 25

trastuzumab

Question 26

estrogen therapy for breast ca

Answer 26

pre menopausal - tamoxifen
post menopausal - anastrazole

Question 27

chrons disease biological agent

Answer 27

tnf alpha inhibitor

Question 28

recurrence of papillary ca thyroid

Answer 28

anti thyroglobulin antibodies

Question 29

thyroid peroxidase antibodies

Answer 29

anti microsomal antibodies
hashimotos thyroiditis

Question 30

tsh receptor antibodies

Answer 30

graves disease

Question 31

calcitonin

Answer 31

medullary thyroid ca

Question 32

hot nodule

Answer 32

toxoc adenoma

Question 33

identification of parathyroid glands intra operatively

Answer 33

methylene blue dye

Question 34

ct scan finding of benign adrenal adenoma

Answer 34

lipid rich core

Question 35

brca

Answer 35

brca 1 - 17 chromosome
brca 2 - 13 chromosome

Question 36

cah

Answer 36

21 hydroxylase deficiency
pseudohermaphroditism in female
precocious puberty in male

Question 37

whipples triad

Answer 37

insulinoma
symptoms broght on by fasting
hypoglycemia
improve with glucose administration

Question 38

breast lymph nodes

Answer 38

1- inferior and lateral to pectoralis minor
2- posterior
3- medial (full clearance)

Question 39

nelson syndrome

Answer 39

bilateral adrenalectomy for cushings
acth secreting pituitary adenoma
symptoms vision loss, hypopituitarism, headache

Question 40

lymphatic drainage of breast

Answer 40

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

Question 41

pheochromocytoma inv

Answer 41

1st - 24 hr urinary vma
2nd line - clonidine supression test

mibg very specefic
extra adrenal or recurrence

Question 42

brca testing

Answer 42

all women <50 with triple negative breast ca

Question 43

acromegally test

Answer 43

1st igf 1
2nd oral glucose tolerance and growth hormone

Question 44

conns syndrome

Answer 44

1 hyperaldosteronism
adrenal adenoma
adrenal hyperplasia
adrenal carcinoma

features harps

htn
high aldosterone
low renin
high potassium
high sodium

Question 45

gitelmans syndrome

Answer 45

hyperkalemia without hypertension
hypokalemic metabolic alkalosis
hypocalciuria
hypokagnesemia
increased plasma renin activity

Question 46

liddle syndrome

Answer 46

hypokalemia with hypertension
decreased plasma renin activity

Question 47

tnm staging breast ca

Answer 47

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

Question 48

nottingham prognostic criteria

Answer 48

npi= 0.2x tumour diameter in cm + tumour grade + ln stage

Question 49

migratory necrolytic erythema

Answer 49

glucaganoma

Question 50

pedicled myocutaneos flap

Answer 50

diep gold standard
tram
ld- thoracodorsal is blood supply