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Surgery Revision > Breast and Endocrine > Flashcards

Breast and Endocrine Flashcards

1
Q

What does ANDI stand for?

A

Abnormalities of normal development and involution

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2
Q

4 reproductive phases of a woman’s life

A
  • development
  • cyclical change
  • pregnancy
  • involution
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3
Q

Benign breast issues by age

A

15-30: fibroadenoma
20s + 30s: mastalgia and lumpiness
30s + 40s: cystic changes
65+: cancer

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4
Q

Object of aspirating a breast cyst

A
  • excluding a solid lesion

- relieve pain

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5
Q

Worrying features after cyst aspiration

A
  • blood stained fluid
  • residual mass

(no cytology needed unless blood stained)

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6
Q

Definition of mastalgia

A

Any pain (tenderness, fullness, aching) felt in the breast

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7
Q

2 types of mastalgia

A
  • cyclical bilateral

- non-cyclical focal

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8
Q

Possible anti-oestrogen meds for severe cases of mastalgia

A
  • danazol 100mg
  • tamoxifen 10mg

for 3 months

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9
Q

Treatment of post partum breast infection

A

Flucloxacillin or erythromycin

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10
Q

Clinical features of periductal mastitis

A
  • retro and peri-areolar inflammation
  • oedema
  • nipple retraction
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11
Q

Treatment of periductal mastitis

A
  • co-amoxiclav for 2 weeks
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12
Q

What are fibroadenomas?

A

NOT NEOPLASMS

- fibrous overgrowths of a single lobule

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13
Q

What are giant fibroadenomas?

A

> 5cm

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14
Q

Clinical features of fibroadenomas

A
  • painless
  • well defined
  • very mobile
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15
Q

How does treatment of fibroadenoma change with age?

A
  • over 25, need triple testing

- over 35, need histological diagnosis

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16
Q

What is triple testing?

A
  • clinical exam
  • cytology
  • mammogram/US
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17
Q

Susupicious features of a nipple discharge

A
  • spontaneous
  • single duct
  • blood stained
  • unilateral
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18
Q

What to do if a nipple discharge is suspect

A
  • microdocotomy
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19
Q

Causes of gynaecomastia

A

Physiological

  • neonatal
  • puberty
  • old age

Drugs

  • oestrogen
  • digoxin
  • steroids

Liver failure

Rare tumours (testes, adrenal)

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20
Q

Risk factors for breast cancer

A
  • female
  • advancing age
  • family history
  • irradiation
  • BRCA1/2
  • wide ostrogen window
  • few/no children
  • late birth of first child
  • HRT
  • OCP
  • smoking
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21
Q

Symptoms of breast cancer

A
  • painless lump
  • change in appearance
  • nipple discharge
  • Paget’s
  • extramammary mets
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22
Q

Signs of breast cancer

A
  • mammographic lesion
  • nipple discharge
  • thickened area/ shelving mass
  • overlying skin dimpling/ ulceration
  • nipple retraction
  • visible mass
  • fixity to underlying msucle
  • skin oedema
  • palpable axillary nodes
  • supraclavicular glands
  • symptomatic mets
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23
Q

Features of breast malignancy on mammogram

A
  • microcalcifications
  • density with surrounding spiculation
  • distortion of breast architecture
  • tethering
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24
Q

Indications for mammography in patients with proven cancer

A
  • to exclude multi-centric/contralat disease
  • to exclude DCIS
  • follow up
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25
Q

Indications for mammography in patients with clinical problems

A
  • discrete mass in women >30
  • vague thickening in women <30
  • single nipple discharge
  • focal mastalgia
  • unexplained nipple retraction
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26
Q

3 categories of primary breast cancers

A
  • non-invasive epithelial cancers (carcinoma in situ)
  • invasive epithelial cancers
  • mixed connective and epithelial
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27
Q

Most common breast cancer

A

Infiltrating ductal carcinoma

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28
Q

Met screen in breast cancer

A

All patients:

  • CSR
  • LFTs

If LFTs abnormal
- liver US

If >T3
- bone scan

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29
Q

Hormone modifying drugs used in breast cancer

A
  • tamoxifen

- Herceptin

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30
Q

Therapy option in breast cancer

A
  • surgery
  • radiotherapy
  • chemotherapy
  • endocrine manipulation
  • biological treatment
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31
Q

Surgical options for breast surgery

A
  • total mastectomy

- wide local excision

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32
Q

Patients suitable for a WLE

A
  • tumour size <5cm, single lesion
  • large breast (only 10% should be removed)
  • outer quadrants
  • no family history
  • no multifocal disease
  • willing to receive 6 weeks of adjuvant radiotherapy
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33
Q

Options for axillary lymph node surgery

A
  • axillary nodal clearance

- sentinel lymph node biopsy

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34
Q

Patients suitable for sentinel lymph node biopsy

A
  • T1/2
  • no palpable lymph nodes
  • no prior axillary surgery, irradiation or chemo
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35
Q

How is sentinel node biopsy done?

A
  • want to remove first draining node
  • technetium injected around the tumour 24 hours prior
  • detected with gamma rays
  • node is detected and sent for frozen section
36
Q

Endocrine manipulation options for pre-menopausal women

A
  • tamoxifen (ER receptor competitor)
  • LHRH agonist (Zoladex)
  • progesterones
  • oopherectomy (rare)
37
Q

Endocrine manipulation options for post-menopausal women

A
  • aromatase inhibitors
  • tamoxifen
  • pregesterones
38
Q

What is a biological modifiers used in breast cancer?

A

Trastuzumab

- for Her-2-neu positive patients

39
Q

What is Pagets?

A

Intraductal carcinoma which invades the skin

  • mimics eczema
  • always involves the nipple and then moves to areola
  • diagnose with punch biopsy
40
Q

What is inflammatory breast cancer?

A
  • locally advanced carcinoma which mimics cellulitis/ abscess
  • red, hot, with rapid course
  • dermal lymphatic invasion
  • needs aggressive neoadjuvant chemo
41
Q

Causes of a goitre

A
  • multinodular
  • physiological
  • throiditis
  • thyroid carcinoma
42
Q

Causes of a solitary nodule

A
  • hyperplastic/adenomatous nodule
  • simple cyst
  • follicular adenoma
  • thryoid carcinoma
43
Q

Bethesda classification

A 
1 = non- diagnostic
2 = benign
3 = indeterminate
4 = suspicious for follicular neoplasm
5 = suspicious for malignancy
6 = malignant
44
Q

Modes of investigation for nodular thyromegaly

A
  • US
  • apiration cytology
  • radio-isotope scanning
  • CT scan
45
Q

US features of thyroid malignancy

A
  • hypoechogenic
  • increased vascularity
  • local lymphadenopathy
  • microcalcification
46
Q

Tumour marker for thyroid medullary carcinoma

A
  • calcitonin
47
Q

Features of a malignant thyroid mass

A
  • asymmetrical goiter/ solitary nodule in children/men
  • rapid onset
  • progressive increase in size
  • pain
  • local invasion
  • lymphadenopathy
  • hoarseness
48
Q

Types of thyroid carcinoma

A
  • well differentiated
  • medullary
  • anaplastic
  • lymphoma
49
Q

Types of well-differentiated thyroid carcinoma

A
  • papillary
  • follicular
  • mixed
50
Q

How does papillary thyroid carcinoma spread?

A

Lymph node spread

51
Q

How does follicular thyroid carcinoma spread?

A

Haematogenous

52
Q

Components of MEN2 syndrome

A
  • Medullary thyroid carcinoma
  • phaeochromocytoma
  • hyperparathyroidism
  • neurofibromatosis
53
Q

Common causes of thyrotoxicosis

A
  • Graves disease
  • Toxic multinodular goitre (Plummers)
  • Toxic solitary nodule (toxic adenoma)
54
Q

Rare causes of thyrotoxocosis

A
  • Excess TSH (pituitary)
  • Excess T4 (iatrogenic)
  • Excess iodine (Jod Basedow)
  • transient during thyroiditis
55
Q

Options for the management of thyrotoxicosis

A
  • Neomercazole
  • Propanolol
  • I131
  • surgery
56
Q

Complications of thyroid surgery

A

Structural

  • laryngeal nerve damage
  • laryngeal oedema
  • haemorrhage
  • thracheomalacia

Endocrine

  • hypoparathyroidism
  • hypothyroidism
  • thyroid crisis
57
Q

Function of the parathyroid glands

A

To maintain the body’s calcium and phosphate levels within a very narrow range so that the muscles and nerves can function properly

58
Q

Hormones that control calcium

A

PTH increases

Calcitonin decreases

59
Q

Causes of hypercalcaemia

A
  • disorders of the parathyroid glands
  • malignancy
  • vit D disorders
  • high bone turn over
  • renal disorders
60
Q

Clinical presentation of hypercalcaemia due to hyperparathyroidism

A
  • recurrent renal calculi
  • progressive bone density loss
  • pathological fractures
  • ill-defined musculo-skeletal complaints
  • neurocognitive impairment
  • unexplained abdo pain

(bones, stones, moans and groans)

61
Q

How does a hypercalcaemic crisis present?

A
  • rapidly rising calcium levels
  • polyuria
  • dehyrdration
  • confusion, coma, death
62
Q

Diagnosis of

primary hyperparathyroidism

A
  • elevated serum calcium
  • elevated parathyroid hormone
  • sestaMIBI scan
  • US
63
Q

Cause of secondary hyperparathyroidism

A
  • chronic renal failure
  • GIT malabsorption states

Phosphate retention and calcium deficiency stimulate glands to secrete PTH

Chronically depletes bone calcium stores

64
Q

Diagnosis of secondary hyperparathyroidism

A

Normal serum calcium levels

High levels of PTH

65
Q

Cause of tertiary hyperparathyroidism

A

Successful renal transplant with ongoing hypercalcaemia

66
Q

Features suggestive of Zollinger-Ellison Syndrome

A
  • recurrent ulcer
  • refractory ulcer
  • multiple ulcers
  • ulcers in unusual sites
  • ulcer and diarrhoea
  • ulcer and MEN syndrome
67
Q

Suggestive features of insulinoma

A
  • hypoglycaemia
  • neuroglycopenia
  • catecholamine release (sweating, palpitations)
68
Q

Other name of MEN1

A

Wermer’s Syndrome

  • pituitary
  • pancreas
  • hyperparathyroidism
69
Q

Other name of MEN 2a

A

Sipple syndrome

  • medullary thyroid cancer
  • phaeochromocytoma
  • hyperparathyroidism
70
Q

Other name of MEN2b

A

mucosal neuroma syndrome

  • medullary thyroid cancer
  • phaeochromocytoma
  • marganoid habitus
  • mucosal neuromas
71
Q

Causes of Cushing’s syndrome

A
  • steroids
  • pituitary
  • ectopic ACTH
  • adrenal (Adenoma/carcinoma)
72
Q

Clinical features of Cushing’s syndrome

A
  • central obesity
  • weakness, proximal myopathy
  • hypertension
  • skin changes
  • psych changes
  • amenorrhoea/impotence
  • osteoporosis
  • thirst/ polyuria
  • glucose intol
73
Q

What are phaechromocytomas?

A

Tumours of the adrenal medulla

- produce adrenalin and noradrenaline

74
Q

Syndromes that phaeochromocytoma is associated with

A
  • MEN2
  • neurofibromatosis
  • Von Hippel-Lindau syndrome
75
Q

Test for phaeochromocytoma

A

Urinary catecholamine

76
Q

Features of phaeochromocytoma

A
  • hypertension in the young
  • rapidly progressive hypertension
  • poorly controlled hypertension
  • paroxysmal attacks
77
Q

Treatment of phaeochromocytoma

A
  • alpha blockade with phenoxybenzamine or prazocin

- removal of the tumour

78
Q

What is Conn’s syndrome

A

An aldosterone secreting adenoma of the adrenal cortex

79
Q

When to suspect Conn’s syndrome

A
  • hypertension

- weakness (from hypokalaemia)

80
Q

Investigation of Conn’s syndrome

A
  • hypokalaemia and excessive urinary potassium secretion
  • excessive aldosterone secretion (blood and urine levels)
  • depressed renin levels
  • localization of the adenoma by CT scanning
81
Q

Surgically correctable hypertension

A
  • coarctation of the aorta
  • renovascular hypertension
  • phaeochromocytoma
  • Conn’s syndrome
  • Cushing’s syndrome
82
Q

What is adrenogenital syndrome

A

Increase in pituitary ACTH production

  • adrenocortical hyperplasia
  • inappropriate adrenal androgen secretion
83
Q

What is Addison’s disease

A

Desctruction of the adrenal gland by:

  • TB
  • autoimmune adrenalitis
  • metastatic disease
  • mineralocorticoid and glucocorticoid insufficiency
84
Q

Symptoms of Addison’s disease

A
  • fatigue
  • weight loss
  • anorexia
  • nausea and vomiting
  • abdo pain
  • diarrhoea
85
Q

Management of Addison’s disease

A
  • immediate administration of 4mg dexamethasone

Surgery Revision (8 decks)

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