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SHU > Breast-endocrine > Flashcards

Breast-endocrine Flashcards

1
Q

Fibroadenoma definition

A

Proliferation of stromal and epithelial tissue of the duct lobules

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2
Q

The most common breast tumour in women <35 years of age is:

A

fibroadenoma

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3
Q

Fibroadenoma development may be associated with:

A

increased levels of oestrogen

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4
Q

Clinical features of fibroadenoma include:

A

Well-defined, mobile mass that is most commonly solitary. Non-tender and rubbery in consistency.

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5
Q

Triple assessment of a breast lump includes:

A

Physical examination, imaging (mammography and/or ultrasound) and biopsy (FNA or CNB)

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6
Q

Ultrasound findings consistent with a fibroadenoma include:

A

A well-circumscribed oval or round hypoechoic solid mass

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7
Q

Mammography findings consistent with a fibroadenoma include:

A

A round mass with a well-defined border. May have popcorn-like calcifications.

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8
Q

Findings associated with fibroadenoma on biopsy include:

A

Fibrous and glandular tissue proliferation

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9
Q

Management of new palpable fibroadenomas in women >40yo:

A

Excisional biopsy even if benign on triple testing

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10
Q

Management of new palpable fibroadenomas in women <40yo that are benign on triple assessment:

A

Managed with either surgical excision or regular clinical and ultrasound review (according to patient preference)

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11
Q

Management of impalpable fibroadenomas that are benign on triple assessment:

A

Imaging surveillance (6-12 monthly)

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12
Q

Fibroadenomas greater than __-__cm in diameter should be considered for excisional biopsy regardless of patient age and triple testing results.

A

3-4cm

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13
Q

Indications for repeat biopsy on surveillance of a fibroadenoma include:

A

significant increase in size or development of atypical features

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14
Q

Prognosis of fibroadenoma

A

Most fibroadenomas are benign and have an excellent prognosis.

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15
Q

Intraductal papilloma definition

A

A tumour that arises from the epithelium of the lactiferous ducts

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16
Q

Intraductal papilloma has a peak incidence in which age range?

A

30-50 years old

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17
Q

The most common cause of bloody or serous nipple discharge is:

A

intraductal papilloma

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18
Q

Clinical features of intraductal papilloma include:

A

Bloody or serous nipple discharge. Palpable retro-areolar mass.

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19
Q

What region are intraductal papillomas most commonly found in?

A

The sub-areolar region, usually <1cm away from the nipple

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20
Q

Features of intraductal papilloma on breast ultrasound include:

A

A well-defined solid nodule or mass within a dilated lactiferous duct

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21
Q

Features of intraductal papilloma on core needle biopsy include:

A

Papillary structure with fibrovascular core covered by both epithelial and myoepithelial calls.

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22
Q

Peripheral intraductal papillomas may be associated with:

A

cellular atypia, DCIS or invasive breast cancer

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23
Q

Most intraductal papillomas are treated with:

A

microdochectomy

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24
Q

Microdochectomy definition

A

Removal of one or more of the lactiferous ducts of the breast

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25
Q

Risk of breast cancer is only increased with ____________ papilloma

A

multi-ductal

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26
Q

Lipoma definition

A

A soft and mobile benign adipose tumour with low malignant potential.

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27
Q

Clinical features of lipoma

A

Slow-growing, round, soft, rubbery lump. Non-tender.

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28
Q

Surgical excision of a lipoma can be considered in the following cases:

A

If the tumour causes pain, cosmetic reasons, if the tumour is rapidly-growing or firm on palpation

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29
Q

Phyllodes tumour definition

A

Rare fibroepithelial tumours that are comprised of both epithelial and stromal tissue.

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30
Q

Peak incidence of phyllodes tumour is in which age group?

A

40-50yo

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31
Q

Clinical features of phyllodes tumours

A

Painless, multinodular lump with an average size of 4-7cm. Variable growth rate.

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32
Q

Ultrasound findings in phyllodes tumours

A

Hypoechoic solid mass that may contain cysts

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33
Q

Biopsy findings in phyllodes tumours

A

Leaf-like architecture with papillary projections of epithelium-lined connective tissue (stroma)

34
Q

Phyllodes tumours can be histologically classified as:

A

Benign, borderline or malignant

35
Q

Management of benign phyllodes tumour

A

Surgical excision

36
Q

Management of borderline or malignant phyllodes tumour

A

Wide excision

37
Q

Phyllodes tumour prognosis

A

High risk of recurrence after excision. Borderline and malignant phyllodes tumours can metastasis haematogenously. Metastatic phyllodes tumour has a poor prognosis.

38
Q

Mastitis definition

A

Acute or chronic inflammation of the breast tissue

39
Q

Mastitis can be classified into:

A

Lactational and non-lactational mastitis

40
Q

The most common causative pathogen of mastitis is:

A

Staphylococcus aureus

41
Q

Risk factors for lactational mastitis include:

A

First child, poor feeding technique

42
Q

Lactational mastitis usually presents within which time period?

A

Within the first 3 months of breastfeeding or during weaning.

43
Q

Risk factors for non-lactational mastitis include:

A

Duct ectasia, tobacco smoking

44
Q

Tobacco smoking can predispose to non-lactational mastitis by:

A

Causing damage to the sub-areolar duct walls and predisposing to bacterial infections

45
Q

Clinical features of mastitis

A

Tender, firm, swollen, erythematous breast (generally unilateral). Systemic symptoms. Pain during breastfeeding. Reduced milk secretion. Possible reactive axillary lymphadenopathy.

46
Q

Breast milk culture is only indicated in patients with mastitis if:

A

there is an inadequate response to empiric antibiotic therapy or signs of severe infection.

47
Q

Imaging is only indicated in patients with mastitis if:

A

There is a poor response to empiric antibiotic therapy, for the exclusion of alternative diagnoses and for evaluation of complications

48
Q

The first line empiric antibiotic used for mastitis is:

A

An oral penicillinase-resistant penicillin such as dicloxacillin OR cephalexin

49
Q

Empiric antibiotic therapy for mastitis with risk factors for MRSA infection is:

A

Clindamycin OR trimethoprim-sulfamethoxazole

50
Q

Empiric antibiotic therapy for severe mastitis is:

A

IV vancomycin

51
Q

Pheochromocytoma definition

A

A catecholamine-secreting tumour that typically develops in the adrenal medulla

52
Q

Pheochromocytoma rule of 10s

A

10% are malignant, 10% are extra-adrenal, 10% are bilateral and 10% affect children

53
Q

The most common tumour of the adrenal medulla in adults is:

A

pheochromocytoma

54
Q

Pheochromocytoma is most common in which age group?

A

30-50yo

55
Q

Pheochromocytomas arise from:

A

chromaffin cells, which are derived from the neural crest

56
Q

Pheochromocytomas are characterised by excessive secretion of:

A

adrenaline and noradrenaline

57
Q

What percentage of pheochromocytomas are hereditary?

A

25%

58
Q

Which genes are implicated in formation of pheochromocytomas?

A

MEN2, NF1, VHL

59
Q

5 Ps of pheochromocytoma

A

Increased blood Pressure, head Pain, Perspiration, Palpitations, Pallor

60
Q

Triggers of episodic hypertension associated with pheochromocytoma include:

A

Foods high in tyramine and pressure on the tumour

61
Q

Starting beta-blockers before alpha-blockers in the setting of pheochromocytoma is contraindicated because:

A

doing so can trigger a life-threatening hypertensive crisis.
Beta-blockers cancel out the vasodilatory effect of peripheral beta-2 adrenoreceptors, potentially leading to unopposed alpha-adrenoreceptor stimulation and thereby causing vasoconstriction and increased blood pressure

62
Q

Surgical management of pheochromocytoma

A

Laparoscopic adrenalectomy

63
Q

Conn syndrome is also known as

A

primary hyperaldosteronism

64
Q

Conn syndrome definition

A

An excess of aldosterone caused by autonomous overproduction, typically due to adrenal hyperplasia or adrenal adenoma

65
Q

Conns syndrome has a prevalence of __-__% in hypertensive patients

A

5-12%

66
Q

Aldosterone is produced in which zone of the adrenal glands?

A

Zona glomerulosa

67
Q

Conn syndrome is most commonly due to the following conditions:

A

Bilateral idiopathic hyperplasia of the adrenal glands or aldosterone-producing adrenal adenoma

68
Q

Physiological aldosterone secretion is regulated by:

A

RAAS

69
Q

Physiological aldosterone secretion occurs in response to:

A

detection of low blood pressure in the kidneys

70
Q

Hyperaldosteronism results in hypertension via the following mechanism:

A

Elevated aldosterone → opens Na+ channels in the principal cells of the luminal membrane at the cortical collecting ducts of the kidneys → Na+ reabsorption and retention → water retention → hypertension

71
Q

Conns syndrome causes hypokalaemia via the following mechanism:

A

↑ Na+ reabsorption → electronegative lumen → electrical gradient through open K+ channels → ↑ K+ secretion → hypokalaemia

72
Q

Clinical features of Conns syndrome include:

A

Drug-resistant hypertension, fatigue, muscle weakness/cramping and headaches

73
Q

Indications for diagnostic evaluation of Conns syndrome include:

A

Resistant hypertension despite combination therapy with 3 antihypertensives and/or hypokalaemia

74
Q

The preferred screening modality for Conns syndrome is:

A

Aldosterone-to-renin ratio (ARR)

75
Q

Diagnostic testing for Conns syndrome includes:

A

Oral sodium loading test or saline infusion test (non-suppressible aldosterone is diagnostic)

76
Q

Imaging is indicated in Conns syndrome to:

A

exclude large tumours and help differentiate possible surgical candidates from non-surgical candidates.

77
Q

Indications for surgical management of Conns syndrome include:

A

Confirmed unilateral adrenal hyperaldosteronism

78
Q

If considering a laparoscopic unilateral adrenalectomy for management of Conns syndrome, the following should be considered:

A

Correction of hypokalaemia prior to surgery and monitoring for hyperkalaemia immediately following the surgery

79
Q

First-line medical management for Conns syndrome is:

A

Aldosterone receptor antagonists e.g. spironolactone

80
Q

The diagnostic tests for pheochromocytoma include:

A

Plasma free metanephrines or urinary fractionated metanephrines

SHU (7 decks)

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