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302 > Case of Abnormal mammogram > Flashcards

Case of Abnormal mammogram Flashcards

1
Q

national breast screening service

A

every 3 years between 50-70 registered as female

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2
Q

images are read by?

A

2 readers

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3
Q

outcome of mammogram?

A

routine recall, technical recall ( blurry), clinical recall female waited until appointement despite mammogram being normal, abnormal mammogram

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4
Q

xrays of breast?

A

4 standard views
craniocaudal view
mediolateral oblique

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5
Q

what biopsy do you take imaging for microcalcification?

A

stereotactic biopsy

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6
Q

ductal cell in situ is?

A

malignant proliferation of epithelial cell in terminal duct lobular unit without invasion of basement membrane

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7
Q

grading by surgery p, imaging m/u, pathology b?

A
  1. normal
  2. benign
  3. indeterminate/ likely benign small
  4. suspicious of malignancy
  5. malignant
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7
Q

grading by surgery p, imaging m/u, pathology b?

A
  1. normal
  2. benign
  3. indeterminate/ likely benign small
  4. suspicious of malignancy
  5. malignant
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8
Q

if you are less than 40 you dont get?

A

mammogram only ultrasound

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9
Q

if benign would you biopsy?

A

if over 30 just in case

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10
Q

which 2 conditions can present the same?

A

abscess, inflammatory breast cancer

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11
Q

symptomatic referral through GP would be?

A

2 week wait

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12
Q

breast biopsy diagnosis

A

b5a- intraepithelial neoplasia- excision but no sentinel lymph node biopsy necessary
b5b- invasive neoplasm - excise and sentinel lymph node biopsy always necessary

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13
Q

neoplastic proliferation will lose?

A

basal cells

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14
Q

fibroadenoma is

A

stromal proliferation

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15
Q

orientating wide local excision

A

blue- anterior
2 long- lateral
2 short- superior

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16
Q

Where does calcification happen?

A

necrosis areas

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17
Q

grading of tumour?

A

presence of ducts
cytonuclear pleomorphism
mitotic count

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18
Q

ductal neoplasia retains?

A

e-cadherin- cell adhesion molecule
whereas lobular neoplasia loses e-cadherin, single cells

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19
Q

lobular neoplasia is usually?

A

bilateral, multifocal- spreads everywhere

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20
Q

her2 expression?

A

to see if herceptin can be treatment if 3 plus
if 2 plus equivocal then requires further testing FISH

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21
Q

if equivocal then what do you perform?

A

in situ hybridization

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22
Q

which classification is associated with BRCA mutations?

A

ER , PR and hER2 negative basal-like

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23
Q

luminal A or B subtypes are?

A

60%- ER/PR positive HER2 variable

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24
Q

HER2/ neu rich subtype?

A

15% ER/PR negative, HER2/neu positive

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25
Q

sentinel lymph node?

A

first lymph node that drains the breast, if negative for metastases in an invasive tumour then reassure other lymph node after will be ok

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26
Q

sentinel lymph node involved by metastasis?

A

axillary dissection

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27
Q

case defintion?

A

criterion/ set for criteria for the determination of whether someone has the disease

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28
Q

case identification?

A

the operationalisation of the case definition how we identify who is/ not a case

29
Q

sensitivity of breast cancer?

A

proportion of women who correctly test positive

30
Q

specificity of breast screening?

A

proportion of women without breast cancer who correctly test negative

31
Q

positive predictive value?

A

likelihood patient with positive test result actually has the disease

32
Q

negative predictive value?

A

likelihood patient with negative test result does not have the disease

33
Q

as prevalence increase?

A

PPV will increase and NPV will decrease

34
Q

case control study?

A

groups with different outcomes (disease), useful for low prevalence conditions

35
Q

case control study strengths weakness?

A

evidence of cause-effect relationship
can identify multiple exposure
retrospective- cheaper/ shorter
good when disease is rare

weakness-cannot calculate prevalence incidence relative risk
less suitable for rare exposure
hard to ensure exposure occurred before onset of disease
retrospective data availability/quality
difficult to find suitable control group

36
Q

risk?

A

outcome of interest/ total number of all possible outcomes

37
Q

odds?

A

outcome of interest/ outcome not of interest

38
Q

odds ratio?

A

odds in exposed/ odds in non exposed

39
Q

why use odds ratio not relative risk?

A

starting population already is selected for disease, whereas relative risk noone started with the disease

OR will always overestimate RR

40
Q

what is chlorpromazine used to treat?

A

psychosis and sometimes anti-emetic

41
Q

antipsychotics are used for?

A

nausea vomiting, choreas and motor tics

42
Q

what can haloperidol be used for?

A

retractable hiccups

43
Q

if you introduce agonist with competitive antagonist?

A

you push the curve to the right so you need more drug for same amount of response

44
Q

naloxone binds to?

A

mu receptors antagonises morphine

45
Q

non competitive antagonist and agonist change curve?

A

decreasing max, lower curve

46
Q

why would you not give antipsychotic iv?

A

risk of infections

47
Q

in an emergency antipsychotic should be given?

A

intramuscular, lower dose due to avoiding first pass metabolism

48
Q

side effects of antipsychotics?

A

dyskinesia, make heart race

49
Q

antipsychotics in schizophrenia will help with?

A

positive psychotic symptoms (hallucination, delusions), but not negative apathy social withdrawal

50
Q

antipsychotics work by?

A

block d2 receptors
mesolimbic dompamine pathways- pleasure and reward
mesocortical dopamine- prefrontal cortex cognition working memory and decision making
nigrostriatal dopamine- purposeful movement
tubero infundibular dopamine- dopamine function inhibit prolactin release

51
Q

antipsychotic drug reactions include?

A

parkinsonian symptoms, dystonia, akathisia tardive dyskinesia
hyperprolactinaemia, sexual dysfunction, cardiovascular side effects hyperglycaemia and weight gain, hypotension and interference with temperature regulation, neuroleptic malignant syndrome, blood dyscrasias

52
Q

in mild/moderate psychotic symptoms elderly patients should?

A

not be given antipsychotics

53
Q

if you need to give an antipsychotic to elderly then?

A

reduce dose to half of adults

54
Q

chlorpromazine is indicated for?

A

schizophrenia, mania, severe anxiety, intractable hiccups, psychomotor agitation violence, relief of acute symptoms of psychoses, nausea and vomiting in palliative care

55
Q

blockade of d2 receptors leads to?

A

movement disorders

56
Q

blockade of cholinergic receptors leads to?

A

dry mouth

57
Q

blockade of alpha adrenergic receptors leads to?

A

tachycardia, arrhythmias,

58
Q

blockade of histaminergic receptors lead to?

A

pruritus itching

59
Q

blockade of histaminergic receptors lead to?

A

pruritus itching

60
Q

blockade of seretonergic receptors leads to issues with?

A

temperature, mood

61
Q

chlorpromazine is?

A

extensively bound to proteins and first pass metabolism

62
Q

anticholinergics help with?

A

reducing tremor, rigidity and sialorrhoea

63
Q

routine administration of antimuscarinics is inappropriate as it may worsen?

A

tardive dyskinesia

64
Q

dystonia?

A

neurological movement disorder with involuntary muscle contractions that cause slow repetitive movements or abnormal postures

65
Q

dykinesia?

A

involuntary, erratic writhing movements of face arms legs and trunk, fluid and dance like

66
Q

akathisia?

A

restlessness, inability to remain still, may think it is the condition

67
Q

tardive dykinesia?

A

rhythmic involuntary movement of tongue face and jaw, develops on long term therapy or high dose

68
Q

1st generation usually cause?

A

hyperprolactinaemia whereas 2nd generation are partial agonist so reduce prolactin

69
Q

chlorpromazine works by?

A

depressant actions on CNS, alpha adrenergic blocking anticholinergic activities, inhibit dopamine, anti seretonin and weak anti histamine

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