Case of Abnormal mammogram Flashcards
national breast screening service
every 3 years between 50-70 registered as female
images are read by?
2 readers
outcome of mammogram?
routine recall, technical recall ( blurry), clinical recall female waited until appointement despite mammogram being normal, abnormal mammogram
xrays of breast?
4 standard views
craniocaudal view
mediolateral oblique
what biopsy do you take imaging for microcalcification?
stereotactic biopsy
ductal cell in situ is?
malignant proliferation of epithelial cell in terminal duct lobular unit without invasion of basement membrane
grading by surgery p, imaging m/u, pathology b?
- normal
- benign
- indeterminate/ likely benign small
- suspicious of malignancy
- malignant
grading by surgery p, imaging m/u, pathology b?
- normal
- benign
- indeterminate/ likely benign small
- suspicious of malignancy
- malignant
if you are less than 40 you dont get?
mammogram only ultrasound
if benign would you biopsy?
if over 30 just in case
which 2 conditions can present the same?
abscess, inflammatory breast cancer
symptomatic referral through GP would be?
2 week wait
breast biopsy diagnosis
b5a- intraepithelial neoplasia- excision but no sentinel lymph node biopsy necessary
b5b- invasive neoplasm - excise and sentinel lymph node biopsy always necessary
neoplastic proliferation will lose?
basal cells
fibroadenoma is
stromal proliferation
orientating wide local excision
blue- anterior
2 long- lateral
2 short- superior
Where does calcification happen?
necrosis areas
grading of tumour?
presence of ducts
cytonuclear pleomorphism
mitotic count
ductal neoplasia retains?
e-cadherin- cell adhesion molecule
whereas lobular neoplasia loses e-cadherin, single cells
lobular neoplasia is usually?
bilateral, multifocal- spreads everywhere
her2 expression?
to see if herceptin can be treatment if 3 plus
if 2 plus equivocal then requires further testing FISH
if equivocal then what do you perform?
in situ hybridization
which classification is associated with BRCA mutations?
ER , PR and hER2 negative basal-like
luminal A or B subtypes are?
60%- ER/PR positive HER2 variable
HER2/ neu rich subtype?
15% ER/PR negative, HER2/neu positive
sentinel lymph node?
first lymph node that drains the breast, if negative for metastases in an invasive tumour then reassure other lymph node after will be ok
sentinel lymph node involved by metastasis?
axillary dissection
case defintion?
criterion/ set for criteria for the determination of whether someone has the disease
case identification?
the operationalisation of the case definition how we identify who is/ not a case
sensitivity of breast cancer?
proportion of women who correctly test positive
specificity of breast screening?
proportion of women without breast cancer who correctly test negative
positive predictive value?
likelihood patient with positive test result actually has the disease
negative predictive value?
likelihood patient with negative test result does not have the disease
as prevalence increase?
PPV will increase and NPV will decrease
case control study?
groups with different outcomes (disease), useful for low prevalence conditions
case control study strengths weakness?
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
risk?
outcome of interest/ total number of all possible outcomes
odds?
outcome of interest/ outcome not of interest
odds ratio?
odds in exposed/ odds in non exposed
why use odds ratio not relative risk?
starting population already is selected for disease, whereas relative risk noone started with the disease
OR will always overestimate RR
what is chlorpromazine used to treat?
psychosis and sometimes anti-emetic
antipsychotics are used for?
nausea vomiting, choreas and motor tics
what can haloperidol be used for?
retractable hiccups
if you introduce agonist with competitive antagonist?
you push the curve to the right so you need more drug for same amount of response
naloxone binds to?
mu receptors antagonises morphine
non competitive antagonist and agonist change curve?
decreasing max, lower curve
why would you not give antipsychotic iv?
risk of infections
in an emergency antipsychotic should be given?
intramuscular, lower dose due to avoiding first pass metabolism
side effects of antipsychotics?
dyskinesia, make heart race
antipsychotics in schizophrenia will help with?
positive psychotic symptoms (hallucination, delusions), but not negative apathy social withdrawal
antipsychotics work by?
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
antipsychotic drug reactions include?
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
in mild/moderate psychotic symptoms elderly patients should?
not be given antipsychotics
if you need to give an antipsychotic to elderly then?
reduce dose to half of adults
chlorpromazine is indicated for?
schizophrenia, mania, severe anxiety, intractable hiccups, psychomotor agitation violence, relief of acute symptoms of psychoses, nausea and vomiting in palliative care
blockade of d2 receptors leads to?
movement disorders
blockade of cholinergic receptors leads to?
dry mouth
blockade of alpha adrenergic receptors leads to?
tachycardia, arrhythmias,
blockade of histaminergic receptors lead to?
pruritus itching
blockade of histaminergic receptors lead to?
pruritus itching
blockade of seretonergic receptors leads to issues with?
temperature, mood
chlorpromazine is?
extensively bound to proteins and first pass metabolism
anticholinergics help with?
reducing tremor, rigidity and sialorrhoea
routine administration of antimuscarinics is inappropriate as it may worsen?
tardive dyskinesia
dystonia?
neurological movement disorder with involuntary muscle contractions that cause slow repetitive movements or abnormal postures
dykinesia?
involuntary, erratic writhing movements of face arms legs and trunk, fluid and dance like
akathisia?
restlessness, inability to remain still, may think it is the condition
tardive dykinesia?
rhythmic involuntary movement of tongue face and jaw, develops on long term therapy or high dose
1st generation usually cause?
hyperprolactinaemia whereas 2nd generation are partial agonist so reduce prolactin
chlorpromazine works by?
depressant actions on CNS, alpha adrenergic blocking anticholinergic activities, inhibit dopamine, anti seretonin and weak anti histamine
