Endocrine And Breast Surgery Flashcards
How often is diabetes retinopathy screened?
- Well controlled DM - every 2 yearly (dilated fundus exam and visual acuity assessment)
- Poorly controlled DM or complicated with Hypertension and dyslipidemia - atleast yearly screening
When to screen for diabetic neuropathy
At the diagnosis of DM and yearly using simple clinical tests
How to screen diabetes nephropathy?
Every yearly by albuminuria( not by urine dipstick test) and by eGFR)
How often should HbA1c done
Every 3-6 months
How often should lipids be checked
Every 3 yearly if low cvs risk
And yearly if risk is high or clinically permits
What are the causes of Thyrotoxicosis 4
Graves’ disease (70%)
Toxic multinodular goiter(15%)
Toxic adenoma (5%)
Thyroiditis(5%)
What’s are the symptoms of Thyrotoxicosis
Excessive TSH affects all body systems by stimulating of metabolic processes and activating sympathetic system
- Weight loss (weight gain in 10% due to increased appetite)
- Heat intolerance
- palpitations and tachycardia
- Breathlessness
- Heart failure in elderly
- Irritability and insomnia
- Anxiety
- Tiredness or lethargy
- Diarrhea
- Fine tremor with proximal muscle weakness
- Sweating
12.goiter - Vertigo and alopecia
- Pretibial myxedema
- Wide pulse pressure
- Eye changes - proptosis, eye muscle involvement, optic nerve compression, lid lag, lid retraction
- Muscular symptoms - vary from mild myasthenia to profound muscle weakness and atrophy, extreme cases shows atrophy of temporal or interossei muscles.
When do you see hip pain in thyroid disease and how
Seen in hypothyroidism due to excess fluid accumulation in joint space and swelling
Why does goiters occur and how
Goiter is enlarged thyroid gland
Causes are autoimmune diseases, iodine deficiency and formation of thyroid nodules
Goiters occur when thyroid hormone synthesis reduces due to biosynthesis defects or/and iodine deficiency, leading to increased TSH. This stimulates thyroid gland growth as a compensatory mechanism to overcome reduced thyroid hormones
What’s pemberton sign
Subalterns goiter may obstruct the thoracic inlet. Permberton sign is faintness with evidence of facial congestion and cyanosis( reddish face) due to external compression of jugular vein , when arms are raised above the head, where thyroid gland was drawn into thoracic inlet
In goiters when is an urgent surgery is indicated
- In troublesome compressive symptoms( positive pemberton sign)
And/or
- Fail to respond to medical therapy
What are the causes of goiter
Hashimoto thyroiditis
Graves’ disease
Familial or sporadic multinodular goiter
Iodine deficiency
Follicular adenoma
Colloid nodule or cyst
thyroid cancer
What are the three phases of physiological gynecomastia
- Neonatal period sue to transplacental passage of estrogen. Almost resolves spontaneously within first year of life
- During puberty when palpable breast tissue and increase in breast size occurs. Peak incidence in 13-14 years and declines in 17-18 years
- Third peak around 50- 80 years
What are the pathological causes of gynecomastia 7
- Medications and drug abuse
- Hypogonadism
- Chronic liver and kidney disease
- Hyperthyroidism
- Tumors - testicular or adrenal
- Malnutrition
- Idiopathic- 25%
When does pubertal gynecomastia settles
After 6 months to 2 years. Should only reassure
Does asthma meds cause gynecomastia
No asthma meds including sal and steroids cause gynecomastia
When can we give testosterone injections
In hypogonadism. But not given merely for gynecomastia
What are the causes of pathological gynecomastia
- Anti androgens -
Cyproterone acetate
Finestride
Spironolactone
Ketoconazole
Lavender oil - Drug abuse - alcohol, amphetamines, marijuana, heroin
- Hormones - estrogens, growth hormone , anabolic steroids, chorionic gonadotrophin
- Antibiotics - ketoconazole, Metronidazole
- Anti ulcer drugs - cimetidine, Omeprazole, ranitidine
- Antipsychotics - Haloperidol, phenothiazines, diazepam
- Cardiovascular drugs - ACE inhibitors, CCBs( diltiazem, nifedipine)
- Other - metoclopromide, theophylline, phenytoin, domperidone, HAART( highly active retroviral therapy)
What are the four characteristics of gynecomastia
Centrally located
Symmetrical in shape
Usually bilateral
Tender to palpation
Gynecomastia is not palpable unless the diameter of glandular tissue exceeds 0.5cm
What is macromastia
Gynecomastia with more than 5cm diameter. More cases has a pathological rather than physiological etiology specially if unilateral
Common features of breast cancer in male
Stony hard lump, usually immobile with probable skin dimpling ,lymphadenopathy and nipple discharge or ulceration in advanced disease
What are the histological categories of benign breast diseases
1.Non proliferative (not associated with high risk of breast cancer) simple cysts, paplillary apocrine change , epithelial related calcification, mild hyperplasia of usual type ( terms like fibromyalgia changes, fibrocystic disease, chronic cystic mastitis, mammary dysplasia refer to non proliferative disease)
- Proliferative without Atypia (mildly increased risk of breast cancer) ductal hyperplasia, intraductal papillomas, sclerosis adenoids, radial scars. FINROADENOMAS- risky if they are complicated with adjacent proliferative disease or with positive family history
- Proliferative with atypical hyperplasia (high risk of ca)
What’s the risk of first full term pregnancy after age of 35
Increased risk of breast cancer
Risk factors of breast ca
Highest RF-
1. Advanced age >65y
2. Atypical hyperplasia in biopsy
3. BRCA1, BRCA2, ATM, TP53
4. Ca breast in multiple first degree relatives.
5. Ductal or lobular in situ
6. Exposure to ionizing radiation <30y
7. Family hx of early ovarian ca <50y
Moderate RF-
High estrogen and testosterone levels post menopausal
Full term pregnancy after 35y
Very dense breast
One 1st degree relat of breast ca
Atypical proliferative breast dx
Mild risk-
Alcohol
30-35 at first full term pregnancy
Diethylsilbesterol expsre in utero
Early menarche <12y
Characteristic malignant features of breast ca
Hypoechogenicity
Irregular and ill defined borders
Speculated margins
Being taller than broader
Posterior acoustic shadowing
Microcalcifications