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4 MBCHB > GEN SURG 1 > Flashcards

GEN SURG 1 Flashcards

1
Q

assessment of breast lumps

A
  1. clinical history and examination
  2. imagined USS for under 40s and mam for over 40s
  3. pathology - FNA and core biopsy
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2
Q 
what is a fibroadenoma 
peak when and who
sump
ix
what can it be mistaken as and whats the difference 
treatment
A

distortion of normal development biphasic E and S
30s and early repro life. african
painless, firm discrete mobile mass, rubbery
solid on USS
phyllodes tumour but phyllodes tumour larger and in older women
conservative if <40. excise if over 40 or >4cm or increasing in size, patient choice

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3
Q

what is a cyst
common in who
symptoms
dx and rx

A

enlarged involuted lobule
common in perimenopausal women, late repro life
lump soft, mobile, smooth, tender esp before menstruation
FNA to diagnose and treat

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4
Q

duct papilloma is what
symp
ix
treatment

A

benign neoplasma - intracystic papillary proliferation
bloody cystic fluid
USS core biopsy is increacystic solid lesion or irregular cytic wall
conservative or microductomy

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5
Q

abscess symptoms
ix
treatment

A

bulging mass usually in centre of mastitis
focal USS - pus filled
aspirate

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6
Q

glalactocele is what
cause
treatment and dx

A

palpable milk filled cyst
preg/lactation
FNA to diagnose and treat

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7
Q

lipoma has what kind of borders on mam

biopsy

A

thin smooth borders

adipose cells on biopsy

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8
Q

mordorors is what
symp
treatment

A

inflammation or vein under chest wall
firm vertical rods and history of trauma
resolves spontaneously in 8-12 weeks

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9
Q 
gynacamastia is what 
common in who 
causes 
ix and when 
risk of breast cancer in males 
treatment
A

breast development in males

elderly and puberty

idiopathic, endogenous/exogenous hormones, cannabis, liver disease, renal disease, digoxin, spinoronolactone, testicular tumours

mammogram if suspicious

1%

remove underlying cause, surgery occasionally

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10
Q 
fibrocystic change how many are asymp
RF
symptoms 
dx/ix
cysts are what 
treatment
A

1/3

menstrual abnormlaities, early menarche, late menopause

cyclic pain, lumps, smooth and discrete, sudden pain from rupture of cysts

incidental finding, screening

blue domed with pale fluid, intervening fibrosis

exclude malignancy, treasure, excise if necessary

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11
Q

haemartoma is what

treatment

A

cicumscribed lesion composed of cell types normal to breast

not troublesome - left alone

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12
Q 
sclerosiing lesions are what 
can cause what that mimic what 
sclerosinign adenosis symp 
radial scar
complex sclerosis lesion 
risk 
ix
rx
A

benin disorderly proliferation of acini and storm

mass or calcicfication which may mimic cancer

pain/tender, lump, thickness, often asymp

1-9mm
>10mm

insitu carcinoma/invasive cancer can occur within the lesion

vacuum biopsy
excise/biopsy

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13
Q 
fat necrosis cause 
assoc with what 
process 
ix
rx
A

local trauma like seatbelt injury

assoc w warfarin

damage to adipocytes -> scarring -> mass

confirm dx w imaging

exclude cancer, reassure

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14
Q 
duct ectasia is what 
caused by what 
symp
RF
treatment
A

keratin plugging causing stasis of secretion - can lead to infection

blockage of lactiferous duct

green/bloody/purulent dc, nipple retraction/distortion, sub alveolar dilatation

smoking

treat acute infection w ABs, exclude malignancy, self limiting - can excise

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15
Q

phyllodes tumour cut surface looks like what
ix
symp
complicatons

A

leaf
biphasic
slow growing, unilateral, mass
can be malignant -> like fibroadenoma but stroll parts neoplastic

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16
Q

angiosarcoma cause

A

post XRT, prev radio for breast cancer

17
Q

mets to breast

A

malig melanoma, bronchial carcinoma, ovarian carcinoma, clear cancer of kidney, leiomyosarcoma

18
Q

breast cancer risk factors

A

female, over 40, BRCA1/2, smoking, obesity, early menarche, late first birth, late menopause, exogenous homrones OCP/HRT, endogenous, not breast feeding, prev breast disease, FH, alcohol

19
Q

symptoms/signs of breast cancer

screening

mets to where

A

dimpled/depressed skin, lump, discharge, pain, nipple change, texture/colour/controur change

50-70 3 yearly

liver, lung, bone, brain, skin

20
Q 
DCIS commonest what 
usually type hyperplasia
atypical hyperplasia 
DCIS
what doe in situ mean
A

commonest in situ carcinoma
2 x RR to invasive carcinoma
4x
not invaded basement membrane

21
Q

microinvaive carcinoma is what

grade what with what

A

rare

DCIS high grade with invasion of under 1mm

22
Q 
lobular in situ carcinoma is what and what may it do
atypical lobular hyperplasia 
lobular carcinoma 
ix
gene
A

incidental, may calcify

<50%
>50%

MRI gold standard. ER pos

E cadherin negative, CDH1 gene deletion - cel adhesion gene

23
Q

pagets is what
in situ?
ix

A

eczematous changes to nipple
still in situ - extends alone ducts - epidermis of nipple
cytokerin to stain

24
Q 
invasive carcinoma is what 
local spread 
lymph
blood
ix
A

breached BM
stroma or breasts, skin, muscles of chest wall
axillary
bone, liver, brain, abd viscera, genital tract
TNM, grade, ER, HER2, Prog

25
Q

treatment surgery
implants
flaps

A

lumpectomy or mastectomy +/- reconstruction
no scar doesn’t last as long and doesn’t feel like breast
LD commonest risk of flap failure and scars

26
Q

treatment nodes

complications of node removal

A

axillary node clearance or biopsy - sentinal node biopsy using blue dye
lymphodema, nerve damage

27
Q

radiotherapy types

A

adjuvant

neojuvent - reduce size of tumour pre op

28
Q

hormone therapy
oestrogen
HER2
post meno

A

temoxifen/anastrazole
herceptin
aromatase inhibitors - letrozole

29
Q

stomas ileostomy
colostomy
urostomy
complications

A

usually in RLQ w sprout
LLQ hart mans can be reversed
drainage through bladder not possible

D/C, electrolyte imbalance, necrosis, prolapse, stenosis of stoma, parastomal hernia, infection

30
Q 
intermittent claudication is what 
cause 
who 
RF
symp
1/3 1/3 1/3
ix
treatment
A

early stage PVD, atherosclerosis, M over 45
DM, htn, smoking
get better stay the same get worse
duplex USS, ABPI normla is 0.9 to 1.2. CTMRA
secondary prevention - aspirin, exercise, stent, bypass, NAftidofury / oxolate if not suitable for surgery

31
Q

varicose veins are what
ix
treatment
cx

A

incompetence of venous veins
venous duplex USS
compression stockings for 3months, surgery if pain (thrombophlebtiits) sclerotherapy, laser ablation
can reoccur after treatment

32
Q

AAA symptoms
ix
treatment

A

back pain, collapse and shock if rupture, pulsatile mass
USS, CT
repair if >1cm every year or >=5.5cm - EVAR

33
Q 
aortic dissection is what 
RF
symp
ix
treatment of type A
treatment of type B
A

blood breaches intima parallel true and false lumens
chronic htn
tearing chest pain -> back, hemiplegia, paraplegia, limb ischaemia
ECG, CXR, CT, ECHO
type A involving ascending aorta - replace affected aorta using cardiopulmonary bypass
type B starts at origin of left subclavian - manage htn, surgery repair with graft if distal ischaemia occurs

34
Q

diabetic foot severe septic treatment

A

2g Fluclox IV, IV Gent and IV metro

PA - give vanc

35
Q

Burns ABCD

surgery

A

A - may require intubation
b - oxygen
C fluid replacement, analgesia
escharotomy graft

36
Q

obesity oral meds

surgery and indications

A

orlistat, lorcevserin, liroglitide
BMI 40 or over OR 35 or over and cormobidities
gastric sleeve, bypass, band

4 MBCHB (80 decks)

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