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year 3 conditions > malignancy / tissue conditions > Flashcards

malignancy / tissue conditions Flashcards

1
Q

lump which gets worse around periods

A

fibroadenoma

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2
Q

tx for fibroadenoma

A

supportive, if >3cm may consider excision

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3
Q

inverted nipple
green/yellow/black discharge
tender
diagnosis

A

mammary duct ectasia

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4
Q

what is a duct papilloma and how does it present

A

benign tumour in mammary duct
clear or bloody discharge
sometimes lump or pain

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5
Q

what is a very big risk factor for periductal mastitis

A

smoking

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6
Q

describe the symptoms of periductal mastitis

A

(ducts behind the nipple are infected)
tender, hot, red
clear or bloody discharge
lump felt behind nipple
inverted nipple
associated w smoking

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7
Q

history very suggestive of malignancy bt mammogram didn’t decide any malignancy
likely diagnosis?

A

invasive lobular carcinoma - (presents as area of thickens breast tissue and nipple changes, unlike invasive ductal carcinoma which presents as a lump)

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8
Q

what to give if breast cancer is HER2 receptor positive

A

Trastuzumab (Herceptin)

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8
Q

firm irregular mass
painful
appears after trauma
appears as an area of coarse calcified tissue on mammograms
mimics appearance of breast cancer
diagnosis

A

fat necrosis

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9
Q

what to give if breast cancer is oestrogen receptor positive, <35

A

tamoxifen

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10
Q

what to give if breast cancer is oestrogen receptor positive, >35

A

anastrozole

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11
Q

likely diagnosis if a new lump appears close to the site of a biopsy and shortly after it

A

fat necrosis - due to the trauma of the biopsy
but always refer to 2ww for triple assessment to rule out cancer

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12
Q

what is the common cause of a breast lump in a woman that has just stopped breast feeding

A

galactocele: Milk builds up and stagnates within the lactiferous ducts, leading to the formation of a mobile, cyst-like lesion which can be tender

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13
Q

what is trastuzumab used for and what is the biggest side effect

A

HER2 positive breast cancer
cardiotoxic –> causes heart failure

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14
Q

what is anastrozole used for and what is the biggest side effect

A

oestrogen receptor positive breast cancer in post menopausal women can cause osteoporosis

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15
Q

what surgical procedure for breast cancer can cause lymphoedema

A

axillary node clearance

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16
Q

clear bloody discharge from one breast, no pain or palpable lump
likely diganosis?

A

intraductal papilloma

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17
Q

how are intraductal papillomas treated

A

complete surgical excision, if symptomatic

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18
Q

symptoms of DCIS

A

asymptomatic

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19
Q

symptoms of invasive ductal carcinoma

A

painless lump
firm
irregular
nipple discharge may occur but its not the primary symptom

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20
Q

what is letrozole used for

A

medication for oestrogen receptor positive breast cancer in post menopausal women - alternative to anastrozole

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21
Q

multiple painful lumps in breast which are worse before menstruation and improve after
the lumps are palpable, mobile and soft
no fever, weightless, night sweats
diagnosis?

A

cystic breast disease

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22
Q

what medication should be used to treat mastitis in a pt who is penicillin allergic

A

erythromycin

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23
Q

29 yo pt presents with new breast lump
what action should be taken

A

Routine referral to the outpatient breast clinic
need to be 30+ with unexplained new breast lump for urgent 2 ww referral
or 50 with nipple discharge, retraction or other concerning features

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24
Q

what is axillary web syndrome aka cording

A

a complication of breast surgery
visible palpable cord like structure in axillary region
sensation of tightness and pulling in the chest area
restriction of shoulder movement and pain

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25
Q

what is capsular contracture

A

potential complication of breast implant surgery
scar tissue that forms around the implant becomes thickened and contracts, causing the breast to feel firm and distorted.

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26
Q

what are the criteria which are someone at higher risk of breast cancer
and warrants a referral from primary care even if they’re asymptomatic

A

Breast cancer in a first-degree male relative of any age
Breast cancer in a first-degree relative under the age of 40
Bilateral breast cancer in a first-degree relative under the age of 50
Breast cancer in two first-degree relatives

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27
Q

what is a radial scar

A

a benign breast lesion which occurs due to idiopathic hyperplasia and hardening of ductal tissue. It is often impalpable and causes no skin changes or nipple discharge. They are most often detected and diagnosed through an ultrasound or mammogram

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27
Q

management of mastitis in a breast feeding woman

A

first advise the pt to continue breastfeeding, to relive the pressure
then second line if this shows no improvement in 24 hours, a nipple fissure is present, the patient is systemically unwell or if cultures indicate a systemic infection, flucloxacillin should be prescribed

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28
Q

management of lactational breast abscess

A

Aspiration or surgical drainage of the abscess, in addition to antibiotics

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29
Q

pt had breast surgery with axillary node clearance
she complains of localised swelling around her surgical scar
what is going on

A

scleroma “accumulation of clear fluid under the skin, typically near the site of a surgical incision”
this is not lymphoedema as that would be more widespread swelling, not localised to the site of surgical incision

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30
Q

mammogram shows a star-shaped pattern of scarring, with a translucent centre in the left breast
diagnosis

A

radial scar

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31
Q

which breast cancer doesn’t often show up open a mammogram

A

lobular carcinoma in situ

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32
Q

what type of breast cancer shows long, fine, linear branching structures of calcification on mammogram

A

ductal carcinoma in situ

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33
Q

what does breastfeeding woman, fever and fluid filled mass suggest

A

breast abscess

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34
Q

irregular hard lump, when pt puts hands on their hips the lump appears to be fixed to deep tissue
diagnosis?

A

invasive breast cancer
The combination of irregular, hard lump which is fixed to the deep tissue (likely her pectorialis major) is very suspicious for invasive breast cancer

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35
Q

what is a phyllodes tumour

A

malignant breast tumour
grows very quickly and presents like a fibroadenoma
occurs in women age 40-60

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36
Q

what cells is a phyllodes tumour made up of

A

epithelial and stromal cells

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37
Q

management of fat necrosis

A

conservative management
body will usually break it down over a few months, just safety net in case lump gets bigger or any other changes

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38
Q

what does primiparous mean

A

producing a child for the first time, or has only had one child

39
Q

woman with puerperal mastitis develops mass lateral to areolar
painful and and fluctuant
diagnosis

A

lactation breast abscess

40
Q

what is puerperal mastitis

A

mastitis during the 6 weeks after childbirth

41
Q

difference in pattern of cells in a lobular carcinoma in situ vs a ductal carcinoma in situ

A

lobular: abnormal proliferation of small, round, lobular cells arranged in a uniform pattern, lobular cells

ductal: irregularly distributed cells which form no obvious pattern, with atypically large nuclei, ductal cells

42
Q

what is the most common breast cancer subtype

A

invasive ductal carcinoma

43
Q

what is triple negative breast cancer

A

doesn’t have any of the receptors that are usually found in breast cancer: estrogen, progesterone, and a protein called human epidermal growth factor
(is more aggress than other types of cancer so needs more aggressive tx)

44
Q

what are fibrocystic breast

A

related to menstrual cycle
pain and lumpiness (multiple lumps) in breast before cycle

45
Q

what is multiparty

A

having 2 or more children

46
Q

what is nulliparity

A

having no children

47
Q

what genes are associated with breast cancer

A

BRCA1, BRCA2

48
Q

pt experiences generalised left-sided paraesthesia, numbness, and weakness of her left arm and hand after undergoing left sided mastectomy with axillary node clearance
what happened

A

brachial plexus injury

49
Q

symptoms of subclavian vein injury after axillary/breast surgery

A

arm pain, cyanosis of the arm or hands, sudden swelling, and muscle fatigue

50
Q

mech of action of tamoxifen

A

oestrogen receptor antagonist

51
Q

new tender lump
no other symptoms
likely diagnosis

A

breast cyst

52
Q

itchy areolar area in a breast feeding woman
likely diagnosis

A

candida of nipple

53
Q

which bacteria is the most common cause of mastitis

A

staph aureus

54
Q

what cancers does BRCA2 increase risk of

A

breast
ovarian
prostate
pancreatic
gastruc

55
Q

which biopsy is needed for histologic and cytological info about a breast lump

A

core needle biopsy

56
Q

which type of gangrene has a clear line of demarcation

A

dry gangrene

57
Q

which gangrenes have skin discolouration to black

A

both dry and wet gangrenes

58
Q

which type of gangrene can poorly controlled diabetes cause

A

both
dry gangrene
(as it contributes to atherosclerosis and chronic impairment of blood flow)
and wet gangrene
(high blood glucose and peripheral neuropathy increase the risk of foot infection)

59
Q

which the of gangrene can alcohol abuse cause

A

both
dry gangrene
(as it contributes to atherosclerosis)
and wet gangrene
(chronic alcohol abuse causes immunosuppression)

60
Q

Tx of pyoderma gangrenosum

A

orla prednisolone

61
Q

lesion on lower limbs after minor trauma
started as small papule, progressed into deep ulcer with purple border
pt has RA/ IBD/leukemia
diagnosis and tx

A

pyoderma gangrenosum
oral prednisolone

62
Q

which conditions is pyoderma gangrenosum associated with

A

IBD
RA
leukaemia

63
Q

what is erythema migraines and which condition is it associated with

A

circular red lesion that is clear in middle
Lyme disease

64
Q

what is dermatitis herpetiformis and which condition is it associated with

A

itchy blistering rash that affects extensors surfaces
coeliac disease

65
Q

what is Charcot foot

A

complication of diabetic neuropathy
characterized by fractures and dislocations of the foot and ankle joints due to repeated trauma and microtrauma.
It typically presents with warm, red, swollen feet and can progress to deformity and ulceration.

66
Q

in foot:
absence of pulses
foul smelling discharge
subcutaneous emphysema
severe pain
diagnosis

A

gas gangrene
(the absence of pulses indicates arterial occlusion which is also a characteristic of wet gangrene, as well as dry gangrene)

67
Q

2 main types of wet gangrene

A

necrotising fasciitis
gas gangrene

68
Q

main cause of dry gangrene

A

PAD

69
Q

what type of gangrene does crests on palpation / emphysema suggest

A

gas gangrene

70
Q

what can be seen on xray in gas gangrene

A

gas bubble

71
Q

describe gas gangrene

A

⇒ darkened skin.
Crepitus may be heard due to escaping gas.
Infective area gives off distinct and potent smell.
May be able to visualise gas on radiograph (air bubbles on x-ray)

72
Q

main causative agent of gas gangrene

A

clostridium perfinges

73
Q

dry vs wet gangrene in terms of appearance and onset

A

dry
- history of clauduaction
- well demarcated, black and painful
- absent pulses and low abpi

wet
- sudden onset pain
- poorly demarcated, black and painful
- fever and chills

74
Q

dry vs wet gangrene in terms of tx

A

dry = IV heparin and surgical revascularisation, amputation if limb is non viable
wet = surgical debridement and broad spec abx

75
Q

definitive ix for gangrene, and extra Ix for suspected infectious gangrene, and for checking for venous/arterial obstruction

A

surgical excision and skin biopsy

Blood Cultures
→ if infectious gangrene suspected

Doppler Ultrasonography
→ may indicate presence and severity of arterial or venous obstruction

76
Q

using which route will breast cancer metastasise to the brain

A

haematogenous route of metastasis

77
Q

non healing ulcer on lateral border of tongue
with white irregular patches
in a pt who smokes
diagnosis

A

squamous cell carcinoma

78
Q

what is the most common type of oral cancer

A

squamous cell carcinoma

79
Q

risk factors for squamous cell carcinoma in the mouth

A

tobacco use
alcohol consumption
HPV

80
Q

white Lacey patches in the mouth with painful sores

A

oil lichen planus

81
Q

what are apthous ulcers aka canker sores

A

small, shallow, painful ulcers that occur in the mouth
typically heal on their own within 1-2 weeks
NOT associated with smoking

82
Q

painless translucent bluish swelling on lower lip
diagnosis

A

mucocele
(benign, mucus-filled cyst that forms due to blockage or damage to a minor salivary gland duct)

83
Q

most common antibody classes in multiple myeloma

A

IgG (first most common)
IgA (second most common)

84
Q

what is erythroplakia

A

red patches appear on oral mucous membranes
transforms into cancer

85
Q

most common site for metastasis for colorectal cancer

A

liver

86
Q

what is upwards gaze fatiguability a sign of

A

myasthenia gravis

87
Q

most common type of cancer which metastasises to the bones in males

A

prostate cancer

88
Q

name drug type which worsens symptoms of myasthenia gravis

A

beta blocker

89
Q

most common route of metastasis for prostate cancer

A

haematogenous spread

90
Q

what is a pryamidela pattern of weakness and which type of conditions is out seen it

A

(so called because of a lesion to the pyramidal tract a.k.a. corticospinal tract)
extensors are weaker than the flexors in the upper limbs
flexors are weaker than the extensors in the lower limbs
seen in upper motor neurone conditions

91
Q

which conditions is clasp knife spasticity seen in

A

UMN conditions

92
Q

which conditions is hyper-reflexia seen in

A

UMN conditions

93
Q

which conditions is fasciculations seen in

A

LMN conditions

94
Q

route of metastatic spread from breast cancer to the spine

A

haematogenous spread

95
Q

what form of metastasis is ‘transcoelemic spread’

A

route of tumour metastasis across a body cavity eg from ovaries to peritoneum

96
Q

what class of drugs is pyridostigmine

A

cholinesterase inhibitor
(Cholinesterase inhibitors such as Pyridostigmine act by maintain higher levels of acetylcholine to attach to nicotinic acetylcholine receptors, to facilitate muscle contraction. This will alleviate weakness commonly featured in myasthenia gravis)

year 3 conditions (17 decks)

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