malignancy / tissue conditions Flashcards
lump which gets worse around periods
fibroadenoma
tx for fibroadenoma
supportive, if >3cm may consider excision
inverted nipple
green/yellow/black discharge
tender
diagnosis
mammary duct ectasia
what is a duct papilloma and how does it present
benign tumour in mammary duct
clear or bloody discharge
sometimes lump or pain
what is a very big risk factor for periductal mastitis
smoking
describe the symptoms of periductal mastitis
(ducts behind the nipple are infected)
tender, hot, red
clear or bloody discharge
lump felt behind nipple
inverted nipple
associated w smoking
history very suggestive of malignancy bt mammogram didn’t decide any malignancy
likely diagnosis?
invasive lobular carcinoma - (presents as area of thickens breast tissue and nipple changes, unlike invasive ductal carcinoma which presents as a lump)
what to give if breast cancer is HER2 receptor positive
Trastuzumab (Herceptin)
firm irregular mass
painful
appears after trauma
appears as an area of coarse calcified tissue on mammograms
mimics appearance of breast cancer
diagnosis
fat necrosis
what to give if breast cancer is oestrogen receptor positive, <35
tamoxifen
what to give if breast cancer is oestrogen receptor positive, >35
anastrozole
likely diagnosis if a new lump appears close to the site of a biopsy and shortly after it
fat necrosis - due to the trauma of the biopsy
but always refer to 2ww for triple assessment to rule out cancer
what is the common cause of a breast lump in a woman that has just stopped breast feeding
galactocele: Milk builds up and stagnates within the lactiferous ducts, leading to the formation of a mobile, cyst-like lesion which can be tender
what is trastuzumab used for and what is the biggest side effect
HER2 positive breast cancer
cardiotoxic –> causes heart failure
what is anastrozole used for and what is the biggest side effect
oestrogen receptor positive breast cancer in post menopausal women can cause osteoporosis
what surgical procedure for breast cancer can cause lymphoedema
axillary node clearance
clear bloody discharge from one breast, no pain or palpable lump
likely diganosis?
intraductal papilloma
how are intraductal papillomas treated
complete surgical excision, if symptomatic
symptoms of DCIS
asymptomatic
symptoms of invasive ductal carcinoma
painless lump
firm
irregular
nipple discharge may occur but its not the primary symptom
what is letrozole used for
medication for oestrogen receptor positive breast cancer in post menopausal women - alternative to anastrozole
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?
cystic breast disease
what medication should be used to treat mastitis in a pt who is penicillin allergic
erythromycin
29 yo pt presents with new breast lump
what action should be taken
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
what is axillary web syndrome aka cording
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
what is capsular contracture
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.
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
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
what is a radial scar
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
management of mastitis in a breast feeding woman
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
management of lactational breast abscess
Aspiration or surgical drainage of the abscess, in addition to antibiotics
pt had breast surgery with axillary node clearance
she complains of localised swelling around her surgical scar
what is going on
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
mammogram shows a star-shaped pattern of scarring, with a translucent centre in the left breast
diagnosis
radial scar
which breast cancer doesn’t often show up open a mammogram
lobular carcinoma in situ
what type of breast cancer shows long, fine, linear branching structures of calcification on mammogram
ductal carcinoma in situ
what does breastfeeding woman, fever and fluid filled mass suggest
breast abscess
irregular hard lump, when pt puts hands on their hips the lump appears to be fixed to deep tissue
diagnosis?
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
what is a phyllodes tumour
malignant breast tumour
grows very quickly and presents like a fibroadenoma
occurs in women age 40-60
what cells is a phyllodes tumour made up of
epithelial and stromal cells
management of fat necrosis
conservative management
body will usually break it down over a few months, just safety net in case lump gets bigger or any other changes
what does primiparous mean
producing a child for the first time, or has only had one child
woman with puerperal mastitis develops mass lateral to areolar
painful and and fluctuant
diagnosis
lactation breast abscess
what is puerperal mastitis
mastitis during the 6 weeks after childbirth
difference in pattern of cells in a lobular carcinoma in situ vs a ductal carcinoma in situ
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
what is the most common breast cancer subtype
invasive ductal carcinoma
what is triple negative breast cancer
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)
what are fibrocystic breast
related to menstrual cycle
pain and lumpiness (multiple lumps) in breast before cycle
what is multiparty
having 2 or more children
what is nulliparity
having no children
what genes are associated with breast cancer
BRCA1, BRCA2
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
brachial plexus injury
symptoms of subclavian vein injury after axillary/breast surgery
arm pain, cyanosis of the arm or hands, sudden swelling, and muscle fatigue
mech of action of tamoxifen
oestrogen receptor antagonist
new tender lump
no other symptoms
likely diagnosis
breast cyst
itchy areolar area in a breast feeding woman
likely diagnosis
candida of nipple
which bacteria is the most common cause of mastitis
staph aureus
what cancers does BRCA2 increase risk of
breast
ovarian
prostate
pancreatic
gastruc
which biopsy is needed for histologic and cytological info about a breast lump
core needle biopsy
which type of gangrene has a clear line of demarcation
dry gangrene
which gangrenes have skin discolouration to black
both dry and wet gangrenes
which type of gangrene can poorly controlled diabetes cause
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)
which the of gangrene can alcohol abuse cause
both
dry gangrene
(as it contributes to atherosclerosis)
and wet gangrene
(chronic alcohol abuse causes immunosuppression)
Tx of pyoderma gangrenosum
orla prednisolone
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
pyoderma gangrenosum
oral prednisolone
which conditions is pyoderma gangrenosum associated with
IBD
RA
leukaemia
what is erythema migraines and which condition is it associated with
circular red lesion that is clear in middle
Lyme disease
what is dermatitis herpetiformis and which condition is it associated with
itchy blistering rash that affects extensors surfaces
coeliac disease
what is Charcot foot
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.
in foot:
absence of pulses
foul smelling discharge
subcutaneous emphysema
severe pain
diagnosis
gas gangrene
(the absence of pulses indicates arterial occlusion which is also a characteristic of wet gangrene, as well as dry gangrene)
2 main types of wet gangrene
necrotising fasciitis
gas gangrene
main cause of dry gangrene
PAD
what type of gangrene does crests on palpation / emphysema suggest
gas gangrene
what can be seen on xray in gas gangrene
gas bubble
describe gas gangrene
⇒ 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)
main causative agent of gas gangrene
clostridium perfinges
dry vs wet gangrene in terms of appearance and onset
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
dry vs wet gangrene in terms of tx
dry = IV heparin and surgical revascularisation, amputation if limb is non viable
wet = surgical debridement and broad spec abx
definitive ix for gangrene, and extra Ix for suspected infectious gangrene, and for checking for venous/arterial obstruction
surgical excision and skin biopsy
Blood Cultures
→ if infectious gangrene suspected
Doppler Ultrasonography
→ may indicate presence and severity of arterial or venous obstruction
using which route will breast cancer metastasise to the brain
haematogenous route of metastasis
non healing ulcer on lateral border of tongue
with white irregular patches
in a pt who smokes
diagnosis
squamous cell carcinoma
what is the most common type of oral cancer
squamous cell carcinoma
risk factors for squamous cell carcinoma in the mouth
tobacco use
alcohol consumption
HPV
white Lacey patches in the mouth with painful sores
oil lichen planus
what are apthous ulcers aka canker sores
small, shallow, painful ulcers that occur in the mouth
typically heal on their own within 1-2 weeks
NOT associated with smoking
painless translucent bluish swelling on lower lip
diagnosis
mucocele
(benign, mucus-filled cyst that forms due to blockage or damage to a minor salivary gland duct)
most common antibody classes in multiple myeloma
IgG (first most common)
IgA (second most common)
what is erythroplakia
red patches appear on oral mucous membranes
transforms into cancer
most common site for metastasis for colorectal cancer
liver
what is upwards gaze fatiguability a sign of
myasthenia gravis
most common type of cancer which metastasises to the bones in males
prostate cancer
name drug type which worsens symptoms of myasthenia gravis
beta blocker
most common route of metastasis for prostate cancer
haematogenous spread
what is a pryamidela pattern of weakness and which type of conditions is out seen it
(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
which conditions is clasp knife spasticity seen in
UMN conditions
which conditions is hyper-reflexia seen in
UMN conditions
which conditions is fasciculations seen in
LMN conditions
route of metastatic spread from breast cancer to the spine
haematogenous spread
what form of metastasis is ‘transcoelemic spread’
route of tumour metastasis across a body cavity eg from ovaries to peritoneum
what class of drugs is pyridostigmine
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)
