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IPAP > Nike > Flashcards

Nike Flashcards

1
Q

By definition a suture is a ?

How are sutures categorized

A

Foreign body

Material Configuration Strength Absorbability Diegradation

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2
Q

What type of suture material causes a more intense inflammatory reaction?

Define Tensile Strength

How is this strength annotated?

A

Natural

Amount of weight required to break a suture

#-0
(number indicates number of 0s: 3.0= 0.001)
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3
Q

Define Configuration

What type of configuration has an increased risk for infection

A

Number of filaments

Braided

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4
Q

What are the absorbable types of sutures?

What are the non-absorbable types?

A

Gut- monofilament
Monocryl- monofilament
Vicryl- multifilament

Ethilon- monofilament
Prolene- monofilament
Silk- miltifilament

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5
Q

Proper sutures should cause wound edges to take on ? appearance

When are Simple Interrupted sutures used?

How long are they left in place?

A

Evert

External closures

7-10 days
5 days- face

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6
Q

When are horizontal mattress sutures used and how long are they left in place?

When are vertical mattress sutures used?

A

Larger lacerations
7-10 days

Poorly everting lacerations

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7
Q

When are running sutures used?

Why would these be preferred?

What type of know is used at the end of the suture?

A

Subcuticular closures (buried)

Cosmetic- pastics/dec scar
Holds skin closed

Aberdeen knot (Fisherman)

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8
Q

Epidermal cysts are AKA ?

Why are these difficult to remove?

A

Sebaceous cyst

Recur if wall is not removed

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9
Q

Pilar cysts are AKA ?

When are time outs conducted in pre-op?

A

EIC/sebaceous cyst of the scalp

Prior to anesthetic injection

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10
Q

What type of scalpel blades make smaller/larger incisions?

What is the only exception to close a wound transversely and not longitudinally?

A

10- larger, hump of blade
15- smaller
11- puncture/cutting

Flexor surface

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11
Q

What are the three benefits of using staples for closure?

What is the down side?

A

High tensile strength
Quickly placed
Resistant to infection

More prominent scar

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12
Q

Wound care needs to be exercised to minimize scarring for ?mon after surgery?

What tool is used for suture removal?

A

12mon

Scissors or,
Elevate w/ Adson’s, cut w/ scissors, pull w/ Adson’s

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13
Q

The ideal anesthetic would be ?

A 
Non-PILSNRS
Non-irritating
Penetrates
Inexpensive
Low toxicity
Soluble
Non-addictive
Reversible
Short latency
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14
Q

What is the drug used for:

Altering consciousness

Analgesia

Amnesia/anxiolysis

Muscle relaxation

Anesthesia adjunct

A

Propofol

Opioid

Benzo

Depolarizing agent

Dexemed, Ketamine

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15
Q

Anesthetics are classified in to ? or ?

What classification are the MC used in GenSurg and how can you tell them apart?

A

Amides- metabolized by liver
Esters- metabolized by plasma cholinesterase into PABA (allergen)

Amides- ‘i’ before ‘-caine’

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16
Q

Advantages and disadvantage of adding Epi to local anesthetics

These combos need to be avoided in ? PT populations?

What part of the body can these combos NOT be used in?

A

Adv: Inc duration
Dec bleeding/volume needed
Dis: Inc myocardial activity

Cardiac Dz
HTN DM Hyperthyroid

Tissues supplied by end arteries- penis ear nose toe finger

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17
Q

What are the MC adverse effects of using local anesthetics?

How are these adverse effects Tx?

A

Dermatitis Urticaria Edema Erythema

Steroid Antihistamine Fluid Epi O2

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18
Q

What are the prodomal Sxs of local anesthetic toxicity?

What are the S/Sxs of cardiovascular toxicity

A

Metallic taste
Curcumoral numbness/tingle
Light headed
Tinnitus

Hyper to HypoTN
Tachy/Brady
V-fib
Collapse

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19
Q

What are the S/Sxs of severe CNS toxicity from local anesthetics?

Max dose of Lidocaine w/ and w/out Epi

What is the ratio of lidocaine to Epi mixtures?

A

Tonic clonic
AMS

W/ Epi: 7mg/kg, max 500mg
W/out: 4mg/kg, max 300mg

1: 10mg/ml
2: 20mg/ml

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20
Q

What is the onset/duration of lidocaine?

Max dosage of Bupivacaine but don’t use in ? PTs?

Onset and duration of Bupivacaine?

A

On: 2-5min
Dur: 30-120min

2mg/kg, max 100mg
<12yrs

On: 5-10min
Dur: 2-4hrs

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21
Q

Anesthetic induced CNS toxicity is exacerbated by ? so how are they Tx?

How are CV Sxs Tx

A

Hypercarbia
Hyperventilate to dec CO2
Benzos for seizure

Fluids for HOTN
Shock wide/drug narrow

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22
Q

What types of anesthetics are more likely to cause malignant hyperthermia?

How do PTs present w/ this issue?

How are they Tx?

A

Volatile/succinylcholine

Hypermetabolic- fever, tetany, HyperK

Cool, BiCarb, Dantrolene

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23
Q

How is malignant hyperthermia avoided?

What is the sequence of effects exerted by local anesthetics?

A

Mix small amounts of multiple different agents

Loss of tone, dilation
Loss of pain/temp
Loss of pressure
Loss of motor

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24
Q

Peripheral nerve blocks are goof for ? use

Digital blocks can be done in ? areas?

A

Rib/digital blocks

Plantar/palmar aspects

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25
Q

What are spinal/subarachnoid block used for?

These types of blocks put ? combo of meds where?

A

Lower abdomen/extremity
GU/GYN

Anesthetic, narcotic, epi into CSF

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26
Q

Spinal/subarachnoid blocks inhibit ?

What is the MC adverse event?

A

Sympathetic Sensory Motor

Post-spinal HA- Tx w/ caffeine and blood patch

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27
Q

Central/Epidural anesthesia places local anesthetic into ?

What type of inhibition is provided?

What type of injury is this type of block good for?

A

Epidural space, not CSF

Sensory only

Rib Fx

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28
Q

Spinal cord terminates at ? level of the spine?

How is HOTN complications from central nerve blocks Tx

A

L1-L2

Pressors and fluid

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29
Q

How does a high spinal complication from central nerve blocks present and how is it Tx?

This is a concern d/t the diaphragm being innervated by ?

A

Brady HOTN Tingling
Ventilate
IV Naloxone

C3-5

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30
Q

How does central nerve block induced cauda equina syndrome present?

What is the MC complication that present later from central nerve blocks?

A

Bladder/bowel dysfunction
Motor/sensory changes in legs

Urinary retention

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31
Q

When would an epidural hematoma induced spinal cord compression be considered after a central nerve block?

Why would this outcome usually be avoided?

A

Anticoagulated PTs

Anesthesia avoided, endotracheal tube anesthesia recommended

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32
Q

What med would be used to help counter HOTN induced from spinal anesthesia?

What is the purpose of doing conscious sedation?

A

Phenylephrine

Analgesia and anxiolysis while allowing PT to maintain airway, respond to commands and provide retrograde amnesia

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33
Q

What types of combos are administered to induce conscious sedation?

Time to Peak and Duration of Propofol, Ketamine and Etomidate

A

Benzo/Propofol + Narcotic

Pro: 90-100min/5-10min
Ket: 30min/10-15min
Etom: 60min/4-10min

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34
Q

Conscious sedation can only be done on PTs w/ ? ASA classes?

What drugs are used for narcotic and benzo reversal?

A

1 and 2

Naloxone- narcotic
Flumazenil- benzo

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35
Q

What are the 3 goals of general anesthesia?

What drugs may be taken prior to surgery if PT is NPO

Cricoid pressure is AKA ?

A

Anesthesia Amnesia Relaxation

Antacid

Sellick maneuver

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36
Q

What are the PACU goals required for d/c?

A 
Stable out of bed x 30min
Stable VS
AnO x 3
Ambulatory
Controlled pain/nausea
\+ void/PO intake
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37
Q

What post-op issues are more likely to occur <48hrs of surgery?

What issues can develop >48hrs after surgery?

A 
Resp/CV-
Sudden cardiac event
HOTN
Aspiration
Ventilation failure

Local: UTI Pneumonia
Systemic: SIRS, MODS

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38
Q

What is one of the MC post-op complications of general anesthesia?

How can this be reduced/prevented in the pre-op setting?

A

Atelectasis

Smoking cessation >14days before procedure

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39
Q

How does pneumonia present on PE?

How does it appear on CXR if it’s early/late?

A

Fever Tachy Rales

Early- infiltrate
Late- consolidation

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40
Q

How is post-op pneumonia Tx?

How can VAP be avoided?

A

ABX
Pulmonary toilet
Ventilate: PCO2- 35-45
O2 >95%

HOB 30-45*
VLTrials daily
PUD/DVT prophylaxis
PO hygiene

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41
Q

How can aspiration pneumonia be prevented?

If aspiration occurs, how is the PT managed?

A

NPO >6hrs pre-op
NG decompression

Mechanical ventilation
ABC
Bronchial hygiene
Immediate suction (bronchoscopy)

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42
Q

What causes post-op pulmonary edema?

How are these PT managed?

A

Volume overload
CHF
RF

Diuretics/fluid monitoring
R/o MI/PE
Sit up

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43
Q

What causes post-op ARDS

How is this Tx

A

Inflammatory reaction
Non-cardiogenic pulmonary edema, not 2/2 fluid overload or HF and non-reponsive to diuretics

Mechanical vent w/ 
Inc PEEP 10-15cm
Inc expiration time
Low tidal volume 5-7ml
FiO2 <60^
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44
Q

PTs being treated for post-op ARDS on ventilators are placed in ? position?

Why are central lines placed?

A

Prone

Administer caustic agents (TPN ABX Blood)
Monitor hemodynamis (Swan ganz Vigeleo)
Longer use than PIC

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45
Q

What are the complications that can arise from central line placements?

When do these need to be removed?

A

Ptx
Arterial injury
Tamponade
Infections

<7days

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46
Q

How are Fat Embolus PTs managed?

Wells criteria

A

PEEP ventilation
Diuretics

3pts: DVT Sxs/No alt Dx
1.5: Tachy >100/Immobile x 3/surgery 6= high
<4= low if D-dimer neg
<2= low

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47
Q

What images are ordered for PE work ups?

What is the most non-specific EKG change to occur due to PE?

A

CXR
Spiral CT
VQ scan (pregnant, RF)
Pulm arteriogram- Dx/Thx, invasive

New Afib/RBBB
S1Q3T3

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48
Q

How are PEs Tx w/ medication

What is used if PTs are unable/intolerant to PO meds and have distal DVTs?

A

IV heparin, SQ LMWH
PO warfarin x 3-6mon w/ goal INR 2-3
PO Xa/direct inhibitors (Diagatraban, Fondaparinux) to replace warfarin

IVC filter

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49
Q

How can surgery induced ileus’ be avoided?

How can GI bleeds be avoided?

A

Pre-op Alvimopan (Entereg)

PPI
H2 blockers

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50
Q

What are the MC causes of C Diff?

Wat criteria make PTs suspicious for this Dx?

A

Clindamycin
Cephalosporin
Floroquinolones

> 3 loose stools <24hrs

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51
Q

How is C Diff Tx?

What causes post-op pre/intra/post renal complications of oliguria

A

PO Vanc/Metronidazole

Pre: dehydration/hypovolemic

Intra: IV contrast, ABX, Diuretics, Myoglobin from crush injury

Post: BPH Urethral injury, Neurogenic bladder (DM Pts)

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52
Q

How is BPH induced post renal oliguria Tx

What is the MC complication after urinary catheterization?

A

A-blockers

UTIs

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53
Q

What nerve has been damaged and how will PT present post hernia repair?

What nerve has been damaged and how will PT present post mastectomy

A

Ilio-inguinal nerve; skin numbness

Long thoracic nerve; winged scapula

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54
Q

What nerve has been damaged and how will PT present post para/thyroid

What nerve has been damaged and how will PT present post carotid endarterectomy?

A

Recurrent laryngeal; hoarsenss

Hypoglossal; deviated tongue

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55
Q

If PT develops AMS post-op, what is the first consideration?

What is the definitive Tx for phomosis/paraphimosis?

A

Hypoxia/hypovolemia

Circumcisions

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56
Q

DIC is initially a ? condition that progresses into ?

How is it Tx?

A

Pro-thrombotic
Consumption of all coagulation proteins

FFP

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57
Q

Why do transfusions induce HypoCa?

How is TRALI Tx?

A

Ca binds to citrate

No diuretics
Stop transfusion, respiratory supportive care

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58
Q

What is the lethal triad?

How are large hematoma/seroma wound complications managed?

A

Metabolic acidosis
Coagulopathy
Hypothermia

Small- self resolving
Large- aspirate/open decompress

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59
Q

How do early/late fascial dehiscence present?

How are surgical site infections Tx?

A

Early: salmon fluid
Late: incisional hernias

Open Irrigate Pack
Leave open

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60
Q

What is the early sign of developing compartment syndrome?

What is a late finding?

A

PooP

Loss of function/distal pulse

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61
Q

If abdomen is closed after surgery, what are the 3 thing monitored for to detect developing compartment syndrome?

What are the 4 stages of decubitus ulcers?

A

Acidosis
Inc lactate
Dec urine output

1- Intact skin
2- open ulcer
3- visible fat
4- exposed tendon/muscle

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62
Q

Where are decubitus ulcers likely to develop?

How are they managed?

A

Hip Elbow Buttocks Sacral

InD and debride necrotic tissue

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63
Q

What is the saying for working fevers up?

What cultures are taken?

A

Wind
Water
Wound

Blood Urine Sputum

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64
Q

What can cause parotiditis?

What can cause epistaxis?

What can cause Ototoxicity?

A

Poor PO hygiene/dehydration

Unhumidified O2

Aminoglycosides
Vancomycin

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65
Q

When rounding on PTs, when is GCS reported?

What drugs are used for anaphylaxis?

A

Not 15 or 3

Epi Diphenhydramine Steroids

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66
Q

What are the MC causes of nosocomial infections?

Define the ICU death spiral

A 
SSIs
C Dif
Catheter 
Central line
VAP

SIRS w/ 2: temp >101.5, Tachy, Tachy, Leukocytosis
Sepsis w/ SIRS source
Septic shock- EOD/MODS
Death

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67
Q

Define Inguinal Hernia

Define Femoral hernia

A

Originates above inguinal ligament

Originates below inguinal ligamentand medial of femoral canal

68
Q

Define Incarcerated hernia

Define Strangulated hernia

A

Non-reucible contents

Incarcerated and ischemic contents

69
Q

Define Indirect Inguinal hernia

Define Direct Inguinal Hernia

A

Develop at internal inguinal ring and lateral to inferior epigastric artery

Occurs through Hesselbech traingle

70
Q

What are the boundaries of Hesselbech triangle?

How doe congenital hernias develop?

A

Inferior: inguinal ligament
Lateral: inferior epigastric artery
Medial: lateral rectus muscle

Patent processus vaginalis, same defect causing hydrocele

71
Q

Where are contents located in congenital hernias?

This type of hernia is the MC ?

A

Down spermatic cord through superficial/deep inguinal rings

Hernia of both genders
Indirect inguinal hernia

72
Q

What makes the hernia sac of congenital hernias?

Define complete hernia

A

Peritoneum passing lateral to epigastric vessels

Inguinal hernia reaching scrotum

73
Q

How do direct inguinal hernias develop?

Where are they located near?

What structure is not involved w/ this type?

A

Weakened floor of inguinal canal

Medal to epigastric vessels

No passage through inguinal ring

74
Q

When are direct inguinal hernias surgical emergencies?

What image is preferred for initial test?

What image is confirmatory?

A

Acute and non-reducible/incarcerated

Groin US

CT

75
Q

What would be an example of an underlying issue that would need to be repaired prior to hernia repair surgery?

What findings indicate need for surgical repair under general anesthesia?

A

Prostatic hyperplasia

All Sx groin hernias

76
Q

What type of prophylactic procedure may be done prior to inguinal hernia repair?

How are unilateral repair done compared to bilateral repairs?

A

Division of ilioinguinal nerve to dec neuroma/pressure related pain

Uni: open repair
Bilat: laparoscopic
Mesh for tension free repair

77
Q

What type of hernia is more common in females?

How does it present?

A

Femoral hernia

Medial to femoral vein
N/V, Ilius
Pain exacerbated w/ valsalva/cough

78
Q

What type of hernia repair has higher incidence of recurrence?

How do epigastric hernias present?

A

Laparoscopic

Protrusion of peritoneal fat through linea alba above umbilicus

79
Q

How are epigastric hernias Tx

Surgically repair pediatric umbilical hernias if they don’t self-resolve by age ?

A

Routine surgery
Corset if not surgical candidate

2yrs

80
Q

What’s the difference of risk between Peds and adult umbilical hernias?

How do incisional hernias develop?

A

Peds rarely incarcerates

Dehiscence through facial closure w/ intact skin

81
Q

What are the RFs that if present increase the chance of incisional hernia development?

What type of condition may look like a hernia but is not defined/categorized as a hernia?

A

Infection
Cough
Obesity
ImmComp

Diastasis recti- widened linea alba w/ prominent midline bulge when PT raises head; do not repair

82
Q

Define Sports Hernia

This type of hernia can be a manifestation of ? DDx

What are the indications to refer to surgery?

A

Not true hernia;
Micro tears in FAR HOP

Osteitis pubis

Pain
Conservative Tx x 8wks failure
Exlcusion

83
Q

Define Hydrocele

Define Epididymitis

A

Patent processus vaginalis allows peritoneal fluid to collect next to testis into non-tender, trans-illuminating sac

Acute onset of pain associated w/ prostatitis/vasectomy

84
Q

What abnormal lab result may be seen w/ epididymitis cases?

What how does Tx differ if PT is young/old?

A

WBCs in urine

Young: ABX for STIs (Ceftriax/Doxy)
Old: ABX for gram neg rods (Evo)

85
Q

Define Spermatocele

Where are varicoceles more likely to develop?

Why is this one investigated more heavily?

A

Fluid filled, non-tender mass attached to epidiymis

L side
If on R, evaluate for mass occluding spermatic vein

Related to infertility

86
Q

What is the functional unit of the breast?

What is the MC and rare form of breast Ca?

A

Lobuloalveolar units (milk producing)

MC- Ductal carcinoma
Rare- Lobular carcinoma

87
Q

What is the suspensory ligament of the breast?

What are the 4 PT positions for a CBE?

A

Cooper (suspensory) ligament

Sitting leaning forward
Sitting w/ arms raised
Sitting w/ pecs flexed
Supine

88
Q

Additional to the four quadrants of the breast, what else is examined during a CBE and why?

Although common, mastalgia can be related to what two things?

A

Tail of spence- lymph flows from breast to axillary/internal mammary nodes

Fibrocystic changes
Infection

89
Q

Define Mondor’s Dz

How is it Tx?

A

Thrombophlebitis of superficial breast vein as tender/palpable cord

NSAIDs ABX
Persistent= surgical referral for definitive management/Dx

90
Q

What drugs are avoided during the Tx of mastalgia?

What can be done for Tx

80% of breast masses are benign and due to ?

A

Danazol Diuretics Tamoxifen Iodine Narcotics

Support bra
Reduce caffeine/saturated fat
Primrose oil
Vit B6/E

Fibrocystic*/adenoma
Fat necrosis
Gynecomastia

91
Q

How do fibrocystic changes present to clinic?

What timing to menses can help w/ Dx

A

Child bearing age w/ bialteral pain, nipple d/c and palpable mass

Correlate to menses
Tenderness peaks w/ late luteal phase

92
Q

How are fibrocystic changes managed?

How are these PTs managed?

A

US/Mammogram
Biopsy

Vitamin E/primrose oil
Avoid caffeine
NSAIDs
Support bras

93
Q

How do fibroadenomas present

These PTs are ok to Tx w/ observation if ? criteria is met?

A

Young w/ dec incidence approaching menopause w/ smooth/lobulated mass 1-3cm in diameter

Benign exam, MMG, FNA

94
Q

When are fibroadenomas removed?

What meds can induce nipple discharge?

A

> 35y/o or,
PT requests

Antipsychotics
Cimetidine
Anti-hypertensives
Narcotics
Sedatives
95
Q

Most nipple d/c are due to ? Dxs?

How are these PTs managed?

A

Benign intraductal papilloma
Mammary duct ectasia
Duct carcinoma in situ

Mamm/US q3-4mon

96
Q

How does galactorrhea present

Labs are drawn to assess ? levels?

How is this Dx and how are the PTs managed?

A

Bilateral milky d/c in non-lactating female

Hyperprolactinemia
Hyperthyroidism- bitemporal hemianopsia

MMG
Re-examine q3-4mon

97
Q

What microbes usually cause mastitis?

How are these PTs worked up?

How are they Tx?

A

Staph A*/Strep

Culture/sensitivity

ABX
Moist heat w/ continued feeding

98
Q

What are he two types of breast masses?

How are these PTs Tx

A

Acute- normal lactating breast
Chronic- duct ectasia- wide duct w/ thick green/black d/c in 40-60y/o female

Stop nursing
Admit w/ IV ABX
InD

99
Q

Define Macromastia

How are supernumerary nipples managed?

These tend to develop during ? week of fetal development?

A

Breast hypertrophy

Noticed during pregnancy along nipple line, completely benign/cosmetic
Surgical excision

6th

100
Q

What images are ordered for unilateral gynecomastia?

If referred to surgery, what is the name of the procedure?

A

Mammogram w/ f/u US

Subcutaneous mastectomy- spares skin and nipple

101
Q

What causes bilateral gynecomastia

What conditions can cause excess/dec estrogen and cause this condition?

A

Dec androgen production as men age

Inc estrogen- testicular tumor, lung Ca, starvation, thyrotoxicosis
Dec estrogen- Klinefelters, secondary teste failure

102
Q

What meds can cause bilateral hynecomastis?

How can this be Tx w/out surgery?

What PE findings makes med Tx not an option?

A

INH Cimetidine Mariujuana Estrogen Digoxin Steroids

Tamoxifen Raloxifene Aromatase inhibitors

Solitary hard mass

103
Q

What is the goal of screening mammography?

What is the use for diagnostic mammography?

What are the two standard views used?

A

Detect Ca before it’s palpable

F/u after lesion found on screening/abnormal exam

Craniocaudal
Mediolateral

104
Q

What does BI-RADS stand for

What are the Bi-RAD categories for mammograms?

A

Breast Imaging- Reporting And Data System

0- additional images needed
1- neg/normal
2: benign finding
3- prob benign, rpt 6mon/biopsy
4- suspicious, consider biopsy
5- suggestive of Ca, definitely biopsy
6- biopsy proven malignancy
105
Q

What are the findings that could be sen in BI-RADS 2 results

A 
Circumscribed homogenous
Macrocalcificaion
Dense calcification
Calcified blood vessels
Stable, no change from last MMG
106
Q

What image is ordered if mass is found on MMG?

How do different results appear?

A

US

Cyst- smooth walled= benign
Irregular- further workup

107
Q

Almost all PTs will receive ? image prior to surgery?

This mode of imaging is better for ? PT populations

A

MRI

Dense tissue
Implants

108
Q

What is the MC found lump in the breast during SBE?

How does this MC present

A

Ca

Painless Unilateral No d/c
Hard w/ irregular margins

109
Q

What is the Dx procedure of choice for palpable and image detected abnormalities?

Why is this method preferred?

A

Core needle biopsy

Tumor markers over expression can be seen

110
Q

When is a localized needle biopsy done for breast Ca Dx?

What is the difference between incisional and excisional biopsy?

A

Non-palpable mass seen on MMG/US

In: piece taken, better cosmetics
Ex: entire mass removed

111
Q

What are the steps of a sentinel node biopsy and lumpectomy

A

Injection into mass

PT scanned and uptake noted

No uptake in first node, likely
no nodal spread, no axillary dissection needed

Perform lumpectomy and post-op radiation

112
Q

How are estrogen receptor breast Cas Tx

How are progesterone receptor breast Cas Tx

A

Antiestrogens

Antiprogesterones

113
Q

How is HER2 breast Ca Tx

Define Triple Negative breast Ca

A

Poor prognosis, metastasis
Monoclonal antibodies

BRCA1 pos
ER PR HER2 neg
Worse prognosis, chemo mainstay

114
Q

What is a finding that signifies a favorable breast Ca prognosis?

What is the MC type of breast Ca

A

Presence of E/P receptors

Infiltrating ductal carcinoma

115
Q

What are the pre-invasive forms of breast Ca?

What type is cancerous and must be removed?

A

Lobular carcinoma in situ- marker for Ca while still encapsulated in lobe

Ductal carcinoma in situ:
Cancerous lesion must be removed, f/u w/ chemo

116
Q

When is breast cancer more likely to be bilateral?

What is the next step?

How are they Tx

A

FamHx
<50yo
Primary tumor is lobular

Mammogram

Mastectomy Tamoxifen

117
Q

Define Paget Carcinoma

When do these PTs need to be referred to surgery?

A

Ductal carcinoma of nipple w/ itch/burning

Refractory to ABX/steroids >1wk

118
Q

What is the MC Cause of Paget Carcinoma

What is the most malignant form of breast Ca

A

Ductal Carcinoma In Situ

Inflammatory breast Ca

119
Q

When should inflammatory breast Ca be high on DDx

How are these PTs Tx

A

Non-lactating woman

Neochemo
Surgery
Radiation

120
Q

Men w/ prostate Ca are at increase risk for developing ?

How is most breast Ca Tx

A

Breast Ca

Modified radical mastectomy: removes breast, nipple and axillary nodes

121
Q

How is radical mastectomy different from modified?

What is the most important prognostic variable

A

Removes breast, pec muscle, skin and lymph

Metastases to axillary lymph node

122
Q

PT w/ damage to thoracodorsal nerve during mastectomy will present w/ ? issue

What Tx is usually done after surgery

A

Lat dorsi- difficult w/ shoulder internal rotation/abduction

2-6wks post-op
Radiation 5x/wk x 6-8wks
Tangent beams to body

123
Q

What muscle is used for cosmetic breast reconstruction

What area of breast and chest tissue is examined during Ca screening?

A

TRAM- transverse rectus abdominus muscle

Lateral sternal border to posterior axillary line

124
Q

What is the MC lesion of the breast?

Once FNA is done for fibrocystic work up, what is next if?

A

Fibrocystic changes

Suspicious and non-malignant, non-resolving= core needle biopsy/excision

125
Q

What is the only FDA approved drug for fibrocystic pain

What s/e makes this drug intolerable?

A

Danazol

Acne Edema Hirsutism

126
Q

Female should examine breast for fibrocystic changes when?

What is a normal variant of breast tissue seen in these PTs

A

Post-menstruation

Lumpy cobblestone w/ ridges

127
Q

Sxs of fibrocystic changes improve w/ ? and are gone w/ ?

What is the MC benign breast lesion

A

OCPs
Menopause

Fibroadenoma

128
Q

How often are fibroadenoma PTs f/u w/?

What procedure is done if PT requests excision of benign fibroadenoma

A

US and CBE q6mon

Enucleation of lesion

129
Q

In decreaseing frequency, what are the MC causes of nipple discharge in non-lactating breasts?

Bloody d/c is suggestive of ? but is usually ?

A

Duct ectasia
Intraductal papilloma
Carcinoma

Ca
Benign papilloma

130
Q

When can PTs w/ nipple discharge be managed w/ f/u and observation?

Nipple d/c is the ?MC breast complaint after ?

A

Non-localized
Non-palpable mass
Non-bloody d/c
Re-examine q3-4mon w/ mammogram and US

3rd
Mastalgia
Mass

131
Q

What type of nipple d/c is considered pathological

What is the next best step?

How long can pregnancy induced gallactoria remain

A

Bright red, rusty/brown or green

Dx mammogram

2nd trimester - 2yrs post partum

132
Q

How is macromastia Tx conservatively

What BIRAD score does an abnormal screening mammogram get?

A

Weight loss
Posture therapy

0

1-2: Annual mammogram
3: ipsilateral mammogram in 6mon/bilatera mammogram in 12, 24mon
4-5: require tissue diagnosis

133
Q

What is the most significant risk for developing breast cancer?

When do these risks fluctuate?

A

Age

Rises until 60s
Peaks in 70s
Drops after

134
Q

What risk assessment tool is used for validating risk of developing Ca?

Breast lesions suspicious for malignancy should have biopsy, preferrably ?

A

Gail 2

Percutaneous needle biopsy

135
Q

What serum markers can help follow breast Ca but not Dx

Disadvantages of FNA

A

CEA
CA 15-3
CA 27.29

Pathologist training
Sampling problem

136
Q

What is the Dx procedure of choice for palpable and image detected abnormalities

Why is this type of biopsy preferred

A

Core needle biopsy

Tumor markers can be performed

137
Q

Lesions that can’t be amendable by core biopsy are excised by ?

? is primarily used for staging and radiation planning?

What is the preferred alternate?

A

Needle wire localization biopsy

Axillary dissection

Sentinal node biopsy

138
Q

When is sentinal node biopsy appropriate

What makes PTs ineligible for this?

A

Invasive cancer but negative nodes

Pos nodes- must have full ALND or neo therapy

139
Q

Tumors w/ ? tend to have more indolent dz process

Tumors that lack ? have higher risk for recurrence, metastases and have worse survivals

A

Receptor positive

Triple negative- ER PR HER2

140
Q

What is the only therapy for reducing metastases in receptor negative Ca

Status of ? is the most important negative prognosis factor

A high nuclear grade has a ? factor

A

Cytotoxic chemo

Axillary nodes

Negative prognostic

141
Q

What is the hallmark of DCIS

Most cases of Pagets Carcinoma have ? underlying issue

A

Noeplastic cell fills duct/lobule and not penetrate basement membrane

DICS
Invasive cancer

142
Q

Biopsy result of suspected inflammatory cancer showing dermal lymphatic involvement means ?

What is the risk for PTs receiving trastuzumab based Tx regimens

A

Don’t classify as inflammatory Ca

Cardiomyopathy

143
Q

What is the most serious long term risk for Pts undergoing radiation?

When is a solitary thyroid nodule more likely to be Ca

A

CADz

Male <20 or >60

144
Q

Functioning thyroid nodule will have ? lab results

How would RAI look like on hyperthyroid or thyroiditis?

A

Los TSH, High T3 T4
“Hot”, benign

Hyper: low TSH, inc uptake
Itis: low TSH, dec uptake

145
Q

First step in investigating solitary thyroid nodule?

What are the indications to refer solitary thryoid nodule to surgery

A

US FNA

Suspected/proven Ca (pappillary atypical medullary follicular)
Hormonally active
Cystic nodule x2/>4cm
Functionally malignant
Cosmesis
146
Q

What are the benign tumors of the thyroid

A

Follicular adenoma: benign hyperplasia surrounded by capsule

Toxic adenoma: hyper functioning tissue
<4cm- radioactive iodine
>4cm- thyroidectomy

147
Q

How does malignant thyroid nodule present?

What are the two most common types?

What are the two more rare types?

A

Solitary nodule early/late in life

Papillary
Follicular

Medullary
Anaplastic

148
Q

Papillary thyroid carcinoma is more common in ?

How do papillary/follicular spread through body?

A

Iodine deficient
Kids
Post-XRT PTs

Papillary- lymph
Follicular- hematogenous

149
Q

How do each mailignant thyroid Cas present

A

Papillary- multi-focal w/ spread to contralateral lobe and regional nodes

Follicular- solitary, encapsulated, soft/rubbery

Medullary: multifocal multilobular metastic

150
Q

How are follicular neoplasms worked up and Dx

A

Partial thyroidectomy
Sample frozen, Dx by pathologist

F adenoma= no resection
F carcinoma= complete ectomy

151
Q

Where does follicular neoplasms like to metasases to?

Medullary neoplasms metastases to ?

A

Via hemoategenous to lung/bone

Liver

152
Q

What adjuvant therapies are used for thyroid Ca

What type of thyroid Ca causes back pain and what is the prognosis?

A

Thyroxine
Radioactive iodine
XRT
Chemo

Follicular

153
Q

Define Thyroglossal duct cyst

How is it worked up

How is it Tx

A

Benign; thyroglossal tract persists into cyst from development

US, Thyroid function

ABX then elective surgery
No InD

154
Q

Goiter

A

Iodine poor regions
Congenital/Hashimoto

Responds to hormone Tx

Mass and Dyspnea Sxs
Normal function test or,
Dec TSH, Inc uptake

155
Q

What types of masses can grow in the mediastinal areas

A

Anterior
Thymoma- MC neoplasm
Substernal thyroid- MC presentation

Middle:
Lymphoma
Bronchogenic cyst

Posterior:
Neurogenic tumor

156
Q

What are the MC causes of hyperthyroidism thyrotoxicosis

How can this kill PTs?

A

Graves- hyper secretory goiter
Plummer- toxic multinodular goiter

Thyroid storm
HF
Cachexia

157
Q

How does achilles reflex relate to thyroid health?

What will be seen on PE during Graves Dz

A

Short- hypo
Prolonged- hyper

Pretibial myxedema
Exophthalmosis
Vitiligo

158
Q

How does thyrotoxicosis appear on lab results

What are two additional tests used for Dx mild hyperthyroidism

A

Dec TSH
Inc T3 T4 and uptake

T3 suppression- fail to suppress radioiodine when given T3
TRH test- TSH levels don’t inc when given TRH

159
Q

How is thryotoxicosis Tx

A

Methimazole 30-100mg PO/day
PTU- not as often d/t s/e but in prep for surgery, 300-1000mg PO/day

R-131 after euthyroid or if +40y/o, poor surgical candidate or recurrent hyperthyroid

Thyroidectomy

160
Q

How are hyperthyroid PTs requiring emergent surgery/thyroid storm Tx

What do PCMs doe for thyroid nodules?

A

Lugol iodine- prevent release of preformed thyroid hormone
BBs
Propylthiouracil to dec T4 to T3 conversion

T3 T4 TSH CBC CMP
US CXR
Refer-
IM if hyper/thyroiditis
GenSurg/ENT if nodule/large GTDCyst
161
Q

Feeback/stimulation of Parathyroid

A

High Ca stims release of CT

CT inhibits clasts to dec Ca

Low Ca stims release of PTH

PTH promotes absorption of Ca and kidney release of calcitriol

Calcitriol sims inc Ca absorption from food

162
Q

Lab results indicative of hyperparathyroid

Lab results indicative of secondary hyperparathyroidism

What are the different names by number of glands involved

A

High PTH and Ca

High PTH, low Ca

Adenoma- single gland
Hyperplasia- multiple

163
Q

What can cause secondary hyperparathyroidism

Why are hand x-rays ordered for this?

What other x-ray finding will be seen?

A

Chronic RF
Malabsorption

Osteitis fibrosa cystica

Mottled skull

164
Q

PT w/ high serum Ca and low serum phosphate points to ? dx

Why do hyperparathyroid PTs have bone pain?

A

Breast Ca

Inc alk phos

165
Q

What does PCM order for hyperparathyroid

A

CMP- Ca PO4 E+ BUN/Cr AlkPhos
PTH
CXR
Refer to Endo/Surgery

IPAP (212 decks)

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