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
What are spinal/subarachnoid block used for? These types of blocks put ? combo of meds where?
Lower abdomen/extremity GU/GYN Anesthetic, narcotic, epi into CSF
26
Spinal/subarachnoid blocks inhibit ? What is the MC adverse event?
Sympathetic Sensory Motor Post-spinal HA- Tx w/ caffeine and blood patch
27
Central/Epidural anesthesia places local anesthetic into ? What type of inhibition is provided? What type of injury is this type of block good for?
Epidural space, not CSF Sensory only Rib Fx
28
Spinal cord terminates at ? level of the spine? How is HOTN complications from central nerve blocks Tx
L1-L2 Pressors and fluid
29
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 ?
Brady HOTN Tingling Ventilate IV Naloxone C3-5
30
How does central nerve block induced cauda equina syndrome present? What is the MC complication that present later from central nerve blocks?
Bladder/bowel dysfunction Motor/sensory changes in legs Urinary retention
31
When would an epidural hematoma induced spinal cord compression be considered after a central nerve block? Why would this outcome usually be avoided?
Anticoagulated PTs Anesthesia avoided, endotracheal tube anesthesia recommended
32
What med would be used to help counter HOTN induced from spinal anesthesia? What is the purpose of doing conscious sedation?
Phenylephrine Analgesia and anxiolysis while allowing PT to maintain airway, respond to commands and provide retrograde amnesia
33
What types of combos are administered to induce conscious sedation? Time to Peak and Duration of Propofol, Ketamine and Etomidate
Benzo/Propofol + Narcotic Pro: 90-100min/5-10min Ket: 30min/10-15min Etom: 60min/4-10min
34
Conscious sedation can only be done on PTs w/ ? ASA classes? What drugs are used for narcotic and benzo reversal?
1 and 2 Naloxone- narcotic Flumazenil- benzo
35
What are the 3 goals of general anesthesia? What drugs may be taken prior to surgery if PT is NPO Cricoid pressure is AKA ?
Anesthesia Amnesia Relaxation Antacid Sellick maneuver
36
What are the PACU goals required for d/c?
``` Stable out of bed x 30min Stable VS AnO x 3 Ambulatory Controlled pain/nausea + void/PO intake ```
37
What post-op issues are more likely to occur <48hrs of surgery? What issues can develop >48hrs after surgery?
``` Resp/CV- Sudden cardiac event HOTN Aspiration Ventilation failure ``` Local: UTI Pneumonia Systemic: SIRS, MODS
38
What is one of the MC post-op complications of general anesthesia? How can this be reduced/prevented in the pre-op setting?
Atelectasis Smoking cessation >14days before procedure
39
How does pneumonia present on PE? How does it appear on CXR if it's early/late?
Fever Tachy Rales Early- infiltrate Late- consolidation
40
How is post-op pneumonia Tx? How can VAP be avoided?
ABX Pulmonary toilet Ventilate: PCO2- 35-45 O2 >95% HOB 30-45* VLTrials daily PUD/DVT prophylaxis PO hygiene
41
How can aspiration pneumonia be prevented? If aspiration occurs, how is the PT managed?
NPO >6hrs pre-op NG decompression Mechanical ventilation ABC Bronchial hygiene Immediate suction (bronchoscopy)
42
What causes post-op pulmonary edema? How are these PT managed?
Volume overload CHF RF Diuretics/fluid monitoring R/o MI/PE Sit up
43
What causes post-op ARDS How is this Tx
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^ ```
44
PTs being treated for post-op ARDS on ventilators are placed in ? position? Why are central lines placed?
Prone Administer caustic agents (TPN ABX Blood) Monitor hemodynamis (Swan ganz Vigeleo) Longer use than PIC
45
What are the complications that can arise from central line placements? When do these need to be removed?
Ptx Arterial injury Tamponade Infections <7days
46
How are Fat Embolus PTs managed? Wells criteria
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
47
What images are ordered for PE work ups? What is the most non-specific EKG change to occur due to PE?
CXR Spiral CT VQ scan (pregnant, RF) Pulm arteriogram- Dx/Thx, invasive New Afib/RBBB S1Q3T3
48
How are PEs Tx w/ medication What is used if PTs are unable/intolerant to PO meds and have distal DVTs?
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
49
How can surgery induced ileus' be avoided? How can GI bleeds be avoided?
Pre-op Alvimopan (Entereg) PPI H2 blockers
50
What are the MC causes of C Diff? Wat criteria make PTs suspicious for this Dx?
Clindamycin Cephalosporin Floroquinolones >3 loose stools <24hrs
51
How is C Diff Tx? What causes post-op pre/intra/post renal complications of oliguria
PO Vanc/Metronidazole Pre: dehydration/hypovolemic Intra: IV contrast, ABX, Diuretics, Myoglobin from crush injury Post: BPH Urethral injury, Neurogenic bladder (DM Pts)
52
How is BPH induced post renal oliguria Tx What is the MC complication after urinary catheterization?
A-blockers UTIs
53
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
Ilio-inguinal nerve; skin numbness Long thoracic nerve; winged scapula
54
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?
Recurrent laryngeal; hoarsenss Hypoglossal; deviated tongue
55
If PT develops AMS post-op, what is the first consideration? What is the definitive Tx for phomosis/paraphimosis?
Hypoxia/hypovolemia Circumcisions
56
DIC is initially a ? condition that progresses into ? How is it Tx?
Pro-thrombotic Consumption of all coagulation proteins FFP
57
Why do transfusions induce HypoCa? How is TRALI Tx?
Ca binds to citrate No diuretics Stop transfusion, respiratory supportive care
58
What is the lethal triad? How are large hematoma/seroma wound complications managed?
Metabolic acidosis Coagulopathy Hypothermia Small- self resolving Large- aspirate/open decompress
59
How do early/late fascial dehiscence present? How are surgical site infections Tx?
Early: salmon fluid Late: incisional hernias Open Irrigate Pack Leave open
60
What is the early sign of developing compartment syndrome? What is a late finding?
PooP Loss of function/distal pulse
61
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?
Acidosis Inc lactate Dec urine output 1- Intact skin 2- open ulcer 3- visible fat 4- exposed tendon/muscle
62
Where are decubitus ulcers likely to develop? How are they managed?
Hip Elbow Buttocks Sacral InD and debride necrotic tissue
63
What is the saying for working fevers up? What cultures are taken?
Wind Water Wound Blood Urine Sputum
64
What can cause parotiditis? What can cause epistaxis? What can cause Ototoxicity?
Poor PO hygiene/dehydration Unhumidified O2 Aminoglycosides Vancomycin
65
When rounding on PTs, when is GCS reported? What drugs are used for anaphylaxis?
Not 15 or 3 Epi Diphenhydramine Steroids
66
What are the MC causes of nosocomial infections? Define the ICU death spiral
``` 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
67
# Define Inguinal Hernia Define Femoral hernia
Originates above inguinal ligament Originates below inguinal ligamentand medial of femoral canal
68
# Define Incarcerated hernia Define Strangulated hernia
Non-reucible contents Incarcerated and ischemic contents
69
# Define Indirect Inguinal hernia Define Direct Inguinal Hernia
Develop at internal inguinal ring and lateral to inferior epigastric artery Occurs through Hesselbech traingle
70
What are the boundaries of Hesselbech triangle? How doe congenital hernias develop?
Inferior: inguinal ligament Lateral: inferior epigastric artery Medial: lateral rectus muscle Patent processus vaginalis, same defect causing hydrocele
71
Where are contents located in congenital hernias? This type of hernia is the MC ?
Down spermatic cord through superficial/deep inguinal rings Hernia of both genders Indirect inguinal hernia
72
What makes the hernia sac of congenital hernias? Define complete hernia
Peritoneum passing lateral to epigastric vessels Inguinal hernia reaching scrotum
73
How do direct inguinal hernias develop? Where are they located near? What structure is not involved w/ this type?
Weakened floor of inguinal canal Medal to epigastric vessels No passage through inguinal ring
74
When are direct inguinal hernias surgical emergencies? What image is preferred for initial test? What image is confirmatory?
Acute and non-reducible/incarcerated Groin US CT
75
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?
Prostatic hyperplasia All Sx groin hernias
76
What type of prophylactic procedure may be done prior to inguinal hernia repair? How are unilateral repair done compared to bilateral repairs?
Division of ilioinguinal nerve to dec neuroma/pressure related pain Uni: open repair Bilat: laparoscopic Mesh for tension free repair
77
What type of hernia is more common in females? How does it present?
Femoral hernia Medial to femoral vein N/V, Ilius Pain exacerbated w/ valsalva/cough
78
What type of hernia repair has higher incidence of recurrence? How do epigastric hernias present?
Laparoscopic Protrusion of peritoneal fat through linea alba above umbilicus
79
How are epigastric hernias Tx Surgically repair pediatric umbilical hernias if they don't self-resolve by age ?
Routine surgery Corset if not surgical candidate 2yrs
80
What's the difference of risk between Peds and adult umbilical hernias? How do incisional hernias develop?
Peds rarely incarcerates Dehiscence through facial closure w/ intact skin
81
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?
Infection Cough Obesity ImmComp Diastasis recti- widened linea alba w/ prominent midline bulge when PT raises head; do not repair
82
# Define Sports Hernia This type of hernia can be a manifestation of ? DDx What are the indications to refer to surgery?
Not true hernia; Micro tears in FAR HOP Osteitis pubis Pain Conservative Tx x 8wks failure Exlcusion
83
# Define Hydrocele Define Epididymitis
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
What abnormal lab result may be seen w/ epididymitis cases? What how does Tx differ if PT is young/old?
WBCs in urine Young: ABX for STIs (Ceftriax/Doxy) Old: ABX for gram neg rods (Evo)
85
# Define Spermatocele Where are varicoceles more likely to develop? Why is this one investigated more heavily?
Fluid filled, non-tender mass attached to epidiymis L side If on R, evaluate for mass occluding spermatic vein Related to infertility
86
What is the functional unit of the breast? What is the MC and rare form of breast Ca?
Lobuloalveolar units (milk producing) MC- Ductal carcinoma Rare- Lobular carcinoma
87
What is the suspensory ligament of the breast? What are the 4 PT positions for a CBE?
Cooper (suspensory) ligament Sitting leaning forward Sitting w/ arms raised Sitting w/ pecs flexed Supine
88
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?
Tail of spence- lymph flows from breast to axillary/internal mammary nodes Fibrocystic changes Infection
89
# Define Mondor's Dz How is it Tx?
Thrombophlebitis of superficial breast vein as tender/palpable cord NSAIDs ABX Persistent= surgical referral for definitive management/Dx
90
What drugs are avoided during the Tx of mastalgia? What can be done for Tx 80% of breast masses are benign and due to ?
Danazol Diuretics Tamoxifen Iodine Narcotics Support bra Reduce caffeine/saturated fat Primrose oil Vit B6/E Fibrocystic*/adenoma Fat necrosis Gynecomastia
91
How do fibrocystic changes present to clinic? What timing to menses can help w/ Dx
Child bearing age w/ bialteral pain, nipple d/c and palpable mass Correlate to menses Tenderness peaks w/ late luteal phase
92
How are fibrocystic changes managed? How are these PTs managed?
US/Mammogram Biopsy Vitamin E/primrose oil Avoid caffeine NSAIDs Support bras
93
How do fibroadenomas present These PTs are ok to Tx w/ observation if ? criteria is met?
Young w/ dec incidence approaching menopause w/ smooth/lobulated mass 1-3cm in diameter Benign exam, MMG, FNA
94
When are fibroadenomas removed? What meds can induce nipple discharge?
>35y/o or, PT requests ``` Antipsychotics Cimetidine Anti-hypertensives Narcotics Sedatives ```
95
Most nipple d/c are due to ? Dxs? How are these PTs managed?
Benign intraductal papilloma Mammary duct ectasia Duct carcinoma in situ Mamm/US q3-4mon
96
How does galactorrhea present Labs are drawn to assess ? levels? How is this Dx and how are the PTs managed?
Bilateral milky d/c in non-lactating female Hyperprolactinemia Hyperthyroidism- bitemporal hemianopsia MMG Re-examine q3-4mon
97
What microbes usually cause mastitis? How are these PTs worked up? How are they Tx?
Staph A*/Strep Culture/sensitivity ABX Moist heat w/ continued feeding
98
What are he two types of breast masses? How are these PTs Tx
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
# Define Macromastia How are supernumerary nipples managed? These tend to develop during ? week of fetal development?
Breast hypertrophy Noticed during pregnancy along nipple line, completely benign/cosmetic Surgical excision 6th
100
What images are ordered for unilateral gynecomastia? If referred to surgery, what is the name of the procedure?
Mammogram w/ f/u US Subcutaneous mastectomy- spares skin and nipple
101
What causes bilateral gynecomastia What conditions can cause excess/dec estrogen and cause this condition?
Dec androgen production as men age Inc estrogen- testicular tumor, lung Ca, starvation, thyrotoxicosis Dec estrogen- Klinefelters, secondary teste failure
102
What meds can cause bilateral hynecomastis? How can this be Tx w/out surgery? What PE findings makes med Tx not an option?
INH Cimetidine Mariujuana Estrogen Digoxin Steroids Tamoxifen Raloxifene Aromatase inhibitors Solitary hard mass
103
What is the goal of screening mammography? What is the use for diagnostic mammography? What are the two standard views used?
Detect Ca before it's palpable F/u after lesion found on screening/abnormal exam Craniocaudal Mediolateral
104
What does BI-RADS stand for What are the Bi-RAD categories for mammograms?
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
What are the findings that could be sen in BI-RADS 2 results
``` Circumscribed homogenous Macrocalcificaion Dense calcification Calcified blood vessels Stable, no change from last MMG ```
106
What image is ordered if mass is found on MMG? How do different results appear?
US Cyst- smooth walled= benign Irregular- further workup
107
Almost all PTs will receive ? image prior to surgery? This mode of imaging is better for ? PT populations
MRI Dense tissue Implants
108
What is the MC found lump in the breast during SBE? How does this MC present
Ca Painless Unilateral No d/c Hard w/ irregular margins
109
What is the Dx procedure of choice for palpable and image detected abnormalities? Why is this method preferred?
Core needle biopsy Tumor markers over expression can be seen
110
When is a localized needle biopsy done for breast Ca Dx? What is the difference between incisional and excisional biopsy?
Non-palpable mass seen on MMG/US In: piece taken, better cosmetics Ex: entire mass removed
111
What are the steps of a sentinel node biopsy and lumpectomy
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
How are estrogen receptor breast Cas Tx How are progesterone receptor breast Cas Tx
Antiestrogens Antiprogesterones
113
How is HER2 breast Ca Tx Define Triple Negative breast Ca
Poor prognosis, metastasis Monoclonal antibodies BRCA1 pos ER PR HER2 neg Worse prognosis, chemo mainstay
114
What is a finding that signifies a favorable breast Ca prognosis? What is the MC type of breast Ca
Presence of E/P receptors Infiltrating ductal carcinoma
115
What are the pre-invasive forms of breast Ca? What type is cancerous and must be removed?
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
When is breast cancer more likely to be bilateral? What is the next step? How are they Tx
FamHx <50yo Primary tumor is lobular Mammogram Mastectomy Tamoxifen
117
# Define Paget Carcinoma When do these PTs need to be referred to surgery?
Ductal carcinoma of nipple w/ itch/burning Refractory to ABX/steroids >1wk
118
What is the MC Cause of Paget Carcinoma What is the most malignant form of breast Ca
Ductal Carcinoma In Situ Inflammatory breast Ca
119
When should inflammatory breast Ca be high on DDx How are these PTs Tx
Non-lactating woman Neochemo Surgery Radiation
120
Men w/ prostate Ca are at increase risk for developing ? How is most breast Ca Tx
Breast Ca Modified radical mastectomy: removes breast, nipple and axillary nodes
121
How is radical mastectomy different from modified? What is the most important prognostic variable
Removes breast, pec muscle, skin and lymph Metastases to axillary lymph node
122
PT w/ damage to thoracodorsal nerve during mastectomy will present w/ ? issue What Tx is usually done after surgery
Lat dorsi- difficult w/ shoulder internal rotation/abduction 2-6wks post-op Radiation 5x/wk x 6-8wks Tangent beams to body
123
What muscle is used for cosmetic breast reconstruction What area of breast and chest tissue is examined during Ca screening?
TRAM- transverse rectus abdominus muscle Lateral sternal border to posterior axillary line
124
What is the MC lesion of the breast? Once FNA is done for fibrocystic work up, what is next if?
Fibrocystic changes Suspicious and non-malignant, non-resolving= core needle biopsy/excision
125
What is the only FDA approved drug for fibrocystic pain What s/e makes this drug intolerable?
Danazol Acne Edema Hirsutism
126
Female should examine breast for fibrocystic changes when? What is a normal variant of breast tissue seen in these PTs
Post-menstruation Lumpy cobblestone w/ ridges
127
Sxs of fibrocystic changes improve w/ ? and are gone w/ ? What is the MC benign breast lesion
OCPs Menopause Fibroadenoma
128
How often are fibroadenoma PTs f/u w/? What procedure is done if PT requests excision of benign fibroadenoma
US and CBE q6mon Enucleation of lesion
129
In decreaseing frequency, what are the MC causes of nipple discharge in non-lactating breasts? Bloody d/c is suggestive of ? but is usually ?
Duct ectasia Intraductal papilloma Carcinoma Ca Benign papilloma
130
When can PTs w/ nipple discharge be managed w/ f/u and observation? Nipple d/c is the ?MC breast complaint after ?
Non-localized Non-palpable mass Non-bloody d/c Re-examine q3-4mon w/ mammogram and US 3rd Mastalgia Mass
131
What type of nipple d/c is considered pathological What is the next best step? How long can pregnancy induced gallactoria remain
Bright red, rusty/brown or green Dx mammogram 2nd trimester - 2yrs post partum
132
How is macromastia Tx conservatively What BIRAD score does an abnormal screening mammogram get?
Weight loss Posture therapy 0 1-2: Annual mammogram 3: ipsilateral mammogram in 6mon/bilatera mammogram in 12, 24mon 4-5: require tissue diagnosis
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What is the most significant risk for developing breast cancer? When do these risks fluctuate?
Age Rises until 60s Peaks in 70s Drops after
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What risk assessment tool is used for validating risk of developing Ca? Breast lesions suspicious for malignancy should have biopsy, preferrably ?
Gail 2 Percutaneous needle biopsy
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What serum markers can help follow breast Ca but not Dx Disadvantages of FNA
CEA CA 15-3 CA 27.29 Pathologist training Sampling problem
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What is the Dx procedure of choice for palpable and image detected abnormalities Why is this type of biopsy preferred
Core needle biopsy Tumor markers can be performed
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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?
Needle wire localization biopsy Axillary dissection Sentinal node biopsy
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When is sentinal node biopsy appropriate What makes PTs ineligible for this?
Invasive cancer but negative nodes Pos nodes- must have full ALND or neo therapy
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Tumors w/ ? tend to have more indolent dz process Tumors that lack ? have higher risk for recurrence, metastases and have worse survivals
Receptor positive Triple negative- ER PR HER2
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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
Cytotoxic chemo Axillary nodes Negative prognostic
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What is the hallmark of DCIS Most cases of Pagets Carcinoma have ? underlying issue
Noeplastic cell fills duct/lobule and not penetrate basement membrane DICS Invasive cancer
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Biopsy result of suspected inflammatory cancer showing dermal lymphatic involvement means ? What is the risk for PTs receiving trastuzumab based Tx regimens
Don't classify as inflammatory Ca Cardiomyopathy
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What is the most serious long term risk for Pts undergoing radiation? When is a solitary thyroid nodule more likely to be Ca
CADz Male <20 or >60
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Functioning thyroid nodule will have ? lab results How would RAI look like on hyperthyroid or thyroiditis?
Los TSH, High T3 T4 "Hot", benign Hyper: low TSH, inc uptake Itis: low TSH, dec uptake
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First step in investigating solitary thyroid nodule? What are the indications to refer solitary thryoid nodule to surgery
US FNA ``` Suspected/proven Ca (pappillary atypical medullary follicular) Hormonally active Cystic nodule x2/>4cm Functionally malignant Cosmesis ```
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What are the benign tumors of the thyroid
Follicular adenoma: benign hyperplasia surrounded by capsule Toxic adenoma: hyper functioning tissue <4cm- radioactive iodine >4cm- thyroidectomy
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How does malignant thyroid nodule present? What are the two most common types? What are the two more rare types?
Solitary nodule early/late in life Papillary Follicular Medullary Anaplastic
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Papillary thyroid carcinoma is more common in ? How do papillary/follicular spread through body?
Iodine deficient Kids Post-XRT PTs Papillary- lymph Follicular- hematogenous
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How do each mailignant thyroid Cas present
Papillary- multi-focal w/ spread to contralateral lobe and regional nodes Follicular- solitary, encapsulated, soft/rubbery Medullary: multifocal multilobular metastic
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How are follicular neoplasms worked up and Dx
Partial thyroidectomy Sample frozen, Dx by pathologist F adenoma= no resection F carcinoma= complete ectomy
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Where does follicular neoplasms like to metasases to? Medullary neoplasms metastases to ?
Via hemoategenous to lung/bone Liver
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What adjuvant therapies are used for thyroid Ca What type of thyroid Ca causes back pain and what is the prognosis?
Thyroxine Radioactive iodine XRT Chemo Follicular
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# Define Thyroglossal duct cyst How is it worked up How is it Tx
Benign; thyroglossal tract persists into cyst from development US, Thyroid function ABX then elective surgery No InD
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Goiter
Iodine poor regions Congenital/Hashimoto Responds to hormone Tx Mass and Dyspnea Sxs Normal function test or, Dec TSH, Inc uptake
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What types of masses can grow in the mediastinal areas
Anterior Thymoma- MC neoplasm Substernal thyroid- MC presentation Middle: Lymphoma Bronchogenic cyst Posterior: Neurogenic tumor
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What are the MC causes of hyperthyroidism thyrotoxicosis How can this kill PTs?
Graves- hyper secretory goiter Plummer- toxic multinodular goiter Thyroid storm HF Cachexia
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How does achilles reflex relate to thyroid health? What will be seen on PE during Graves Dz
Short- hypo Prolonged- hyper Pretibial myxedema Exophthalmosis Vitiligo
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How does thyrotoxicosis appear on lab results What are two additional tests used for Dx mild hyperthyroidism
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
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How is thryotoxicosis Tx
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
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How are hyperthyroid PTs requiring emergent surgery/thyroid storm Tx What do PCMs doe for thyroid nodules?
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 ```
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Feeback/stimulation of Parathyroid
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
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Lab results indicative of hyperparathyroid Lab results indicative of secondary hyperparathyroidism What are the different names by number of glands involved
High PTH and Ca High PTH, low Ca Adenoma- single gland Hyperplasia- multiple
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What can cause secondary hyperparathyroidism Why are hand x-rays ordered for this? What other x-ray finding will be seen?
Chronic RF Malabsorption Osteitis fibrosa cystica Mottled skull
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PT w/ high serum Ca and low serum phosphate points to ? dx Why do hyperparathyroid PTs have bone pain?
Breast Ca Inc alk phos
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What does PCM order for hyperparathyroid
CMP- Ca PO4 E+ BUN/Cr AlkPhos PTH CXR Refer to Endo/Surgery