Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

year 5 > OPB > Flashcards

OPB Flashcards

1
Q

what age are fibroadenomas seen in

A

20-30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are are cyst seen in

A

30-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

main 2 causes of breast infection

A

smoking

lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is slit like nipple inversion signify

A

usually benign

often nipple can be fully everted with manipulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

presentation of nipple eczema

A

often starts on the areola and spreads

red scaly nipples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

paget’s disease presentation

A

-starts on the nipple itself
does not completely resolve with topical steroids
older women
can be assoc. to pre-invasive cancer so take a biopsy if in doubt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ages and benign breast disease presentation 20-30

A

fibroadenoma

juvenile hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

25-35 breast benign disease

A

cyclical mastalgia
galactocele
papilloma duct discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

> 40 benign breast disease

A

cysts
periductal mastitis
sclerosing lesions, hyperplasia, atypia
duct ectasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pathology of breast cyst

A

fluid filled and benign
usually pre-menopausal
distended involuted lobules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

presentation of breast cyst

A
  • mobile well defined lumps
  • firm and rounded
  • not fixed
  • not assoc. with skin changes
  • most are impalpable, asymptoamtic and found incidentally
  • can be painful
  • can appear rapidly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

diagnosis of breast cyst

A

USS/ mammogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

management of first breast cyst

A

-refer for exclusion of malignancy -urgently if >30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

management of past hx of breast cyst -

A

aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which signs on breast cyst aspiration need referring on

A
  • blood stained
  • cyst refills
  • residual lump after aspiration / solid areas (intra-cystic papillary carcinoma?)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a galactocele

A

milk containing cyst which arise during pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

management of a new lump in pregnancy

A

refer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is a radical scar/ complex sclerosing lesion on the breast

A
  • scar arising in breast but without any previous trauma or surgery
  • cause unknown- inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

management of breast radical scar

A

-1 in 5 have cancer
-need to refer
often excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

assoc. of breast radical scar

A

atypical duct hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

risks of papilloma

A

-can cause breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is a breast papilloma

A
  • wart like lump that forms in the duct if intraductal

- develops inside the lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

presentation of breast papilloma

A
  • wart like lump in the duct

- nipple discharge which can be blood stained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

management of breast papilloma

A

refer for excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

fibroadenoma pathology

A
  • derived from lobules
  • aberration of normal breast development
  • under hormonal control -can increase in pregnancy
  • benign breast tumour–> formed by proliferation of both stromal and epithelial components of the breast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

classification of fibroadenoma

A

-common
giant >5cm
juvenile- teenage girls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

presentation of fibroadenomas

A

-mobile well defined lump
-non tender
-highly mobile
-firm or rubbery
smooth mobile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

management of fibroadenoma

A
  • refer for confirmation of diagnosis
  • urgent referral if >30, fhx or suspcious feature
  • triple assessment need core biopsy to confirm not a phyllodes tumour
  • remove if growing/ patient wish
  • excise if >3cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

diff dx of fibroadenoma

A

phyllodes tumour so need core biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

prognosis of fibroadenoma

A

1/3 regress alone
1/3 stay same
1/3 grow
vv rare to become cancerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

cause of fat necrosis of breast

A
  • usually hx of injury or bruising
  • as bruising settles, scarring results in a firm lump of the breast
  • most common in large breast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

management of fat necrosis of breast

A
  • refer for breast triple assessment
  • always urgent referral
  • once dx confirmed no treatment needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

mondor’s disease of breast is…

A

inflammation of the superficial veins of the breast

benign thrombophlebitis of vein and axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

presentation of mondor’s disease

A
  • red pain and cord like thickening of vein

- self limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

management of Mondor’s disease

A
  • triple assesment - referral
  • rarely assoc. to malignancy

-treatment NSAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Hydranitis suppurativa what is it

A

-young patients

acne on arm pits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

cause of hydranitis suppurativa

A

-chronic inflammation of axillary apocrine sweat glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

management of hydranitis suppurativa

A

antibiotics, drain abscesses, excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

complications of hydranitis suppurativa

A

recurrent infection
abscess
scar formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what age does hydranitis suppurativa tend to stop

A

35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

congenital abnormalities of the breast

A

-third nipple

accessory axillary breast tissue- as breast tissue develops in the axilla and moves across- so if left behind

abscence or hypoplasia of the breast- symmetricla or asymmetrical can use implants

inverted nipples

absence of chest wall

gigantomastia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is poland syndrome

A

absence of chest wall
dont develop pectoralis major and breast and chest wall
reconstructive procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is gigantomastia

A

breast tissue becomes very inflamed red and grows rapidly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is duct ectasia

A

-abberation of development and involution
-occurs when a milk duct beneath the nipple widens, the duct walls thicken
duct fills with fluid and becomes blocked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

who gets duct ectasia

A

often >50 around menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

symptoms of duct ectasia

A
  • nipple discharge- often green
  • retraction
  • inverted nipples
  • doughy palpable mass
  • discharge cheesy/ white
  • slit like nipple retraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

management of duct ectasia

A

-refer for confirmation of dx
conservative management or
surgical with excision of total duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what is phyllodes tumour

A
  • hypercellular stroma with atypia
  • large and fast growing
  • arise from periductal stromal cells of the breast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

differentiating phyllodes and fibroadenomas

A

phyllodes usually larger and older age group

30-50 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

behaviour of phyllodes tumour

A

-varies
benign 70%, malignant 5% or borderline 25%
-malignant potential
-can have an infiltrative margin especially in aggressive forms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

management of phyllodes tumour

A

need referral for triple assessment

wide local excision with clear margin of normal breast tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

mastitis presentation

A
  • develops quickly
  • red swollen area on breast that may feel hot and painful to touch
  • area of hardness on the breast
  • burning pain- continuous or with breastfeeding
  • nipple discharge- white and blood stained
  • feeling generally unwell- aches, fever, shiver, tired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

when to refer mastitis

A
  • if not settling after one course of antibiotics
  • refer for abscess
  • breast inflammation in >35 even if settling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

management of mastitis

A

-antibiotics

drain abscess under la

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

lactational infection cause

A
  • usually in early weeks post-partum

- poor latch, nipple trauma, milk stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

management of lactational infection

A
  • treat early with antibiotics- flucoxacillin

- continue feeding as avoid milk stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

cause of non-lactational infection

A

-mostly due to smoking
periductal infection
often chronic and difficult to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is peri-ductal mastitis

A

-inflammation of ducts below nipples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

who gets peri-ductal mastitis

A

smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

presentation of peri-ductal mastitis

A

-repeated infection +/- abscess formation at edge of areola and can get fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

management of peri-ductal mastitis

A 
-co-amoxicillin first line
smoking cessation
drain abscess when they occur 
can evenutally over yrs burn out 
-mostly non -operative approach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

sebaceous cyst on breast management

A
  • treat as elsewhere
  • drain if abscess
  • consider formal excision of cyst wall when acute resolves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

main cause of breast abscess in lactation

A

staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

causes of breast absceses

A

lactation infection
periductal mastitis-peri-areolar
epidermoid cyst, hidraenitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

management of breast abscess

A
  • refer for surgical assessment
  • will aspirate with large needle and drain
  • flucox or erythromycin for lactation

-non: lactating: co-amox, or erythromycin and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

complication of peri-ductal mastitis

A

mammary duct fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

management of mammary duct fistula

A

-excision of fistula and total duct excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

A 49-year-old woman presents with a 2 week history of left nipple itching. There has been no discharge from the nipple and there is no personal or family history of breast disease. The patient’s history is remarkable for asthma and eczema.

On examination, the left nipple and surrounding areola are reddened and the skin appears thickened. Examination of both breasts is otherwise unremarkable.

A

paget’s disease as redenning and thickening of nipple and areola

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

differentiating eczema and pagets of nipple

A

-pagets starts on nipple and later spreads to areola
(vice versa in eczema)

  • paget’s thicken and red nipple
  • need to biopsy as risk of underlying pre-invasive cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

paget’s disease management

A

refer urgently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

A 52-year-old lady presents to her general practitioner. She is concerned about a lump which she has noticed on her left breast associated with a green nipple discharge. On examination, she has a tender lump on her left breast next to her areola. It is not discoloured or hot to touch. Which one of the following conditions would be most likely to cause this presentation?

A

duct ectasia
also get involution
menopausal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

paget’s of nipple is assoc. too

A

invasive ductal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

fibroadenosis pressentation

A

-most common middle age
lumpy breasts which can be painful
symptoms may worsen prior to mensturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

A 21-year-old female notices a bloody discharge from the nipple. She is otherwise well. On examination there are no discrete lesions to feel and mammography shows dense breast tissue but no mass lesion.

A

intraductal papilloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

commonest cause of blood nipple discharge in young women

A

intraductal papilloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

A 18-year-old female notices a non tender mobile breast lump. Clinically there is a smooth lump which is not tethered to the skin.

A

fibroadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Females < 30 years with a non-tender, discrete and mobile lump =

A

fibroadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

A 30 year old lady presents with a 3 week history of worsening erythema over her left breast. She is not breastfeeding and feels otherwise well. She says that it is not painful but is concerned as it has not resolved. On examination the breast is swollen with marked erythema but no discharge, no nipple changes and no mass palpable. Her vitals are within normal range and she is apyrexial. Results of blood tests are outlined below.

White cell count 6x10^9/L
C-reactive protein 4 mg/L
CA 15-3 level 57 Units/ml (normal range <30 Units/ml)

What is the most likely diagnosis?

A

inflammatory breast cancer
as raised Ca marker
and also mastitis would have fever or elevated WCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

inidcations for antibiotics for lactational mastitis

A

1st line= continue breast feeding

give antibiotics if

  1. culture positive
  2. nipple fissure present
  3. systemic symptoms
  4. no improvement 12-24hrs of effective milk removal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

. A 48-year-old lady presents with discomfort in the right breast. On examination she has a discrete soft fluctuant area in the upper outer quadrant of her right breast. A mammogram is performed and a ‘halo sign’ is seen by the radiologist.

A

halo sign= cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

You are working in general practice. An 87-year-old lady complains that her right nipple is exquisitely itchy. On examination, you note that the nipple is erythematous and there is some blood-stained discharge on the inside of her bra.

A

paget’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

A 52-year-old lady presents with an episode of nipple discharge. It is usually clear in nature. On examination the discharge is seen to originate from a single duct and although it appears clear, when the discharge is tested with a labstix it is shown to contain blood. Imaging and examination shows no obvious mass lesion.

A

intraductal papilloma
as no mass or lesion seen
and can arise from a single duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what does a triple assessment involve

A
  • clinical hx and exam
  • imaging- USS or mammogram
  • pathology- FNA, core biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

breast awareness 5 point code

A
  1. know what is normal for you
  2. know what changes to look and feel for you
  3. look and feel
  4. report any changes to GP without delay
  5. attend for routine breast screening if >50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

lump features that require an urgent referral 7

A
  1. any new discrete hard lump in patients over 30
  2. any age with phx of breast cancer presenting with a further lump or suspcisious symptoms
  3. asymmetrical nodularity that persists after period in patients over 35
  4. aged >35 with discrete lump that persists after next period or presents after menopause
  5. unilateral isolated axillary lymph node in women persisting at review after 2-3 weeks
  6. recurrent lump at site of previously aspirated cyst
  7. aged <35yrs with a lump that enlarges or is fixed/ hard in whom there are other reasons for concerns such as hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

nipple changes that require an urgent referral 3

A
  1. unilateral eczematous skin or nipple changes that don’t respond to topical treatment
  2. nipple distortion of recent onset eg retraction
  3. spontaneous unilateral blood nipple discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

skin changes that require an urgent referral

A
  1. skin tethering or dimpling
  2. fixation
  3. ulceration or peau d’orange
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

non urgent referral for breast cancer

A
  • if <35 yrs with a lump that has no suspicious features and not enlarging
    2. persistnet unilateral spontaneous discharge- not blood stained
    3. breast pain and no palpable abnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

where do most breast cancer arise from

A

terminal duct lobular unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

breast symptoms

A 
lump
nipple discharge retraction
skin changes
abscess/ infection
pain
gynaecomastia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

breast lump causes

A 
breast cancer
fibroadenoma
cyst
duct ectasia
fat necrosis
phyllodes tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

signs of malignancy of breast on mammogram

A 
high density lesion
microcalcification
irregular margin
distortion
asymmetry 
lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

signs of malignancy on USS

A 
irregualr margin
posterior acoustic shadowing
distorition
heterogenous echo tecture
echogenic halo
TALLER THAN WIDE 
vascularity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

signs of fibroadenoma on mamogram

A

wider than taller- suggest more benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

indications for MRI

A

good for implants, occult lesions and extent of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

indications for choosing FNA over core biopsy

A

core biopsy main one done but

USE FNA if

  • if core biopsy is not technically possible with location?
  • cyst
  • lymph node assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

when is core biopsy not indicated for fibroadenoma

A

if <22 and lesion <2cm with unequivocal radiological appearance of fibroadnoma- dont need biopsy but should re-scan after 6 months check not growing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

breast pain 2 causes

A
  1. cyclical breast pain-true breast pain usually bilateral

2. MSK usually unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

mastalgia causes

A 
physiological
duct ectaasia
breast cancer
sclerosing adenosis
mastitis
abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

mild to moderate cyclical breast pain management

A
  • diet reduce sat fats and caffeine
  • support- wear soft support bra at night
  • NSAID
  • change or stop OTC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

severe cyclical breast pain management

A

for 7 days for >6 months and interferes with lifestyle

  • trial mild to moderate management first for 3 months and then referral if no response
  • tamoxifen can be given
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

non cyclical breast pain means

A

continuous or intermittent pain but not related to menstrual cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

causes of non cyclical brest pain

A
  • well localised= ill fitting bras, cyst, abscess, cancer

- more generalised= referred pain eg nerve root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

bilateral nipple discharge causes

A

central

-pituitary adenoma- galactorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

causes of nipple discharge

A

-pregnancy
-duct ectasia
inflammation
papilloma
DCIS/ invasive cancer
endocrine
mamary fistulas
joggers nipple
medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

drugs that cause nipple discharge

A

haloperidol
methyldopa
phenothiazines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

red flags nipple discharge

A

unilateral
blood stained
single duct (except papilloma-although can sometimes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

management of nipple discharge

A 
triple assessment
explain and re-assure
microdohectomy
total duct excision
specific intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

when to refer for nipple discharge

A
  • unilateral-urgent
  • bloody-urgent
  • > 50 and pathological cause suspected= unilateral, single duct, spontaneous, red brown or black, profuse and watery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

gynaecomastia cause

A
  • age- puberty (self-limiting), old age
  • liver disease
  • testicular problems
  • drugs- alcohol, smoking, steroids, diuretics, omeprazole, allopurinol, digoxin

-tumours- pituitary lung and testicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

presentation of gynaecomastia

A

benign enlargement of the male breast resulting from the glandular component of the breast

  • rubbery or firm mass
  • ususally bilateral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

inx for gynaecomastia

A
  • 18 to 60 do a blood test if no obvious cause
  • > 40 mamogram
  • <40 USS
  • lesions FNA or core biopsy
  • testicular USS or CXR if suggestion of other cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

management gynaecomastia

A
  • treat underlying cause
  • reassurance of innocent nature of condition and resolves spontaneously
  • endocrine refer to endocrinologist
  • no inx for puberty gynaecomastia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

medical treatment for gynaecomastia

A

for idiopathic or residual gynaecomastia

  • tamoxifen if justified for 6 months
  • aromatase inhibitors older men
  • surgery is rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

when to refer breast nodularity

A

if asymmetrical and older than 30 or fhx of breast cancer then refer

if asymmetrical <30 and no fhx review in 6 weeks and if still present then refer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

when to refer nipple eczema

A

if no response to topical treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

choice of breast imaging >40

A

use mammogram

need two views

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

two views needed on mammogram

A

mediolateral oblique and

cranial caudal projection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

choice of breast imaging <40

A

USS if focal breast problem- 1st line

adjunct mammography where malignancy is suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

choice of breast imaging in male <40

A

USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

choice of breast imaging in males >40

A

mammography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

imaging choice if implants

A

mammography >40 plus USS
uss <40
may also need MRI to exclude malignancy or implant rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

USS indications

A

palpable lump
not in pain
-examine axillary lymph nodes

useful for

  • core biopsy or aspiration
  • detects solid vs fluid filled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

why is USS not used for breast screening programs

A

very user dependent

should only be used as a targeted inx not for whole breast screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

implant rupture imaging

A

USS or MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

mammography indications

A

breast abnormalities >40
national screening program
early screening if fhx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

routine referral breast

A

Lump in breast that isn’t caused by anything else and under 30​

Lumpiness in breast that doesn’t go away after period/ 2 or 3 weeks and you are under 35​

Persistent nipple discharge that stains outer clothes​

Breast pain lasting for over 3 months and you are post menopausal​

Severe breast pain that is affecting your daily life or sleep at night and trialled rx for 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

urgent breast referral

A

Over 30 with a new breast lump​

Swollen lymph node in armpit that doesn’t go away after 2 or 3 weeks​

Over 35 and with lumpiness in breast that doesn’t go away after period/ 2 or 3 weeks​

Recurrent cyst in breast​

Nipple changes such as pulling inward, a bloodstained discharge, or an eczema-type rash (that doesn’t respond to steroid treatment after at least 2 weeks)​

Skin changes, such as tightening, redness and soreness, or looking like orange peel​

Inflammation of the breast that doesn’t respond to antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

why is mammography used for breast screening

A

because it can also detect micro-calcification in situ disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

what is tomosynthesis

A

3D mammography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

additional information of core biopsy

A

tells you about grade, ER PR and HER2 status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

additional information of core biopsy

A

tells you about grade, ER PR and HER2 status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

breast cancer epidemiology

A

most common cancer in UK women

second commonest overall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

lifetime risk of breast cancer

A

1 in 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

worrying signs for breast cancer

A
  • hx of new lump
  • does not change size with periods
  • nipple discharge that is spontaneous and blood stained
  • axillary lymphadenopathy
  • weight loss, fatigue
  • fixed nipple retraction
  • orange d peau
  • ulceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

risk factors for breast cancer

A

-most after >65 (>50)

-oestrogen exposure-
early menarche and late menopause (>55)
age at first pregnnacy (late age and nulliparity)
HRT and contraception use
use of unopposed oestrogen
use of oral contraceptives for >4 yrs before pregnnacy

diet weight and alcohol

fhx and SES

specific benign abnormalities
-radical scar and papilloma

benign breast disease

  • espeically cystic disease
  • previous breast surgery for severe atypical hyperplasia

proliferative types of hyperplasia

exposure to ionising radiation

later first childbirth

hormone therapy

nulliparity

obesity BMI >30

not breastfeeding?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

diet and breast cancer

A

high in fat
low in beta carotene
folate vit a and c low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

what does a fhx of breast cancer mean

A
  • > 1 affected relative on same side of family especially <50
  • bilateral breast disease in close family member
  • male breast cancer in close family member
  • breast and ovarian cancer in close relatives on same side of family
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

genes invovled in breast cancer

A 
5% are BRCA
BRCA1
BRCA2
PTEN COWDEN
MSH1 or MSH2 in HNPCC 
p53 syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

penetrance and assoc. cancers of BRCA 1

A

80% penetrance

ovarian, colon, prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

BRCA2 penetrance and assoc. cancer

A

50% penetrance
male relatives
also ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

management of BRCA breast cancer

A

bilateral mastectomy
MRI screening annually
prevent Tamoxifen in ER positive fhx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

breast screening procedure

A

-all women 50 to 69 get invited every 3 years for a mammogram

but can drop in and get a mammogram done whenever at local centre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

breast screening for moderate risk

A

begins with yearly mammography at 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

breast screening for high risk

A

begins with yearly mammography at 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

breast screening program for BRCA 1 or 2

A

yearly MRI and mammography from age 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

breast screening program for Tp53 faulty gene

A

yearly MRI from 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

breast cancer pathology

A
  • commoner in the left breast

- 50% in upper outer quadrant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

most common breast cancer type

A

ductal carcinoma

150
Q

breast carcinoma pathological types

A
  • invasive = ductal, lobular
  • non-invasive= DCIS, LCIS
  • mixed lobular and ductal
  • sarcoma
  • medullary, mucinous, tubular, micropapillary, metaplastic, inflammatory, paget
  • phyllodes and angiosarcoma
151
Q

angiosarcoma breast cancer pathology

A

-originates from blood vessels of lymphatic and can occur as primary or secondary in patients who have been previously treated by radiotherapy for breast cancer
rare

152
Q

lobular in situ neoplasia

A
  • often an incidental finding
  • risk factor for recurrence
  • doesn’t impact Rx decision
  • need a guided excision to exclude DCIS or invasive disease
153
Q

ductal carcinoma in situ % of breast cancers

A

90%

154
Q

definition of ductal carcinoma in situ

A

-abnormal proliferation of cells within the mammary ducts which does NOT spread beyond the basement membrane
aka no invasion
doesnt spread elsewhere
progression to invasive over months to decades

155
Q

inx for DCIS

A

-can be seen on mammography as microcalcification
impalpable so usually only seen on screening

core biopsy

156
Q

management of DCIS

A

surgical: all diseased tissue must be excised with clear histological margins
- radiotherapy in high grade DCIS

157
Q

invasive ductal carcinoma % of breast cancer

A

75%

158
Q

how does invasive cancer spread

A

tumour invades through the lymphatics

159
Q

signs of locally advanced and metastatic breast cancer

A

peau d orange
skin inflammation
skin involvement
chest wall involvement

rare
systemic treatment prior to surgery

160
Q

inflammatory breast cancer presentation

A

need to always consider as a cause of mastitis

so if mastitis doesnt improve with antibitiocs then refer urgently

161
Q

management of inflammatory breast cancer

A

-aggressive cancer
-triple assessment
chemo
surgical
radiotherapy

162
Q

receptors for breast cancer

A

ER- estrogen receptors
PR-progesterone receptors
HER2-human epidermal growth factor receptor 2

163
Q

ER positive breast cancer is

A

expressed in 60-70% of breast cancers
dependent on oestrogen to control tumour growth
better prognosis

164
Q

HER2 breast cancer assoc,

A

25-30% breast cancers

assoc. to aggressive behaviour and high risk lymph node involvement
- cell surface receptor involved in cell growth and differentiation

165
Q

Ki-67 assoc. to breast cancer

A

marker of cell proliferation

assoc. to better response to neo-adjuvant chemo but overall prognosis is poorer

166
Q

triple negative breast cancer meaning and who

A

-dont have ER, PR or HER2
-15%
more seen in pre-menopausal, BRCA1 gene
-most express EGFR epidermal growth factor receptor

167
Q

diagnosis breast cancer

A 
triple assessment 
mammo or USS
MRI
FNAC or core
vacuum assisted biopsy 
USS of axilla
blood test
168
Q

early breast cancer staging inx

A

-blood test- LFT and calcium
x-ray chest
USS liver
sentinel lymph node biopsy

169
Q

locally advanced breast cancer staging

A 
-CT scan
MRI
bone scan 
liver USS
blood tests 
sentinel lymph node biopsy
170
Q

what is a sentinel lymph node biopsy

A

need to dx whether there is a cancer in the lowest level of lymph nodes- ie closest to the cancer

alterantive is 4 node sampling but SNLB is first line

171
Q

management if sentinel lymph node biopsy is positive

A

need definitive axillary surgery and clearance

172
Q

risks of axillary clearance

A

lymphoedema

173
Q

mets of breast cancer

A

liver lung bone brain

axilla

174
Q

non invasive insitu managemetn options

A
  • simple mastectomy
  • wide excision alone or breast conserving surgery
  • wide excision and post-op radiotherapy
175
Q

when would a mastectomy be indicated over a wide local excision

A

mastectomy if

  • central tumour
  • multifocal tumour
  • large lesion in small breast
  • DCIS >4cm
176
Q

LCIS management

A

close monitoring

177
Q

low grade DCIS management

A

wide local excision

178
Q

high grade DCIS management

DCIS in two or more quadrants

A

mastectomy (multifocal) and post-op radiotherapy

179
Q

DCIS in males management

A

mastectomy

180
Q

recurrence DCIS

A

mastectomy

181
Q

early breast cancer management

A

breast conserving surgery- lumpectomy
and SNLB
+/- axillary clearance

182
Q

locally advanced breast cancer management

A

neo-adjuvant chemotherapy
mastectomy or lumpectomy
axillary clearance

183
Q

advanced breast cancer management

A

salvage mastectomy with or without reconstruction

axillary clearance

184
Q

patients suitable for breast conservation

A

-primary tumour/ breast size will give satisfactory cosmesis aka
small tumour, large breast, localised, no nipple, peripheral
-able and willing to tend for follow up
-suitable for radiotherapy
-patient choice

185
Q

patients not suitable for breast conservation surgery

A 
unable to have post-op radiotherapy 
severe lung and heart disease
pes excavatum
chronic lack of mobility of shoulder
kyphoscolisosis
large tumour small breast
DCIS >4cm
multifocal
central tumour around involving nipple
186
Q

breast conserving surgery margins and exceptions

A

needs to be 1 mm
unless
-posterior tumour margin abutting on pectoral fascia acceptable <1mm
-anterior tumour margin abutting on subcutaneous fascia acceptable <1mm

187
Q

mastectomy indications

A
  • patient choice
  • cosmemsis after breast conservation likely to be poor
  • multifocal
  • bilateral disease
  • > 4cm DCIS
  • technically unsuitable for breast radiotherapy
  • significant fhx
  • central tumour
188
Q

mastectomy and reconstruction

A

generally offered

-primary reconstruction may be avoided if chest wall radiotherapy likely to be indicated

189
Q

if not using SLNB how many nodes must be sampled

A

at least 4

190
Q

types of breast reconstruction

A

-either as immediate or delayed

  1. implant/ expander
  2. latissimus dorsi muscle flap
  3. free tissue transfer eg from stomach TRAM/DIEP flap
191
Q

radiotherapy of whole breast indications

A
  1. all patients after breast conserving surgery
  2. no lymph node mets in an adequate axillary node sample of 4 nodes
  3. > 4 nodes positive
  4. women <50 at surgery
  5. invasive disease with inadequate excision margins unsuitable for re-excision
  6. conserved breast unsuitable for excision
  7. T4 disease at presentation
192
Q

radiotherapy for chest wall indications

A

-after mastectomy in some cases

tumour size >5cm, 4 or more involved nodes and involved resection margins

193
Q

radiotherapy for axilla indications

A
  • involved axillary node sampling if patient does not want axillary clearance
  • not indicated after axillary node clearance unless residual disease left
194
Q

chemotherapy for breast cancer indications

A

early breast cancer

  • reduce risk of relapse
  • grade 3, LVI, nodal involvement, triple negative, HER2+

locally advanced disease

metastatic disease

195
Q

what chemo is given for breast cancer

A

cyclophos
methotrexate
5 fu

196
Q

how is chemo given for breast cancer

A

-can be neo-adjuvant eg to shrink down for surgery
to do breast conserving

  • or adjuvant
197
Q

medical treatments given in breast cancer

A

-hormone, tamoxifen, aromastase
-chemotherapy
-biological
-bisphosphonates
radiotherapy

198
Q

determining if patient is post-menopausal and >50yrs

A

Check hormones 6/52 off tamoxifen

FSH>30 on 2 occasions 6/52 apart confirms menopause if amenorrhoeic for 24 months. If patient on Zoladex hormones return to baseline levels after 2/4 weeks

199
Q

determine post-menopausal 50-54

A

check hormones after 6 weeks off tamoxifen.

FSH>30 on 2 occasions 6/52 apart confirms menopause if ammenorroiec for 12 months

200
Q

determine post-menopausal >54 and amenorrhoeic for 12 months

A

no need to check

if patient has PV bleed then stop

201
Q

prognostic factors of breast cancer

A 
lymph node status
tumour size
grade I-III
lymphatic/ vascular
biological factors
202
Q

breast cancer follow up yr1

A

clinical and mammogram

check hx

203
Q

breast cancer follow up yr 2-4

A

mammogram only

204
Q

breast cancer follow up yr 5

A

-clinical exam
mammogram
if on endocrine therapy consider switching, extending or stoping

205
Q

breast cancer follow up yr 6-10

A

mammogram only with clinic appointment yr 10 if on endocrine treatment

206
Q

HER2+ additioanl management

A
  • chemotherapy-docetexal, paclitaxel

- Herceptin -transtuzumab

207
Q

ER+ additional management pre menopause and men

A

-tamoxifen
goserelin
oophorectomy

208
Q

ER + additional management post menopausal

A

aromatase inhibitors

fulvestrant

209
Q

reducing risk of recurrence of breast cancer ER+

A

-USE TAMOXIFEN OR LETROZOLE

  • tamoxifen if low risk postmenopausal or aromatase CI
  • aromatase can be switched too if after 5 yrs on tamoxifen for higher grades (post menopausal)
210
Q

indications for bisphosphonates for breast cancer

A

node positive invasive breast cancer

reduces risk of bony mets in later life

211
Q

tamoxifen indication

A
  • ER positive breast cancer
  • anovulatory infertility
  • primary prevention of breast cancer for women at high risk BRCA
  • adjuvant treatment
  • Ductal carcinoma in situ
212
Q

action of tamoxifen

A

SERM selective estrogen receptor modulator
oestrogen receptor antagonist
anti-oestrogen which induces gonadotrophin release by occupying oestrogen receptors in the hypothalamus- so interferes with feedback mechanisms
binds to oestrogen receptors

213
Q

administration of tamoxifen

A

oral

214
Q

SE of tamoxifen

A 
alopecia
anaemia
cataracts
cerebral ischaemia
constipation
diarrhoea
dizziness
embolism and thrombosis
fluid retention
headache 
menstrual disturbance- vaginal bleeding, amenorrhoea
hot flushes
endometrial cancer
osteoporosis
vulvovaginal disorders
- rare- agranulocytosis
215
Q

contrainidcations to tamoxifen

A

pregnancy
hypersensitivity
concurrent anastrozole therapy
personal hx or fhx of VTE

216
Q

drug interactions of tamoxifen

A

anastrazole
hormonal therapy
warfarin- enhances
cyp450

217
Q

aromatase inhibitors example

A

anastrozole,-type 1 oral steroidal
letrozole- type 2
exemestane

218
Q

indication for aromatase inhibitors

A
  • post menopausal ER positive breast cancer
  • can also be adjuvant treatment following 2-3 yrs of tamoxifen therapy
  • neo-adjuvant to try and shrink
219
Q

action of aromatase inhibitors

A

in post-menopausal women peripherlal oestrogen synthesis from aromatase in adipose tissue
-aromatisation blocking reduce oestrogen

220
Q

administration of aromatase

A

oral

221
Q

monitoring on aromatase

A

need DEXA scan due to risk of osteoporosis

222
Q

SE of aromatase

A 
alopecia
hot flushes
tired
muscle pain
dry skin
hair thinning
sweats
reduced appetite
arthritis
insomnia
osteoporosis
223
Q

contraindications to aromatase

A 
pregnancy
pre-menopausal
breast feeding
use with caution in liver failure
avoid if CrCL <20
hypersensitivity to lactose
224
Q

drug interactions aromatase

A

dont give with tamoxifen or oestrogen containing therapies

225
Q

goserelin zoladex indications

A

prostate cancer
oestrogen receptor positive breast cancer
endometriosis
fibroids

226
Q

action of Goserelin

A 
GnRH analogue 
initial stimulation of GnRh 
then donw regulation of gonadotrophin releasing hormone receptors
reduce FSH and LH 
reduce oestrogen
227
Q

administration of goserelin

A

SC

implant

228
Q

contraindications of goserelin

A

undx vaginal bleeding
pregnancy
breast feeding

229
Q

side effects goserelin

A 
prolong QT
greater risk cord compression
alopecia
arthralgia
bone pain 
breast abnormalities
depresssion
glucose tolerance
gynaecomastia
hypercalcaemia
230
Q

Herceptin is

A

transtuzumab

231
Q

herceptin indication

A

breast cancer with HER2 positive

gastric cancer HER2

232
Q

HER2 pathology

A

normally HER2 controls healthy breast cell growth
but in cancer HER2 human epidermal growth factor receptor becomes an oncogene and are overexpressed (make too many copies)
promotes uncontrolled cell growth and proliferation when overexpressed

233
Q

herceptin mechanism of action

A

monoclonal antibody targets HER2 to prevent it being overexpressed

234
Q

administraction herceptin

A

IV

SC

235
Q

Contraindications to herceptin

A

severe dyspnoea at rest
caution in heart problems
avoid in pregnancy and breast feeding

236
Q

SE herceptin

A 
alopecia
anaemia
angioedema and dyspnoea
arthritis, asthma
GI problems
infusion reactions
237
Q

monitoring needed for Herceptin

A

cardiotoxicity

238
Q

drug interactions of herceptin

A

vaccines

drugs cardiotoxic

239
Q

Imatinib action

A

tyrosine kinase inhibitor

240
Q

imatinib indications

A

haem malignancies
-CML
ALL

GIST tumours
dermatofibrosarcoma protuberans

241
Q

interactions SE of imatinib

A 
infection risk
alopecia
anaemia
chills and constipation 
cough 
nandv
photosensitivity
thrombocytopaenia
242
Q

administration imatinib

A

oral

243
Q

CI imatinib

A

pregnnacy

breast feeding

244
Q

monitoring imatinib

A

GI
bloods
growth in children

245
Q

capecitabine indications

A

colon cancer
gastric cancer
breast cancer

246
Q

action of capecitabine

A

metabolised to fluorouracil in the liver which is a thymidylate synthase inhibitor
chemo medicaiton

247
Q

CI to capecitabine

A 
dihydropyrimidine dehydrogenase deficiency 
avoid in pregnancy
discontinue breast feeding
avoid if CrCL <30
 severe neutropaenia
lactose intolerant 
avoid live vaccines
248
Q

capecitabine SE

A 
alopecia, anaemia, chest pain, na and v
hypokalaemia
hand and foot syndrome
mouth sores and ulcers
risk of neutropaenia
depression, thrombosis,
thrombocytopaenia, cardiac
249
Q

monitoring for capecitabine

A

calcium
eyes
skin
hand and foot

250
Q

drug interactions capecitabine

A

warfarin
sorivudine
phenytoin
calcium folinate

251
Q

rituximab indications

A

non hodgkin lymphoma
CLL
pemphigus vulgaris

252
Q

action rituximab

A

monoclonal antibody to B cells

253
Q

administration rituximab

A

IV

SC

254
Q

CI rituximab

A

cardiac
pregnnacy
breast feeding
live vaccines

255
Q

SE rituximab

A 
alopecia
anaemia
conjunctivitis
GI
depression
increased risk of infection
MI
neutropaenia
pain
thrombocytopaenia 
tumour lysis syndrome
infusion related se
256
Q

ZOLEDRONIC acid indication

A

hypercalcaemia of malginancy
bone mets
node positive breast cancer
steroid induced osteoporosis

257
Q

action of zoledronic acid

A

binds to hydroxyapatite crystals in bone
disrupts osteoclasts
prevent break down

258
Q

interactions of zoledronic acid

A

calcium
diuretics
gentamycin

259
Q

toxicity signs zoledronic acid

A

amount of urine, muscle spasms weakness, mood, heart beat seizures

260
Q

monitoring zoledronic acid

A

-blood test

must be on birth control

261
Q

inx of prostate cancer

A 
PSA
DRE
MRI prostate
TRUS transrectal biopsy
gleason score
262
Q

localised prostate cancer treatment options

A

observation-watchful waiting
active surveillance
radiotherapy and bracytherapy
surgical

263
Q

complications prostate cancer management

A
  • surgery- impotence/ incontinence

- radiation- proctitis, cystitis

264
Q

metastatic prostate cancer management

A

Goserelin
bicalutmide and casodex- anti androgen -give with first injection of goserelin to prevent rise

LHRH antagonist- firmagon/ degarelix
orchidectomy

plus chemo
palliative radiotherapy if bone mets

265
Q

colorectal cancer inx

A 
bloods
sigmoidoscopy
biopsy
barium enema
colonoscopy
USS
MRI
CT
266
Q

FAP

A

familial adenomatous polyposis
autosomal dominant
lots of polyps
APC andeomatous polyposis colii gene

267
Q

HNPCC hereditary non polyposis colorectal carcinoma

A

autosomal dominant

mutation MLH1 MSH2 DNA mismatch repair gene so get microsatellite instability

268
Q

neo-adjuvant management of rectal cancer

A

-radiotherapy

chemotherapy

269
Q

management of GI cancers

A

-rectal only get neo-adjuvant
surgical
-adjuvant chemotherapy - capecitabine or oxaliplatin

270
Q

side effects of radiotherapy

A

-normal tissue complications
-acute toxicities- lethargy, erythema, mucosal, alopecia
-late toxicities- GI, neuro, MSK,resp, lymphoedema
-infertility
second malignancies
cardiac toxic

271
Q

management of acute skin toxicities radiotherapy

A

aqueous cream

prophylactic use of bethamethasone- topical steroid

272
Q

minimising toxicities of radiotherapy

A

positioning
cardiac shielding eg MLC
breathing manoeuvres

273
Q

what is bracytherapy

A

sealed radiation source is placed inside or next to the area requiring treatment

274
Q

LUNG CANCER presentation

A 
asymptomatic
invasive symptoms eg SVCO 
dysphagia
horner 
airway symptoms 
systemic 
finger clubbing
HPOA
275
Q

where does lung cancer spread

A 
lumph nodes
adrenals
pleura
liver
skin
bones
brain
276
Q

types of lung cancer

A

SCLC 15%

NSCLC
-adenocarcinoma
squamous
large cell

277
Q

adenocarcinoma lung

A
  • more common type in non-smokers

- overall most common

278
Q

large cell lung cancer

A

peripheral
anaplastic, poorly differentiated
poor prognosis

279
Q

squamous cell lung cancer

A 
-slower growing
paraneoplastic
-hypercalcaemia- ectopic PTH
-finger clubbing
-hyperthyrodisim produces TSH 
HPOA
central
280
Q

small cell lung cancer feature

A

grows faster
smoking related
arises from APUD cells
-ectopic ADH and ACTH

SIADH- hyponatraemia
ectopic ACTH- cushing like, adrenal
Eaton lambert- myasthenia gravis like

281
Q

mesothelioma lung

A

linked to asbestos

282
Q

INX for lung cancer

A
  1. CXR
  2. CT CA with contrast
  3. tissue collection
    - bronchoscopy for central lesions
    - EBUS
    - CT guided percutaneous tranthroacic FNA for peripheral lesions
  4. CT PET if surgical considered stages 1-3
283
Q

small cell lung cancer management

A

usually metastatic by dx
can resect if early
chemo cisplatin and radiotherapy
SACT

284
Q

non small cell management

A
  • surgery and chemoradiotherapy

- tyrosine kinase inhibitor for eGFR mutation

285
Q

causes of pulmonary mets

A 
renal
breast
colorectal 
bladder
remember big colourful balls
286
Q

types of ovarian cancer

A

-epithelial tumours
serous 50% malignancy
mucinous 10%
endometrioid 25%

Germ cell tumours
teratoma- mostly benign, increased AFP, teeth hair and bone
germinoma- most common younger women

sex cord tumour
-granulosa
thecomas

287
Q

main biomarker for ovarian cancer

A

ca125

288
Q

management ovarian cancer

A

surgical- full hysterectomy with bilatearl salpingo-oophorectomy and partial omentectomy

in young women wishing to preserve fertility and early stage may be able to just remove the ovary affected

chemotherapy

289
Q

neutropaenic sepsis pathology

A

patients on SACT
-cytotoxic drugs target high rapid dividing cells so stem cells also get affected and get neutropaenia

-also affects mucosa and break down of gastric mucosa means bacteria can get across

290
Q

definition of neutropaenic sepsis

A

patient on chemotherapy
neutrophil count <0.5 and either
-temp >38
signs of symptoms of sepsis

(in practice dont wait for neutrophil count)

291
Q

presentation of neutropaenic sepsis

A

temperature >37.5 or <36.5
-not always

symptoms
-sspsi
unwell

patient at risk especially 7-21 days post SACT

292
Q

assessment of Neutropaenic sepsi

A

admission-preferrably onto oncology
NEWS
MASCC score

-specific risks to look for
catheters, wounds, previous MRSA colonisation, atypical resp pathogens

IV access- take bloods and cultures

antibiotics empirical

293
Q

DEFINING high and low risk in neutropaenic sepsis

A

MASCC score

  • greater than or equal to 21 are standard risk
  • less than 21 are high risk

NEWS score greater than or equal to 6 is automatically high risk independent of the MASCC score

high risk also if
-BP <90
shocked
PS 3 and above

or 2 of

  • dehydration
  • COPD
  • PS 2 or more
  • previous fungal
  • inpatient when developed
  • age >60
294
Q

inx for neutropaenic sepsis

A

SEPSIS 6 and initial assessment

hx and exam
bloods 
cultures from blood and lines
viral throat swabs
urine 
imaging- CXR, CT 
stool cultures
295
Q

antibiotics for standard risk

A

21 or above MASCC, or 5 or less NEWS

  • IV piperacillin and tazobactam- tazocin
  • 1st dose give regardless of renal function
  • after that tailor dose to creatinine

also cover any specific risks

  • vancomycin for MRSA
  • clarithromycin for atypical pneumonia

allergies-true penicillin
-vancomycin, metronidazole, IV azetreonam
if mild allergy
-ceftazidime+ IV gentamicin+ metronidazole

296
Q

MASCC <21 or News 6 and above

A

IV piperacillin/ tazobactam and IV gentamicin

  • if clear hx of renal impairment need to refer to guidelines and discuss with microbio
  • again dose both with creatinine levels
297
Q

other management option for neutropaenic sepsis

A 
Granulocyte- colony stimulating factor
-profound neutropaenia <0.1
prolonged >10days 
pneumonia
hypotension
multiforgan dysfunction
invasive fungal
>65 
hospital inpatient at the time
298
Q

presentation of malignant cord compression

A 
pain -back pain- radicular pain- band like 
weakness bilateral or unilateral
sensory or autonomic disturbance
bowel problems- constipated
altered sensation
urinary problems
faecal incontinence
paraplegia
UMN signs if >l1
LMN signs if
299
Q

main causes of malginant cord compression

A

-breast
lung
prostate
myeloma

300
Q

types of cord compression

A

complete compression
anterior compression- pain and temp
-posterior- vibration and position
lateral- brown sequard pain and temp

301
Q

dx of cord compression

A

URGENT MRI OF WHOLE SPINE

302
Q

cauda equina is

A

compression below L1/2
sciatic pain, bladder dysfunction and retention, overflow incontinence, impotence, saddle anaesthesia, loss of anal sphincter tone, weakness and wasting of gluteal muscles

303
Q

treatment of malignant cord compress acute

A 
-lie flat
steroids- immediate dexamethasone plus PPI cover
analgesia
thromboprophylaxis
prompt physio
ensure spine stable
304
Q

next mangement of malignant cord compress

A
  • radiotherapy- mainstay of treatment
    start as soon as practical, llie supine

-surgical- laminectomy

  • chemotherapy-usually after RADIOTHERAPY-mainstay
  • hormone therapy -prostate
305
Q

radicular pain plus active or recent cancer is

A

malignant cord compression until determined otherwise

306
Q

SVCO is

A

obstruction of blood flow through the SVC

due to compression, invasion or intra-luminal thrombus in SVC

307
Q

causes of an SVCO

A

-lung cancer 80% bronchus more non small cell
lymphoma
other malignancies

benign causes: aneurysm, goitre, fibrosis, infection, central line in situ

other
-blood clots
TB
aortic aneurysm

308
Q

symptoms of SVCO

A 
often insidious over time
swelling of face, neck, arms
distended veins
SOB
headache
lethargy
conjunctival suffusion- red eye
nasal congestion
epistaxis
dizziness
syncope
worse on bending forwards
309
Q

assessment SVCO

A
  • extent

- any evidence of malginancy elsewhere eg lymphs, collapsed lung

310
Q

signs of SVCO

A 
non pulsatile raised JVP
collateral venous
arm oedema
plethora 
acute unwell patient in cases sudden occlusion

early stage= puffy neck and veins
later= distended veins, swollen face, neck and arms

311
Q

cause of obstruction SVCO

A

within

  • clot
  • foreign body
  • tumour eg renal cancer

extrinisc compression

312
Q

inx SVCO

A 
usually not an emergency so inx
-CXR-widened mediastinum
-venogram
CT chest
bloods
mass-biopsy
313
Q

treatment SVCO in emergency

A 
A to E
sit upright
oxygen 
dexamethasone and PPI
if clot- anticoagulant, line removal if present

extrinisc compression

  • dexamethasone
  • radiological stent insertion
  • chemo-SCLC, lymphoma and teratoma
  • radiotherapy -solid tumours
314
Q

treatment SVCO in emergency

A 
A to E
sit upright
oxygen 
dexamethasone and PPI
if clot- anticoagulant, line removal if present

extrinisc compression

  • dexamethasone
  • radiological stent insertion
  • chemo-SCLC, lymphoma and teratoma
  • radiotherapy -solid tumours
315
Q

definition of malignant hypercalcaemia

A

hypercalcaemia >2.65 on two occasions following adjustment for serum albumin concentration

-urgent intervention needed if >3

316
Q

mechanisms of malignant hypercalcaemia

A
  • osteolytic measures due to bone mets-release protein that increase osteoclast activation
  • circualting PTHrP or calcitriol released
317
Q

tumours that release PTHrP

A 
squamous carcinomas of lungs
head and neck
renal
bladder 
ovarian
318
Q

tumours that release calcitriol

A

lymphoma-hodgkin’s

319
Q

inx for tumour PTHrP findings

A

low vit D-calcitriol
high PTHrP
low PTH

320
Q

inx for osteolytic measure tumour findings

A

low PTH
low calcitriol or normal
low PTHrP

321
Q

calcitonin function

A

meant to reduce calcium re-uptake and increase calcium bone deposition when calcium is high

322
Q

severity hypercalcaemia

A

mild=2.65-3
mod 3.01-3.40
severe >3.40

323
Q

malignant causes of hypercalcaemia

A 
lung
breast
myeloma
osteolysis lytic bone mets
humoral mediators 
dehydration 
tumour specific mechanisms eg myeloma depositis bence proteins in kidneys which decreases calcium excretion
324
Q

clinical features of hypercalcaemia

A

-stones bones groans moans overtones, thrones
bone pain
neuromuscular- droswy, delirium coma, fatigue depression, n and v, weight loss, constipation

renal: polyuria, polydipsia, dehydration
cardio: HTN, shorten QT

325
Q

INX hypercalcaemia

A

-calcium
-renal function
PTH - high suggest primary hyperparathyroidism- throid gland

vit D high or low depending on cause

ECG- increased PR interval, widened QRS

326
Q

management <3 calcium

A

no active treatment needed

avoid dehydration and medications

327
Q

management 3-3.5

A

-generally no active treatment unless symptomatic or acute

symptomatic- fluid replacement 0.9% sodium chloride

328
Q

management calcium >3.5

A

emergency treatment needed
rehydration-IV fluids first
bisphosphonates-zoledronate- IV
give Pamidronate if GFR <30
review medication
check renal function in 3-4 days- (rescue zoledronate)
haemofiltration- dialysis if not responding

329
Q

SE of bisphosphonates

A 
GI upset
flu like symptoms
exacerbation of metastatic bone pain
ostenecrosis of the jaw
hypocalcaemia
330
Q

other drug options for hypercalcaemia

A
  • salcatonin- calcitonin
  • gallium nitrate- inhibits osteoclatic bone resporption and inhibits PTH
  • dialysis if severe who have good prognosis and adequate hydration cannot be achieved due to renal or cardiac failure
331
Q

malignant pericardial effusion causes

A

-thoracic malignancies such as lung cancer, mesothelioma or metastatic disease

332
Q

presentation of malignant pericardial effusions

A

acute dyspnoea
chest pain

rapid accumulation of fluid or pericardial stiffening due to the tumour can result in tamponade with worsening symptoms including orthopnoea, cough, syncope

-heart sounds muffled and pericardial rub
-apex beat not detectable
-low bp
pulsus paraodxus

333
Q

inx for malignant pericardial effusion

A

ECG
CXR
ECHO confirm
aspiration

334
Q

CXR signs of pericardial effusion

A
  • increased cardiothoracic ratio

enlarged globular heart

335
Q

management of pericardial effusion

A

-drain by needle under radiological control
-surgical procedure of pericardial window formation
treat underlying cancer

336
Q

tumour lysis syndrome cause

A

-syndrome of metabolic abnormalities and renal impairment due to massive lysis of a rapidly proliferating tumour cells resulting in the release of intracellular contents into the circualtion

337
Q

patient with large volume malignant disease develops acute renal failure

A

tumour lysis sundrome

338
Q

which tumours are assoc. to tumour lysis

A

-poorly differentiated lymphomas
leukaemias
germ cell tumours
breast myeloma

-chemo sensitive tumours

339
Q

presentation tumour lysis syndrome

A

recent chemotherapy/ initiation- can also be spontaneous in tumours with high turnover or following steroid monotherapy for lymphoma

bulky chemo sensitive cancer
oliguric
HTN
tachycardic
fatigue
weakness
N and V
340
Q

metabolic abnormalities of tumour lysis syndrome and presentation

A
  1. hyperuricaemia
    - release of nucleic acids metabolised to uric acid
    - then depositis in renal tubules and causes acute uric acid nephropathy
    - oliguric ARF
  2. hyperphosphateamia
    - 2ndary to release of intra-cellular phosphate
    - malignant cells have higher phosphate
    - precipitate with calcium deposits in kidney- ARF
  3. hyperkalaemia
    - exacerbated by deteriorating renal function
    - cardiac- ECG tall t, loss p, wide qrs, sine wave
  4. hypocalcaemia / hypomagnesia
    - secondary to increase phosphate
    - muscle weakness and tetany
  5. Acute renal failure
    - uric acid and phosphate deposit
  6. metabolic acidosis
341
Q

patients at risk of tumour lysis syndrome

A

1.-patients specific- baseline metabolic abnormality
2. suboptimal renal function
3. large volume, rapid cell turnover, chemo sensitive tumours
4, especially lymphomas, leukaemias, germ cell tumours

342
Q

preventing tumour lysis syndrome

A
  1. optimise renal function before and during treatment
    - relieve any obstruction
    - correct any existing electrolyte abnormalities
    - ensure adequate fluid replacement
    - (mannitol)
  2. if low risk- absence of pre-treatment hyperiuricaemia
    - allopurinol can be given pre-chemo for 48 hrs to decrease incidence of post-treatment hyperuric
  3. if high risk- presence of pre treatment hyperuricaemia
    -rasburicase given (recombinant urate oxidase)
    -degradation of uric acid
    1-7 DAYS
    CI G6PD

-leucophoresis if blast count high

343
Q

management of tumour lysis syndrome

A 
-urgent correct hyperkalaemia
fluid balance monitor
urinalysis- uric acid crystals
exclude post-renal cause USS
monitor renal function 
calcium supplementation
consider alkalinising the urine-sodium bicarb
haemodialysis
344
Q

main cancer pains

A 
bone 
nerve compression
visceral pain
muscle spasm
soft tissue pain
post-op pain
neuropathy
back pain
capsulitis shoulder
constipation
345
Q

neuropathic pain cause

A

nerve damage
burning, sharp, pins and needles
allodynia may occur
can be localised to dermatomes

346
Q

WHO analgesic ladder

A
  1. non opioid
    -paracetamol
    NSAID
  2. mild opioid eg codeine
  3. strong opioid for moderate to severe pain
    eg morphine
347
Q

SE opioids

A 
DESIGNER
dry mouth
euthoria
sedation
itch
GI
nausea
eyes
resp depression
348
Q

opioid toxicity

A 
confusion
drowsiness
myooclonic jerk
hallucinations
peripheral shadows
349
Q

withdrawal symptoms of opioids

A

n and v
diarrhoea
depression

350
Q

strong opioids

A 
morphine 
diamorphine
fentanyl
oxycodone
alfentanil
methadone
351
Q

weak opioids

A 
codeine
co-codamol
dihydrocodeine
tramadol
buprenorphine
352
Q

codeine

A

metabolised to morphine at liver

avoid in CKD 4 and 5

353
Q

dihydrocodeine

A

similar to codeine
metabolised in liver
avoid in CKD 4 and 5

354
Q

tramadol

A 
also an opioid
but different chemically
renal excreted
use with caution in CKD 4 and 5 
CI if on MAOI or epilepsy
355
Q

buprenorphine patches

A

7 day patch
treats moderate pain
CI in patients with acute short term pain and in those who need rapid dose titration for severe uncontrolled pain
can be used in CKD 4 and 5

356
Q

morphine

A

immediate or modified release
oral or parenteral

cautions

  • frail or elderly
  • liver impairment

CI
-CKD 4 and 5

prescribe with stimulant/ laxative and anti-emetic

357
Q

diamorphine

A 
parenteral 
SC and pump
highly soluble 
use for high dose SC breakthrough
avoid in CKD 4 and 5
358
Q

oxycodone

A

moderate to severe pain if morphine/ diamorphine not tolerate
immediate, modified, oral and parenteral

moderate forms CI in

  • CKD 4 and 5
  • moderate to severe liver impairment
359
Q

fentanyl patches

A

transdermal patch lasts 72 hours
use if oral and SC routes are unsuitable
can be used in CKD

indication
-for stable pain if morphine not tolerated
second line opioid
oral and SC not suitable
patient unable to tolerate morphine/ diamorphine

360
Q

opioid toxicity

A

precipitated by dose escalation, renal impairment, sepsis, electrolyte abnormalities, drug interactions

361
Q

presentation opioid toxicity

A 
persistent sedation
vivid dreams, hallucinations, myoclonus jerking 
confusion
delirium 
muscle twitch
362
Q

management opioid toxicity

A

if pain controlled reduce opioid by 1/3
ensure hydrated
for agitation can give haloperidol
if patient is still in pain consider reducing dose by a 1/3 and consider adjuvant analgesics
naloxone only for life threatening severe resp depression

363
Q

causes of pain

A

total pain-interaction in nervous system of all physical and emotional aspects

disease related- direct invasion of organ, pressure, cancer, distension
bone pain- worse on pressure, stress
nerve pain- burning shooting, tingling
liver pain- RUQ pain, referred shoulder tip
raised ICP- headache worse on lying
colic: intermittent cramp
cancer pain related- eg liver capsule, plexopathy, coelaic plexus

364
Q

pain management

A

mild pain

  1. paracetamol/ NSAID
  2. weak opioid- codeine, dyhydrocodeine, buprenorphine, tramadol

moderate to severe pain

  1. morphine and stop any weak opiods
  2. nerve blocks, epidurals,
365
Q

anorexia in cancer causes

A 
-neurohumoral  
multifactoial
metabolic
reduced fuel supply
accelerated metabolism
366
Q

causes cancer related fatigue

A 
depression
anaemia
cancer rx
tumour bulk
cytokine release
367
Q

delirium definition

A

disturbed consciousness and inattention with cognitive impairment
delirium is often reversible
fluctuating state of lucid points with confusion, hallucination, agitation

368
Q

three types delirium

A

hyperactive
hypoactive
mixed

369
Q

causes of delirium

A 
drugs- opioids, ach, steroids, benzos, anti dp
drug withdrawal- alcohol, sedatives, adp
dehydration, constipation, urianry retention
uncontrolled pain
liver renal imapirment
electrolytes
infection 
hypoxia
metabolic
cancer treatment eg cranial radiotherapy
brain mets
paraneoplastic syndromes
substance abuse
visual impairment and deafness are RF
370
Q

inx delirium

A

bloods
infection
review all meds and stop any non essential drugs
assess sensory impairment
check for opioid toxicity
check for constipation, retention, catheter

year 5 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions