Pretest - endocrine problems and the breast Flashcards

1
Q

45yo woman complains to her PCP of nervousness, sweating, tremulousness and weight loos. the thyroid scan shown here with a hot nodule, slightly right of midline, spotty uptake of on radioactive iodineexhibits a pattern that is most consistent with which of the following disorders?

a. hypersecreting adenoma
b. Graves disease
c. lateral aberrant thyroid
d. papillary carcinoma of thyroid
e. medullary carcinoma of thyroid

A

A. consistent uptake of ioddide

not cancer
both papillary & follicular cancer have good uptake, usually cold- but pts are usually euthyroid

Graves - diffuse uptake

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2
Q

a pt with mild skin pigmentation is admitted emergently to your service b/c of sudden abdominal pain, fever, and a rigid abdomen. her blood work indicates a marked leukocytosis, a blood sugar of 55, Na 119, and K 6.2. her BP is 88/58. she undergoes an exploratory laparotomy. which of the following is the definitive treatment for her primary condition.

a. 10% dextrose infusion
b. bicarbonate
c. hypertonic saline
d. corticosteroids
e. vasopressors

A

D. for sepsis / hypovolemia

perforation?
“mild skin pigmentation” - jaundice or hemochromatosis; hyperpigmentation from POMC from low cortisol feedback causing overproduction of ACTH (+ melanin)

adrenal crisis

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3
Q

35yo woman with a hx of previous R thyroidectomy for a benign thyroid nodule now undergoes completion thyroidectomy for a suspicious thyroid mass. several hours postoperatively, she develops progressive swelling under the incision, stridor & difficulty breathing. orotracheat intubation is successful. which of the following is the most appropriate next step?

a. fiberoptic laryngoscopy to rule out bilateral vocal cord paralysis
b. administration of IV Ca
c. administration of broad-spectrum abx and debridement of wound
d. wound exploration
e. administration of high-dose steroids & antihistamines

A

D

–> swelling under incision (wound hematoma)- there wasn’t enough of a hole left in the fascia and hematoma developed

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4
Q

a 62yo woman presents with invasive ductal carcinoma of the eR breast. which of the following findings would still allow her to receive breast conservation surgery (partial mastectomy)?

a. diffuse suspicious microcalcifications throughout the breast
b. multifocal disease
c. previous treatment of a breast Ca with lumpectomy and radiation
d. large tumor relative to breast size
e. persistently postiive margins after multiple reexcisions of the breast ca

A

B. multifocal disease = multiple tumors within 1 quadrant of the breast. okay to do lumpectomy if lesions are small relative to the size of the breast

DEFINITELY need total mastectomy

  • diffuse disease
  • large tumor –> b/c might as well take the whole breast
  • positive margins
  • hx of theraputic radiation
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5
Q

29yo woman presents with a 6mo hx of erythema and edema of the R breast with palpable axillary lympahdenoapthy. a punch biopsy of te skin reveals neoplastic cells in the dermal lymphatics. which of the following is the best next step in her management?

a. a course of nafcillin to treat the overlying cellulitis and then neoadjuvant chemotherapy for breast cancer
b. modified radical mastectomy followed by adjuvant chemotherapy
c. modified radical mastectomy followed by hormonal therapy
d. combined modality chemotherapy & radiation therapy to the R breast with surgery reserved for residual disease
e. combined modality therapy with chemotherapy, surgery and radiation.

A

E. need to get the lymph nodes as well

likely inflammatory carcinoma, with involvement of lymphatics

50% 5-year survival rate

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6
Q

15yo otherwise healthy female HS student begins to notice galactorrhea. a pregnancy test is negative. which of the following is a frequently associated physical finding?

a. gonadal atrophy
b. bitemporal hemianopsia
c. exophthalmos and lidlag
d. episodic HTN
e. buffalo hump

A

B

likely proloactinoma

amenorrhea, galactorrhea, lack of libido, impotence, infertility

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7
Q

52yo woman sees her physician with complaints of fatigue, HA, flank pain, hematuria, and abdominal pain. she undergoes a sestamibi scna that demonstrates persistent uptake in the R superior parathyroid gland at 2h. which of the following lab values is most suggestive of her diagnosis?

a. serum acid phosphatase > 120
b. serum alkaline phsophatase > 120
c. serum Ca > 11
d. urinary calcium < 100
e. parathyroid hormone levels < 5

A

C

recurrent Ca stones –> hyperparathyroidism

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8
Q

53yo woman presents with weight loss and a persistent rash to her lower abdomen and perineum. she is diagnosed with necrolytic migrating erythema and additional workup demonstrates DM, anemia, and a large mass in the tail of the pancreas. which of the following is the most likely diagnosis?

a. Verner-Morrison syndrome (VIPoma)
b. glucagonoma
c. somatostatinoma
d. insulinoma
e. gastrinoma

A

B

glucagonoma –> necrolytic migrating erythema; DM, anemia, weight loss.
–> high levels of serum glucose; low glucose storage

(reversal insulin)

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9
Q

49yo obese man has become irritable, his face has changed to a round configuration, he has developed purplish lines on his flanks, and he is hypertensive. a 24h urine collection demonstrate elevated cortisol levels. this is confirmed with bedtime cortisol measurements of 700. which of the following findings is most consistent with the diagnosis of Cushing disease?

a. decreased ACTH levels
b. glucocorticoid use for the treatment of inflammatory d/o
c. a 3cm adrenal mass on the CT scan
d. suppression with high-dose dexamethasone suppression testing
e. a 1cm bronchogenic mass on MRI

A

D

Cushing disease –> anterior pituitary tumor = high ACTH, high cortisol. will respond to suppression b/c it’s in the right spot for negative feedback
Cushing syndrome –> adrenal gland tumor = low ACTH, high cortisol

ectopic tissue –> low ACTH, high cortisol

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10
Q

35yo woman presents with a lump in the L breast. her family hx is negative for breast ca. on exam, the mass is rubbery, mobile, and nontender to palpation. there are no overlying skin changes and the axilla is negative for lymphadenopathy. US demonstrates a simple cm cyst in the area of the palpable mass in the L breast. which of the folllowing represents the most appropriate management of this pt?

a. reassurance and reexamination
b. immediate excisional biopsy
c. . aspiration fo the cyst with cytologic analysis
d. fluoroscopically guided needle localization biopsy
e. mammography & reevaluation of options with new info

A

A
>35 yo –> don’t wait. get mammogram /MRI
possibly reconsider if already find that it is a simple cyst

<35yo –> mammogram & US –> b/c can detect cyst

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11
Q

55yo woman presets with a slow-growing painlesss mass on the R side of the neck. a FNA shows a well-differentiated papillary carcinoma. a complete neck ultrasound demonstrates a 1cm nodule in the R thyroid without masses in the C/L lobe or lymph node metastasis in the central & lateral neck compartments. with regards to this pt, which of the following is associated w/ a poor prognosis?

a. age
b. sex
c. grade of tumor
d. size of tumor
c. lymph node status

A

A

older, female (>45yo = poor prognosis)
low grade (T0-1, N0, M0), low stage (well-differentiated)
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12
Q

55yo woman presents with a 6cm R thyroid mass and palpable cervical lymphadenopahy. FNA of one of the lymph nodes demonstrates the presence of calcified clumps of sloughed cells. which of the following best management of this thyroid d/o?

a. the pt should be screened for pancreatic endocrine neoplasms and hypercalcemia.
b. the pt should undergo total thyroidectomy with modified radical neck dissection.
c. the pt should undergo total thyroidectomy with frozen section intraoperatively, with modified radical neck dissection reserved for pts with extracapsular invasion
d. the pt should undergo R thyroid lobectomy followed by iodine 131 therapy
e. the pt should undergo R thyroid lobectomy.

A

B

“calcified clumps of sloughed cells” = psomoma bodies –> papillary carcinoma + spread to lymph nodes

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13
Q

45yo woman is foudn to have suspicious appearing calcifications in the R breast on a screening mammogram. stereotactic biopsy of the calcifications shows lobular carcinoma in situ (LCIS). on exam, both breasts are dense without palpable masses. the neck and b/l axilla are negative for lymphadenopathy. which of the following is the most appropriate management of the pt?

a. frequent self-breast exams and yearly screening mammograms
b. chemotherapy
c. radiation
d. R total mastectomy with sentinel lymph node biopsy
e. b/l modified radical mastectomy

A

A. LCIS «< DCIS in terms of concern for malignancy

  • limited disease = partial mastectomy + radiation + sentinel node
  • diffuse disease = total mastectomy + sentinel node

in situ

If DCIS –> D

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14
Q

a 14yo black has her R breast removed /c of a large mass. the tumor weighs 1400g and has a bulging, very firm lobulated surface with a whorl-like pattern. which of the following is the most likely diagnosis?

a. cystosarcoma phyllodes
b. intraductal carcinoma
c. malignant lymphoma
d. fibroadenoma
e. juvenile hypertrophy

A

D. Fibroadenoma = most common breast tumors between teens to 30s. well-demarcated and firm;

it’s has whorls - something is making that shape (fibrin?)

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15
Q

53yo woman presents with complaints of weakness, anorexia, malaise, constipation, and back pain. while being evaluated, she becomes somewhat lethargic. lab studies include a normal chest xray, serum albumin 3.2, serum Ca 14, serum phosphate 2.6, serum Cl 108, BUn 32, and creatine 2. which of the following is the most appropriate initial management?

a. IV normal saline infusion
b. adminstration of thiazide diuretics
c. administration of IV phosphorus
d. use of mithramycin
e. neck exploration and parathyroidectoy

A

A –> get rid of serum Ca

Corrected Ca = 14 + 0.8 (0.8) = 14.64

Can be hyperparathyroidism or cancer

1) saline
2) loops (NOT THIAZIDES)
3) bisphosphonate

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16
Q

which of the following pts with primary hyperparathyroidism should undergo parathyroidectomy

a. 62yo symptomatic woman
b. 54 yowoman with fatigue and depression
c. 42yo woman with a history of kidney stones
d. 59yo woman with mildly elevated 24h urinary Ca excretion
e. 60yo woman with mildly decrease dbone mineral density measured at the hip of <2 standard deviations below peak bone density

A

C

indications for parathyroidectomy

  • recurrent stones
  • osteoporosis (
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17
Q
45yo woman presents with HTN, development of facial hair, and a 7cm suprarenal mass. which of the following is the most likely diagnosis?
a. myelolipoma
b. Cushing disease
c. adrenocortical carcinoma
d pheochromocytoma
e. carcinoid
A

C

virilization / hirsutism –> from sex hormones (testosterone) from adrenal tumor

Cushing disease - from pituitary

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18
Q

36yo woman presents with palpitations, anxiety, and HTN. workup reveals a pheochromocytoma. which of the following is the best approach to optiizing the pt preoperatively?
a. fluid restriction 24h preoperatively to prevent intraoperative congresive heart failure
b. initiation of an alpha blocker 24h before surgery
c. initiation of an alpha blocker 1-3w before surgery
D. initiation of an beta blocker 1-3w before surgery
e. escalating an antihypertensive drug therapy with B blockers - followed by alpha blockage starting at least 1w prior to surgery

A

C. Always want to give alpha blockers first (or alone, if necessary –> can’t give beta blockers alone d/t alpha vasoconstriction)

intraoperaive - give alpha blockers (b/c of effect of peripheral vasoconstrictors), then beta blockers

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19
Q

33yo pregnant woman notices a persistent, painless lump in the L breast. on exam, the L breast has a single mobile mass without evidence of skin changes or lyphadenopathy in the neck of axilla. an US demonstrates a solid 1cm mass in the upper outer quadrant of the breast. a core-needle biopsy shows invasive ductal carcinoma. the pt is in her first trimester of her pregnancy. which of the following options is in her first treatment of this pt?

a. termination of the pregnancy followed by modified radical mastectomy
b. immediate administration of chemotherapy followed by modified radical mastectomy after delivery of the baby
c. administration of radiation in the third trimester followed by modified radical mastectomy after delivery of the baby
d. total mastectomy with sentinel lyph node biopsy
e. modified radical biopsy

A

E

–> wait for delivery of the baby before anything else?

any radiation would harm the baby (radiation / chemotherpay or sentinel node)

no evidence that general anaesthesia and nonabdominal surgery increases premature labor or hurts the baby

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20
Q

40yo woman presents with a rash involving the nipple-areola complex for the last month with associated itching. on PE, there is crusting and ulceration of the nipple with surrounding erythema involving the areola and surrounding skin, no palpable breast masses, and no cervical or axillary lymphadenopathy. which fo teh following is the most appropriate next step in the management of this pt?
a reexamine the pt in 1mo
b. corticosteroids cream to the affected
c. administration of oral Abx
d. mammogran and biopsy of the affected area
e. modified radical mastectomy

A

D

crusting of nipple = Paget

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21
Q

50yo man presents with intractable peptic ulcer disease, severe esophagitis, and abdominal pain. which of the following is most consistent with the diagnosis of Zollinger-Ellison syndrome?

a. hypercalcemia
b. fasting gastrin level of 10
c. fasting gastrin level of 100
d. increase in gastrin level (>200) after administration of secretin
e. decrease in gastrin level (>200) after administration of secretin

A

D

tumor that produces a lot of gastric acid (paradoxically increases with administration of secretion)

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22
Q

29yo woman with a history of difficulty becoming pregnant presents to her primary care physician and is diagnosed with Grave disease on iodine uptake scan. her TSH is markedly suppressed and her free thyroxine (T4) is elevated. she desires to conceive as soon as possible and elects to undergo thyroidectomy. after hse is rendered euthyroid with medications preoperatively, which of teh following management strategies should also be employed to reduce the risk of developing thyroid storm in the operatig room?

a. drops of lugol iodine solution daily beginning 10d preop
b. preoperative treatment with pheoxybenzamine for 3w
c. preop treatment with propalolol for 1w
d. 24h of corticosteroids preop
e. no other preop medication is required

A

A
drops of lugol –> decreases likelihood of postoperative thyroid storm

treatment of thyroid storm

  • propanolol
  • corticosteroid
  • propylthiouracil
23
Q

30yo woman presents with HTN, weakness, bone pain, and a serum Ca of 15.2. Hand films show osteitis fibrosa cystica. which of the following is the most likely cause cause of these findings?

a. sarcoidosis
b. vitD intoxication
c. paget disease
d. meastatic carcinoma
e. primary hyperparathyroidism

A

E

–> severe deminieralization fo subperiosteal bone resorption; bone cysts; tufting of distal phalanges

24
Q

35yo woman presents with a serum Ca 15.2 mg/dL and an elevated parathyroid hormone level. Following correction of the pts hypercalcemia with hydration and furosemide, which of the following is the best therapeutic approach?

a. administration of steroids
b. radiation treatment to the neck
c. neck exploration and resection of all 4 parathyroids
d. neck exploration and resection of a parathroid adenoma
e. avoidance of sunlight, vit D, and Ca-containing dairy products.

A

D

most likely - parathyroid adenoma (85%)

25
Q

58yo man presents with tachycardia, feer, confusion and vomiting. w/up reveals markedly elevated (tridiodothyronin) T3 and (thyroxine) T4 levels. he is diagnosed as having a thyroid storm. which of the following is the most appropriate next step in the management of this pt?

a. emergent subtotal thyroidectomy
b. emergent total thyroidectomy
c. emergent hemodialysis
d. administration of fluid, antithyroid, B-blockers, iodine solution, and steroids
e. emergent radiation therapy to the eck

A

D

more likely to care for it medically first

lugol = decrease iodine uptake and thyroid hormone production. 
PTU = block formation of new thyroid hromone; reduce peripheral conversion
26
Q

34yo woman presents with HTN, generalized weakness, and polyuria. her electrolyte panel is significant for hypokalemia. which of the following is the best initial est given her prsentation and lab findngs.

a. plasma renin ativity & plasma aldosterone conc.
b. urine electrolytes
c. plasma cortisol level
d. overnight low-dose dexamethasone suppression est
e. 24h urinary aldosterone level

A

A

hyperaldosterone

27
Q

incisional biopsy of a breast mass in a 35yo woman demonstrates cystosarcoma phyllodes at the time of frozen section. which of the following is the most appropriate management strategy for this lesion?

a. wide local excision with arim of normal tissue
b. lumpectomy and axillary lymphadenectomy
c. modified radial mastectomy
d. excision and postoperative radiotherapy
e. excision, postoperative radiotherapy and systemic chemotherapy

A

A

Cystosarcoma phyllodes = can grow enormous; +/- ulceration through the skin. LOW RISK of metastasis; common for local recurrence.
tx = excision with adequate margins of normal breast tissue.

Only do axillary lymphadenectomy with biopsy-positive demonstration fo tumor in the nodes

28
Q

36yo woman, 20w pregnant, presents with a 1.5cm R thyroid mass. FNA is consistent with a papillary neoplasm. the mass is cold on scan and solid on US. which of the followig methods is C/I in this pt?

a. R thyroid lobectomy
b. subtotal thyroidectomy
c. total thyroidectomy
d. total thyroidectomy with lymph node dissection
e. I-131 radioactive ablation of the thyroid gland

A

E

no radiation for preggers

29
Q

63yo woman notices lumps on both sides of her neck. a FNA is nondiagnostic, and she undergoes total thyroidecomy. Final pathology reveals a 2cm Hurthle cell carcinoma. which of the following is the most appropriate postsurgical management of this pt?

a. no further therapy is indicated
b. chemotherapy
e. external beam radiotherapy
d. radioiodine ablation
e. chemotherapy, external beam radiotherapy, and radioiodine ablation.

A

D

Treatment for follicular carcinoma & Hurtle

1) thyroidectomy
2) radioiodine ablation

Hurtle = more multifocal; b/l; more likely to spread to local nodes & distant sites.

30
Q

51yo man presents with a 2cm L thyroid nodule. thyroid scan shows a cold lesion. FNA cytology demonstrates follicular cells. which of the following is the most appropriate initial treatment of this pt?

a. external beam radiation to the neck
b. multidrug chemotherapy
c. TSH suppression by thyroid hormone
d. prophylactic neck dissection is indicated along with a total thyroidectomy
e. thyroid lobectomy

A

E

cold nodule, follicular –> CANCER; but no invasion seen.

if it’s cancer and >4cm - we take out the whole thing so that we can follow the thyroglobulin levels

< 4cm –> thyroid lobectomy.

31
Q

41yo woman has noted b/l thin serous discharge from her breasts. there seems to be no mass associated with it. which fo the following statements would be appropriate to tell the pt?

a. intermittent thin or milky discharge can be physiologic
b. expressive nipple discharge is an indication for open biopsy
c. absence of a mass on mammogram r/out malignancy
d. galactorrea is indicative of an underlying malignancy
e. pathologic discharge is usually b/l

A

A

> 35yo - would need more than a mammogram
galactorrhea can be due to drug (estrogens, tranquilizers)
pathological = U/L; bloody, serous , gray-green; localized to a single nipple duct.
Physiological = intermittent; serous, b/l, arise from multiple ducts

32
Q

52yo woman presents with HTN, obesity, and new skins triage. you are concerned about possible CUshing syndrome. which of the following is the most common cause of Cushing syndrome?

a. adrenocortical hyperpasia
b. ACTH-producing tumor
c. primary adrenal neoplasm
d. ectopic ACTH - secreting carcinoid tumor
e. pharmacologic glucocorticoid use

A

E

glucocorticoid due to any cause

Cushing’s by pathological reason
- 90% pituitary adenoma
10% pituitary corticotrope hyperplasia

33
Q

34yo woman has recurrent fainting spells induced by fasting. she also reports palpitations, trembling, diaphoresis, and confusion prior to the syncopal episodes. she has relief of ss with the administration of glucose. which of the following findings is most consistent with the diagnosis of an insulinoma?

a. serum glucose > 50, elevated serum insulin elvels, elevated C-peptide levels
b. serum glucose > 50, elevated serum insulin elvels, decreased C-peptide levels
c. serum glucose < 50, elevated serum insulin elvels, elevated C-peptide levels
d. serum glucose < 50, elevated serum insulin elvels, decresed C-peptide levels
e. serum glucose <50, decreased serum insulin elvels, decreased C-peptide levels

A

C
high levels of insulin; high C-peptide; low glucose

insulin + c-peptide together

high C-peptide = only due to excess endogenous insulin production

34
Q

36yo woman whose mother has just undergone treatment for breast Ca is asking about how this affects her and what can be done to lessen her changes of having the disease. which f the following has the lowest risk factor for breast Ca?

a. dietary fat intake
b. paternal relative with BRCA1 mutation
c. excessive estrogen exposure - early menarche, late menopause, nulliparity
d. previous biopsy with atypical hyperpasia
e. exposure to ionizing radiation

A

A

which she can change, but it won’t do much

RFs for breast ca

  • Age
  • FHx of BRCA1, 2
  • Excessive estrogen exposure
  • obesity
  • EtOH
  • hormone replacement
  • ionizing radiation
  • hx of prior breast Ca or abnormal breast biopsy (LCIS / atypical hyperplasia)
35
Q

For each clinical description, select the appropriate stage of breast Ca.
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
Tumor not palpable, clinical positive ipsilateral axillary lymph nodes fixed to one another, no evidence of metastases

A

D. Esp. stage 3 of the nodes are fixed (worse)
T1N2M0

stage 1 = larger size
stage 2-3 nodes involved
stage 4 = mets

36
Q

For each clinical description, select the appropriate stage of breast Ca.
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
tumor 4.0 cm, clinical positive, movable axillary ipsilateral lymph nodes; no evidence of metastases

A

C

T2 = 2-5cm;
T2N0M0 - still movable
= Stage 2a

stage 1 = larger size
stage 2-3 nodes involved
stage 4 = mets

37
Q

For each clinical description, select the appropriate stage of breast Ca.
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
tumor 2.1cm, clinical negative lymph nodes; no evidnece of metastases. final pathology shows only DCIS

A

A
stage 1 = larger size
stage 2-3 nodes involved
stage 4 = mets

DCIS = Stage 0

38
Q

For each clinical description, select the appropriate stage of breast Ca.
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
Tumor not palpable, but breast diffusely enlarged and erythematous, clinical positive supraclavicular nodes, no evidence of metastases

A

D
stage 1 = larger size
stage 2-3 nodes involved
stage 4 = mets

T0
Enlarged & erythematous = inflammatory carcinoma? = Stage 3b

39
Q

For each clinical description, select the appropriate stage of breast Ca.
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
tumor 0.5cm, clinical negative lymph nodes; pathological lunar fracture

A

E
stage 1 = larger size
stage 2-3 nodes involved
stage 4 = mets

T1N0M1

mets to the bone

40
Q

a43 yo man presents with signs & sxs of peritonitis in the RLQ. the clinical impression and supportive data suggest acute appendicitis. at exploration, however, a tumor is found frozen section suggest carcinoid features. for each tumor described, choose the most appropriate surgical procedure.

a. appendectomy
b. segmental ileal resection
c. cecectomy
d. R hemicolectomy
e. hepatic wedge resectiona nd appropriate bowel resection
2. 5 cm tumor at the base of the appendix

A

D

b/c involves the cecum

Carcinoid tumors = most commonly found in appendix & SB

<1cm = uncommonly metastasize –> appendectomy
Base of appendix –> R hemicolectomy

> 2cm = most likely to be metastatic; esp of liver (= carcinoid syndrome) –> hepatic resection

Extensive hepatic metastases = non-resectable

Resection of appendix & cecum - palliable to prevent early intstinal obstruction

Serosal lymphatics = NOT metastatic –> local resection.

41
Q

a43 yo man presents with signs & sxs of peritonitis in the RLQ. the clinical impression and supportive data suggest acute appendicitis. at exploration, however, a tumor is found frozen section suggest carcinoid features. for each tumor described, choose the most appropriate surgical procedure.

a. appendectomy
b. segmental ileal resection
c. cecectomy
d. R hemocolectomy
e. hepatic wedge resection and appropriate bowel resection
1. 0 cm tumor at the tip of the appendix

A

A

Carcinoid tumors = most commonly found in appendix & SB

<1cm = uncommonly metastasize –> appendectomy
Base of appendix –> R hemicolectomy

> 2cm = most likely to be metastatic; esp of liver (= carcinoid syndrome) –> hepatic resection

Extensive hepatic metastases = non-resectable

Resection of appendix & cecum - palliable to prevent early intstinal obstruction

Serosal lymphatics = NOT metastatic; –> local resection.

42
Q

a43 yo man presents with signs & sxs of peritonitis in the RLQ. the clinical impression and supportive data suggest acute appendicitis. at exploration, however, a tumor is found frozen section suggest carcinoid features. for each tumor described, choose the most appropriate surgical procedure.

a. appendectomy
b. segmental ileal resection
c. cecectomy
d. R hemocolectomy
e. hepatic wedge resection and appropriate bowel resection
0. 5cm tumor with serosal umbilication in the ileum

A

B

b/c involves the ileum

Carcinoid tumors = most commonly found in appendix & SB

<1cm = uncommonly metastasize –> appendectomy
Base of appendix –> R hemicolectomy

> 2cm = most likely to be metastatic; esp of liver (= carcinoid syndrome) –> hepatic resection

Extensive hepatic metastases = non-resectable

Resection of appendix & cecum - palliable to prevent early intstinal obstruction

Serosal lymphatics = NOT metastatic; –> local resection.

43
Q

a43 yo man presents with signs & sxs of peritonitis in the RLQ. the clinical impression and supportive data suggest acute appendicitis. at exploration, however, a tumor is found frozen section suggest carcinoid features. for each tumor described, choose the most appropriate surgical procedure.

a. appendectomy
b. segmental ileal resection
c. cecectomy
d. R hemocolectomy
e. hepatic wedge resection and appropriate bowel resection
1. 0 tumor of the midappendix; a 1cm, firm, pale lesion at the peripheral of the R lobe of the liver

A

E

b/c also involves the liver

Carcinoid tumors = most commonly found in appendix & SB

<1cm = uncommonly metastasize –> appendectomy
Base of appendix –> R hemicolectomy

> 2cm = most likely to be metastatic; esp of liver (= carcinoid syndrome) –> hepatic resection

Extensive hepatic metastases = non-resectable

Resection of appendix & cecum - palliable to prevent early intstinal obstruction

Serosal lymphatics = NOT metastatic; –> local resection.

44
Q

a43 yo man presents with signs & sxs of peritonitis in the RLQ. the clinical impression and supportive data suggest acute appendicitis. at exploration, however, a tumor is found frozen section suggest carcinoid features. for each tumor described, choose the most appropriate surgical procedure.

a. appendectomy
b. segmental ileal resection
c. cecectomy
d. R hemicolectomy
e. hepatic wedge resection and appropriate bowel resection
3. 5cm tumor encroaching onto the cecum and extensive liver metastases.

A

C

can’t do much for the liver, but can take out the cecum & appendix for palliable reasons to prevent obstruciton

Carcinoid tumors = most commonly found in appendix & SB

<1cm = uncommonly metastasize –> appendectomy
Base of appendix –> R hemicolectomy

> 2cm = most likely to be metastatic; esp of liver (= carcinoid syndrome) –> hepatic resection

Extensive hepatic metastases = non-resectable

Resection of appendix & cecum - palliable to prevent early intstinal obstruction

Serosal lymphatics = NOT metastatic; –> local resection.

45
Q

for each of the clinical problems outlined, the select appropriate treatment options.
a. no further surgical intervention
b. wide local excision
c. wide local excision with adjuvant radiation therapy
d. wide local excision with axillary lymph node dissection and radiation therapy
e. simple mastectomy (w/out axillary lymph node dissection)
f. modified radical mastectomy (simple mastectomy with in-continuity axillary lymph node dissection)
g. radical mastectomy
h. b/l prophylactic simple mastectomies
49yo woman undergoes biopsy of a 5cm L breast mass. she has no palpable axillary lymph nodes. biopsy of the mass shows cystosarcoma phyllodes

A

B

cystosarcoma phyllodes - wide local excision (w/out radiation)

46
Q

for each of the clinical problems outlined, the select appropriate treatment options.
a. no further surgical intervention
b. wide local excision
c. wide local excision with adjuvant radiation therapy
d. wide local excision with axillary lymph node dissection and radiation therapy
e. simple mastectomy (w/out axillary lymph node dissection)
f. modified radical mastectomy (simple mastectomy with in-continuity axillary lymph node dissection)
g. radical mastectomy
h. b/l prophylactic simple mastectomies
42yo woman has a mammogram that demonstrates diffuse suspicious mammographic calcifications suggestive of multicentric disease. biopsy of one of the lesions reveals DCIS.

A

E

multiobular DCIS - treat as invasive cancer - wide local excision +/- therapy

47
Q

for each of the clinical problems outlined, the select appropriate treatment options.
a. no further surgical intervention
b. wide local excision
c. wide local excision with adjuvant radiation therapy
d. wide local excision with axillary lymph node dissection and radiation therapy
e. simple mastectomy (w/out axillary lymph node dissection)
f. modified radical mastectomy (simple mastectomy with in-continuity axillary lymph node dissection)
g. radical mastectomy
h. b/l prophylactic simple mastectomies
51o premenopausal woman undergoes needle localization biopsy for microcalcifications. pathology reveals sclerosis adenosis

A

A

sclerosis adenosis = is a benign (non-cancerous) proliferative condition of the terminal duct lobular units characterised by an increased number of the acini and their glands.

48
Q

for each of the clinical problems outlined, the select appropriate treatment options.
a. no further surgical intervention
b. wide local excision
c. wide local excision with adjuvant radiation therapy
d. wide local excision with axillary lymph node dissection and radiation therapy
e. simple mastectomy (w/out axillary lymph node dissection)
f. modified radical mastectomy (simple mastectomy with in-continuity axillary lymph node dissection)
g. radical mastectomy
h. b/l prophylactic simple mastectomies
49y woman has a 6cm palpable mass that is biopsy-proven ductal adenocarcinoma. she undergoes neoadjuvant chemotherapy, which reduces the tumor to 3cm ins size. however, she has palpable axillary lymph nodes. FNA demonstrates adenocarcinoma. she desires breast conservation therapy if possible.

A

D.

T2N1M0 = Stage 2

equivalent

  • lumpectomy + radiation
  • Mastectomy

might have to do a flap, b/c she has involved lymph nodes that are proven to be adenocarcinoma

49
Q

for each of the clinical problems outlined, the select appropriate treatment options.
a. no further surgical intervention
b. wide local excision
c. wide local excision with adjuvant radiation therapy
d. wide local excision with axillary lymph node dissection and radiation therapy
e. simple mastectomy (w/out axillary lymph node dissection)
f. modified radical mastectomy (simple mastectomy with in-continuity axillary lymph node dissection)
g. radical mastectomy
h. b/l prophylactic simple mastectomies
a neglected 82yo woman presents with a locally advanced breast Ca that is invading the pectoralis major muscle over a rad base. she is otherwise healthy

A

G

radical mastectomy = surgical procedure in which the breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla are removed as a treatment for breast cancer.

50
Q

risk factors for head & neck cancer

A
  • male
  • older
  • smoking
  • EtOH
51
Q

sxs of head & neck cancer

why do tongue lesiosn cause pain in the ear?

A
  • leukoplakia in the mouth / teeth
  • poor dentition
  • ear pain d/t greater auricular nerve that passes behind sternocleidomastoid
52
Q

Management of head & neck cancer

A

1) full body physical exam (esp. regional lymph nodes)
2) laryngoscopy
3) biopsy (excisional)
4) CT scan +/- PET
5) staging
6) surgical resection (+/- skin graft [ear, pectoralis, quad]], +/- mandibular graft [fibula]) v. radiotherapy v. chemotherapy

53
Q

Which is more common on upper or lower lip? SCC or BCC

A
BCC = upper lip
SCC = lower lip