Surgery (1) Flashcards
Potential causes of neck lump in lateral anterior triangle
Lateral anterior triangle
Pulsatile
- Carotid artery (tortuous/aneurysm)
- Chemodectoma
Non-pulsatile
- Sebaceous cyst/lipoma
- Salivary gland
- Lymphadenopathy
- Brachial cyst
Potential causes of neck lump in midline anterior triangle
Midline anterior triangle
•Goitre
- Thyroid mass
- Thyroglossal cyst
- Dermoid cyst
Potential causes of neck lump in the posterior triangle (3)
- Cystic hygroma
- Cervical rib
- Lymphadenopathy
Causes of hyperthyroidism
• Graves’ Disease – autoimmune
(Triad of goitre, eye signs and thyrotoxicosis)
- Toxic multinodular goitre
- Thyroid adenoma
- Ectopic thyroid tissue
- De Quervains thyroiditis
- Iatrogenic – drugs
- Postpartum
What’s anterior neck triangle?
Borders of posterior neck triangle
Ix for suspected hyperthyroidism
- Bedside: ECG (tachycardia/AF)
- Bloods: TFTs (low TSH, high T3), Autoantibodies (anti-TSH), FBC (anaemia), HbA1c (associated diabetes), lipids
- Imaging: USS Scan thyroid (if lump)
Management of hyperthyroidism
- conservative
- medical
- surgery (+indications)
Thyroidectomy
- complications
• Bleeding (dual blood supply from
superior and inferior thyroid artery)
- Damage to Parathyroid (low PTH) →↓Ca2+
- Damege to Recurrent laryngeal nerve
(hoarseness)
• Late hyperthyroidism
Match these to answers
Types of thyroid cancer
- Papillary Ca → mets via the lymph
- Follicular Ca → mets via the blood
- Anaplastic → acute aggressive
- Medullary → associated with MEN II
What’s the most common tumour of the parotid gland?
Pleomorphic adenoma – small non-progressive tumour
What clinical features distinguish a benign from a malignant salivary gland tumour?
Facial nerve involvement
What are the complications of the surgery to parotid gland?
- Damage to the facial nerve
- Frey’s syndrome - gustatory sweating due to divided parasympathetic nerves
Triad of Grave’s disease
- thyrotoxicosis
- goitre
- eye signs
Risk factors for breast cancer
- BRCA genes - 40% lifetime risk of breast/ovarian cancer
- Family history 1st degree relative premenopausal relative with breast cancer (e.g. mother)
- nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs)
- early menarche, late menopause
- HRT
- combined oral contraceptive use
- past breast cancer
- not breast feeding
- obesity
What triple assessment consist of?
- History and Clinical Examination
- Radiology
- < 35 years = USS
- > 35 years = USS + Mammography
- Histopathology
- Solid tumour – core biopsy
- Cystic lumo – Fine Needle Aspraition
Types of breast tumours
Clinical staging of breast cancer
Stage 1: confined to breast, mobile, no lymph nodes
Stage 2: Stage 1 + nodes in ipsilateral axilla
Stage 3: Stage 2 + fixation to muscle (not chest wall). LNs fixed.
Stage 4: Complete fixation to chest wall and metastases
Clinicopathological features of breast cancer (3)
- Clinical staging
- Oestrogen receptor status
- Majority are oestrogen dependent
- respond to hormonal therapy and carry a better prognosis
- HER2 receptor status
- Found in 20 of invasive cancers
- Associated with a poor prognosis
Management of breast ca if carcinoma in situ
Breast-conserving surgery with 2 cm margin
Management of breast ca if stage 1 or stage 2
- Surgery with adjuvant therapy
- Radiotherapy if wide local excision
- Tamoxifen for oestrogen + if premenopausal
- Aromatase inhibitors if post -menopausal
- Herceptin if HER2 positive
Management of breast cancer if stage 3 or 4
- Chemo with palliation
- Tamoxifen for oestrogen + if premenopausal
- Aromatase inhibitors if post-menopausal
Mastectomy vs wide local excision
