Surgery Flashcards
Patient has severe swings of Hypertension during a surgery
What would you do?
continue
pr
don’t start the operation until stabilise
What are causes of hypertension?
Cushing’s
Renal artery stenosis
polycycstic kidney disease
Conn’s syndrome
Phaechromocytoma
Acromegaly
Aortic coarctation
How do you investigate the sever changesin hypertension
renal ultrasound- lookfor renal artery stenosis
Echocardiogram- look for end organ damage
dexomethasone suppression- look for cushing’s
plasma renin/aldosterone- conn’s
plasma metanephrine- phaechromocytoma
What is the first investigation if you supect phaechromocytoma
urine metanephrine
urine catecholamines
how would you investigate connes
plasma renin/ aldosterone
saline infusion
sample from the righ and left adrenal vein and a sample from below the IVC below the renal arteries
How would you investigate cushings intially
MOST appropriats:
Do first: dexamethosone suppression test
Do second: measure the 24h urine cortisol measure
IF they are in clinic you can also do spot serum cortisol ()
What happens to the heart in phaechromocytoma
ECHOCARDIOGRAM
- enlagement of all 4 chambers
how do you treat a phaechromocytoma
alpha blocker!
mortality is 50% if untreated
A patient comes back with an elevated catechomalamine and metanephrines
What do you do as an investagation
- Adrenal CT
- look for metastasis GAD
What are conditions that can cause phaechromocytoma
MEN2a
Paraganglioma syndrome (suxinate dehydrogenase (SDHD
and SHDB)
VHL- von hippel lindau
What are the procedures used to remove a phaechromocytoma
Open
through the back
or front (midline or )
lateral and anterior - minimally invasive (key hole)
persistant hypertension
resistant to hypertension medication
what inestigations?
serum renin aldosterone
RENIN must be suppressed
What medicatoin interfere with renin aldosterone system
supress renin secretion
therefore might fake Conn’s
when you do renin/ aldo ratio
What is the aetiology of breast cancer
Braca 1
braca 2
Lifraumeni syndrome
Hormone:
HRT, oral contraception
early period
nulliparity
late menopause
breastfeeding
late first birth
what is breast screenin program
47 -70 every 3 years
what are normal variant of
multi duct discharge without blood is usually normal
accessory appear during pregnancy
what arethe different types of mastalgia?
cyclical - young womemn around period
non cyclical- menopause
What are conscerning feature on a breast examination
dimpling
lump
nipple inversion
peau d’orange
what could nipple crusting or nipple eczema
padget disease
not itchy, unilateral
someone has padget’s disease of the breast how do you determine it
punch biopsy - padget’s disease
what is a thrombophlebitis of the breast
mondors disease
What are teh different mastitis
lactational mastitis- breast feeeding lady - can progress to a an abcess
periductal mastitis- smokers
granulomatous mastitis- TB, sarcoid
cancerous mastitis-
What is the cause of peau d’orange
lymphoedema
What would a black dot near the breast be?
radiotherapy tattoo
What would you like to do to complete your examination
check for nipple discharge
auscultate the chest
What is the technique with which you remove the breast tissue?
wire guided
and also insert clips into the sample to orientate the pathologist
What are the histological sybtypes in breast cancer
non invasive
ductalcarcinoma in situ
lobular carcinoma in situ
invasive
What are the stages of breast cancer
Stage 1
stage 2 - some nodes small tumour
stage 3- stuck to skin or involve supra or infra clavicular nodes
stage 4- infiltrate other organs
What is the index that is used for prognosis of breast cancer
nottigham prognostic index
archaic
because now the recepors (Her,ER, PR) also play and play a bigger role in prognosis (Predict NHS)
What are the different types of surgery for breast cancer
breast conserving therapy
wide local incision
oncoplastic surgery - more novel
ALWAYS coupled with Radiotherapy
Mastectomy
radical- remove breast
simple mastectomy - breast and
WHy would you do a mastectomy vs a lumpectomy?
- size of the breast vs the size of the lump
- genetic predisposition
- recurrance (can’t do radiotherapy 2x)
- patient choice
pregnant - can not get radiotherapy
What are people demographics that can not have radiotherapy?
What does that mean?
how do radiotherapy look like
daily treatment for 3 weeks
