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Surgery Flashcards

1
Q

Patient has severe swings of Hypertension during a surgery

What would you do?

continue

pr

A

don’t start the operation until stabilise

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2
Q

What are causes of hypertension?

A

Cushing’s

Renal artery stenosis

polycycstic kidney disease

Conn’s syndrome

Phaechromocytoma

Acromegaly

Aortic coarctation

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3
Q

How do you investigate the sever changesin hypertension

A

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

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4
Q

What is the first investigation if you supect phaechromocytoma

A

urine metanephrine

urine catecholamines

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5
Q

how would you investigate connes

A

plasma renin/ aldosterone

saline infusion

sample from the righ and left adrenal vein and a sample from below the IVC below the renal arteries

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6
Q

How would you investigate cushings intially

A

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 ()

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7
Q

What happens to the heart in phaechromocytoma

A

ECHOCARDIOGRAM

  • enlagement of all 4 chambers
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8
Q

how do you treat a phaechromocytoma

A

alpha blocker!

mortality is 50% if untreated

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9
Q

A patient comes back with an elevated catechomalamine and metanephrines

What do you do as an investagation

A
  1. Adrenal CT
  2. look for metastasis GAD
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10
Q

What are conditions that can cause phaechromocytoma

A

MEN2a

Paraganglioma syndrome (suxinate dehydrogenase (SDHD

and SHDB)

VHL- von hippel lindau

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11
Q

What are the procedures used to remove a phaechromocytoma

A

Open

through the back

or front (midline or )

lateral and anterior - minimally invasive (key hole)

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12
Q

persistant hypertension

resistant to hypertension medication

what inestigations?

A

serum renin aldosterone

RENIN must be suppressed

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13
Q

What medicatoin interfere with renin aldosterone system

A

supress renin secretion

therefore might fake Conn’s

when you do renin/ aldo ratio

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14
Q

What is the aetiology of breast cancer

A

Braca 1

braca 2

Lifraumeni syndrome

Hormone:

HRT, oral contraception

early period

nulliparity

late menopause

breastfeeding

late first birth

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15
Q

what is breast screenin program

A

47 -70 every 3 years

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16
Q

what are normal variant of

A

multi duct discharge without blood is usually normal

accessory appear during pregnancy

17
Q

what arethe different types of mastalgia?

A

cyclical - young womemn around period

non cyclical- menopause

18
Q

What are conscerning feature on a breast examination

A

dimpling

lump

nipple inversion

peau d’orange

19
Q
A
20
Q

what could nipple crusting or nipple eczema

A

padget disease

not itchy, unilateral

21
Q

someone has padget’s disease of the breast how do you determine it

A

punch biopsy - padget’s disease

22
Q

what is a thrombophlebitis of the breast

A

mondors disease

23
Q

What are teh different mastitis

A

lactational mastitis- breast feeeding lady - can progress to a an abcess

periductal mastitis- smokers

granulomatous mastitis- TB, sarcoid

cancerous mastitis-

24
Q

What is the cause of peau d’orange

A

lymphoedema

25
Q

What would a black dot near the breast be?

A

radiotherapy tattoo

26
Q

What would you like to do to complete your examination

A

check for nipple discharge

auscultate the chest

27
Q

What is the technique with which you remove the breast tissue?

A

wire guided

and also insert clips into the sample to orientate the pathologist

28
Q

What are the histological sybtypes in breast cancer

A

non invasive

ductalcarcinoma in situ

lobular carcinoma in situ

invasive

29
Q

What are the stages of breast cancer

A

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

30
Q

What is the index that is used for prognosis of breast cancer

A

nottigham prognostic index

archaic

because now the recepors (Her,ER, PR) also play and play a bigger role in prognosis (Predict NHS)

31
Q

What are the different types of surgery for breast cancer

A

breast conserving therapy

wide local incision

oncoplastic surgery - more novel

ALWAYS coupled with Radiotherapy

Mastectomy

radical- remove breast

simple mastectomy - breast and

32
Q

WHy would you do a mastectomy vs a lumpectomy?

A
  • 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

33
Q

What are people demographics that can not have radiotherapy?

What does that mean?

A
34
Q

how do radiotherapy look like

A

daily treatment for 3 weeks

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