SURGERY EOR SKIN & BREAST

Question 1

Soft, large, mobile mass on a person’s body makes you think of?

Answer 1

lipoma

Question 2

If a sebaceous cyst becomes infected, how do you treat it?

Answer 2

Make an incision and drain

Question 3

What is the most common skin cancer?

Answer 3

Basal cell

Question 4

What is the Tx for Seborrheic keratosis?

Answer 4

Leave it, could biopsy it

Question 5

What is the Tx for Aktinic keratosis?

Answer 5

Freeze, 5-F,U cream, or excise

Question 6

What’s the general Tx for all suspicious skin lesions?

Answer 6

Excision

Question 7

What’s special about the Tx for Melanoma?

Answer 7

Need 1-3mm of skin surrounding + SubQ fat

Question 8

If you see pearly, rolled border think?

Answer 8

BCC

Question 9

If you see raised, ulcerated, chronic scab/non-healing wound think?

Answer 9

SCC

Question 10

On what POD would we see a wound infection?

Answer 10

5-7

Question 11

What are the MC causes of wound infection?

Answer 11

Staph aureus, E coli, and enterococcus

Question 12

What type of wound would a GI or pulm (including biliary/urinary) be classified as?

Answer 12

Clean contaminated

Question 13

If there is a GI apillage, acute inflammation, or traumatic wound how would it be classified?

Answer 13

Contaminated

Question 14

If a 20 y/o woman comes in with concern for breast lump, and you note 1-3cm, freely moveable, firm/rubbery mass – how do you proceed? Dx?

Answer 14

could do an U/S first

Most likely a FNA or core biopsy
Dx: Fibroadenoma

Question 15

If you see a 40y/o woman with a firm, bollotable, mobile mass – how do you proceed? Dx?

Answer 15

Age 40 can do a mammogram → then, with U/S + FNA

Dx: breast cyst

Question 16

A pt has a breast cyst and during FNA blood is extracted – how do you proceed? What if there was no blood?

Answer 16

If bloody = surgical referral

Not bloody = close F/U in 2-4 months for recurrence or does not result in complete collapse → surgical referral

Question 17

If a 30y/o patient has a painful, erythematous breast what should you do?

Answer 17

Mastitis or breast abscess

Treat with Doxy or Clinda (for staph aureus)

Question 18

What if your pt with an erythematous, painful breast is 58y/o?

Answer 18

Not normal to have mastitis or breast abcess in a post-menopausal woman
[if !supportLists]⇒ [endif]GET A MAMMOGRAM

Question 19

What are some risk factors to breast cancer?

Answer 19

> 55; no children/breastfeeding; exogenous estrogen exposure; family Hx; overweight

Question 20

How does breast cancer present?

Answer 20

lumps, bumps, skin changes, dimpling, red/hot, pain/no pain, regional node enlargement

Question 21

When do we start mammograms?

Answer 21

Age 40 annually or every 2 years

Age 50 annually or every 2 years

Question 22

if you have a post-menopausal woman with a new mass, discharge, or asymmetry what should you always think about?

Answer 22

Presumed cancerous until proven otherwise

Question 23

What is the GOLD STANDARD of breast mass diagnosis?

Answer 23

Aspiration/biopsy = superior to imaging

Question 24

What’s the most common type of breast cancer?

Answer 24

Infiltrating ductal carcinoma = spreads

Question 25

What sxs make you think of infiltrating ductal carcinoma?

Answer 25

redness, scaling, dimpling, thickening of the nipple

Question 26

How do you treat infiltrating ductal carcinoma?

Answer 26

Lumpectomy (if <2cm) or mastectomy

Sentinel node biopsy

Question 27

What type of breast cancer does not metastasis but has a high incidence of recurrence?

Answer 27

Ductal carcinoma insitu

Question 28

What are the systemic treatment options for breast CA?

Answer 28

Chemo, hormonal therapy, estrogen receptor downregulators (Tamoxifen) for pre-menopausal

Question 29

If breast CA were to metastasize, where does it most likely go?

Answer 29

obvi lymph nodes/muscle/fat/skin around the breast

But vertebral pedicles & ribs

Question 30

What does the F/U involve after breast CA?

Answer 30

every 3-6 months x 3 years
Every 6-12 months years 4 & 5
Every year after year 5

*Yearly mammogram + pelvic exams (some drugs can increase uterine cancer)

Question 31

If a pt has itching, burning, pain, scales/thickening of the nipple – what should you think?

Answer 31

Not just eczema but possible breast CA!

Paget’s