Saeed Bahloul 42 4102 11:04

By Saed Bahloul
breast+thyriod+salivary
I-BREAST MCQs
*Athelia very rare
*polythelia 2-6% of human females
*ashoford operation to correct congenital retraction
*Poland $: male without rafraf-eldoctor kal keda :D
*polymastia most common site in axilla
*acute lactating mastitis most common type of mastitis
*most common route of infection direct by nipple
*most common PF of mastitis is milk engorgement
*fluctuation is a late sign NOT early
*Thomas incision best TTT of retro mammary abscess
*mondord D:thrombophelipitis of superfacial veins of the beast,silf limiting
*TTT of chronic breast abscess excision of the whole abscess
*mammary duct ectasia is NOT precancerous
*mammary duct ectasia more common in female,smoker
*mammary duct ectasia most common cause of nipple discharge
*persistant cases of mammary duct ectasia TTT by hadfield operation
*fibroadenosis (ANDI) most frequent breast disorder in ptn clinic
*most common site of fibroadenosis upper outer quadrant
* fibroadenosis precancerous when occur Atypical epithelial hyperplasia
* fibroadenosis+extensive fibrosis called sclerosing adenosis
*cyst of bloodgood is large cyst contains altered blood
* fibroadenosis it is NOT precancerous
* fibroadenosis cyclic pain & cyclic swelling & cyclic discharge
* fibroadenosis better to be felt by tip of fingers not by flat of the hand
*triple assisment clinical evaluation & imaging & cytology
* fibroadenosis NOTrelated to estrogen
* fibroadenosis TTT ARPD:analgesic,regulation of cycle,primaleve,parlodel,
psychotherapy & danazol
*Fibroadenosis NOT clinically diffrentaited from carcinoma
*duct papilloma most common cause of bleeding ber nipple
*duct papilloma=serosanguious discharge
*duct papilloma with NO pain
*duct papilloma NOT felt but which felt is retention cyst
*duct papilloma:No axillary LN enlargement
*duct papilloma 10% precancerous
*duct papilloma TTT by local excision with safety margin
*fibroadenoma is the commnest cause of breat mass in young female
*fibroadenoma benign & fibrous element predominates
*pericanalicular-hard-benign simple:never turn malignant no LN-painless-TTT
enucleation
*intracanalicular:laible to turn sarcoma-painful-no LN
*if small intracnalicular TTT by excision with safety margin
*if large intacnalicular TTT by simple mastectomy
*to differentiate between benign lesion & malignant by probe test
*Massive sw. of the breast include:cystosarcoma phylloid,diffuse hypertrophy,gaint
fibroadenoma
*all of the following risk factors of Breast Cancer except
*most common site of Breast Cancer upper lateral quadrant d.t increase estreogen
receptors & breast mass
*most common type of Breast Cancer is duct carcinoma
* most common type of duct carcinoma is infiltrating
*infiltrating lobular carcinoma: 25%-bilateral-multicentric-indain file
*LCIS bilateral & multifocal
*schirrous carcinoma (NOS) commonest histological type
*medullary carcinoma: malignant cells>fibrous tissue-good prognosis
*mastitis carcinomatosis:most common during pregnancy and lactation
*mastitis carcinomatosis rare & highly aggressive d.t high vascularity
*pagets disease: main presentation is red scaly nipple
*most common discharge in breast cancer is watery
*nipple retraction d.t infiltration of milk duct-not diagnostic
*skin tethering is induced dimpling
*skin dimpling earliest skin sign & d.t contracture of cooper ligament not diagnostic
*Skin nodule d.t retrograde lymphatic permeation
*skin nodule is sure sign of malignancy (diagnostic)
*cancer en cuirasse lat stage skin nodule lymphadema
*peu d orange d.t obstruction of lymphatics
*brawny edema d.t obstruction of lymph vs & axillary vein
*TNM classification T0 detected by screening Tis by histopathology
*TNM classification Pagets disease with no palpable tumor: Tis
*TNM classification T1<2cm T2 (2-5) T3 >5
*clustered micro calcification occur in ductal carcinoma
*20% of microcalcification are malignant
*star shape mass useful in detection of multifocal lesion
*Follow up of synthetic prosthesis by MRI
*tirade of early detection: self assessment/2m-physical examination/6m
mammography/2y
*all signs of skin manifestation in breast cancer not diagnostic except SKIN NODULE
*normal direction of nipple forward downward lateral
*chch of malignant cyst & benign cyst
*QAART: decrease incidence of recurrent NOT increase survival
*QAART: quadrenectomy axillary dissection & radiotherapy
*pagets disease radio resistant & TTT by Radical mastectomy
*contraindication of conservative & indication of MRM
*radiation after conservative surgery 5000 RAD
*radiation after post radical mastectomy 1500 RAD: G3 or all LN affected
*S.E of radiation: local burn,IPF,endarteritis
*tamoxifen: increase incidence of endometrial carcinoma
*tamoxifen: decrease incidence of recurrent in affected breast & other breast
*tamoxfen: effective in pre & post menopausal
*indication of chemo therapy
*CMF: cyclophosphomide-methotrexate- 5-flurouracil (all of ! following except)
* Down staging in locally advanced "stage 3" by neoadjuvent chemotherapy
*chemotherapy NOT cross BBB
*lypmpadema TTT by complete decongested thearapy
*breast cancer with pregnancy TTT by mastectomy radiotherapy C.I
*breast cancer with pregnancy chemotherapy NOT given in ! 1st trimester
*breast cancer with pregnancy hormonal therapy not given usually
*BRCA-1 in chr 17 associated with ovarian cancer
*BRCA-2 in chr 13 assocaited with male breast cancer
*M.C.C of gynecmastia is idiopathic
*genetic cause of gynecomastia is klinefilter standars surgical ttt subcutaneous
mastectomy
*mastitis carcinosa NOT associated with a palpable mass in breast
*Soft tissue mammography is most valuable in detection of impalpable breast cancer
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II-Thyriod MCQs
*as regard embryology of thyroid develops from 1st & 4th branchail arch
*c cells: develop from altimobranchail body produce calcitonin- origin of medullary
carcinoma
*thyroid scan appear as cold in 2ry thyrotoxicosis-warm in active nodule-hot in toxic nodule
*TSH: increase after total thyriodectomy-N:??-most sensitive in mild cases
*FNA:outptn procedure-cheape-safe-Not need GA-not differentiated between follicular
adenoma & carcinoma
*metabolism of iodine:trapping,oxidation,organification,coupling,release
*T3 less concentration than T- more potent than T4 mostly bound to TBG
*presentation of ectopic thyroid:dysarthria,midline neck swelling,myxedema if removed by
mistake
*most common site of ectopic thyroid lingual
*thyroglossal cyst: most common site subhyiod in midline
*thyroglossal cyst lined by st.sq.epith (eldoctor kal shabah dermiod cyst)
*thyroglossal cyst most common complication infection as it is rich in lymphatics
*thyroglossal fistula NEVER congenital
*thyroglossal cyst TTT by sistrunk operation
*Endemic Gioter d.t deficient intake of iodine in ! food
*! Daily requirement of iodine 0.1-0.15 mg/d or 100-125 ug
*Endemic Gioter investigated by iodine creatinine clearance in urine
*most important factor leading to simple goiter is Iodine deficiency
*dyshormonogenesis A.R d.t peroxidase enzyme deficiency
*dyshormonogenesis thyroid enlargement only presentation
*dyshormonogenesis associated with hypothyrodism
*pendards $ goiter, deafness, dwarfism, M.R
*lateral aberrant thyroid it is L.N metastasis of papillary carcinoma not congenital
*simple nodular goiter, most nodules inactive, active follicle in interodular tissue
*simple nodular goiter main complaint cosmotic
*simple nodular goiter, blackout increase on leaning forward d.t pressure on IJV
*simple nodular goiter malignant changes 3% pressure/infiltration symp.chain=> Horner $
*kochers test Slight compression of the lateral lobe of thyroid gland produces stridor. If the
test is positive , it signifies that the patient has an obstructed trachea.
*simple nodular goiter surgery not advised below 25y
*simple nodular goiter Aim of operation cosmotic pressure complication
* simple nodular goiter dunhil operation: total lobectomy on more affected side with subtotal
on less affected side
*2ry toxic giotre <45 y =>subtotalthyriodectomy if >45y radioactive iodine
*histopathological surprise if follicula carcinoma TTT by completion thyriodectomy
*histopathological surprise if papillary carcinoma TTT by reoperative with total
thyriodectomy
*most common cause of diffuse toxic giotre is graves
*jad basedow: d.t intake lg dose of iodine in ttt of endemic goiter it is temporary
*Graves Disease A.I.D type V (4) hypersensitivity
*Graves Disease most early $ insomnia
*Graves Disease achilis reflex time is shortened
*Graves Disease differentiated from psychoneurosis by metabolic $
*thyroid paradox increase appetite with loss of weight
*Graves Disease eye sign may be unilateral
*Graves Disease: auto immune manifestation NOT include palmar erythema
*Neomercazol complication: goiter- agranuloscytosis-hepatotoxicity
*Graves Disease follows up by TSI
*Graves Disease main line of TTT is medical
*most dangerous complication of medical TTT agranulocytosis, hepatotoxicity
*radioactive I indicated in old ptn with failure of medical ttt / most common complication
myxedema- lg dose myxedama small dose recurrent
*Gioter in children radioactive iodine is Contraindicated
* 2ry thyrotoxicosis main line of ttt surgery
*thyro cardia ttt by thyriodectomy is ideal
*toxic nodule in ptn >45 y total lopectomy
*toxic nodule in ptn <45 y radioactive iodine very effective
*diarrhea d.t increase c-AMP
*pretibial myxedema:depositin of hyaluronic acid in dermis
*neomercazol act by: decreas oxidation of iodide to iodine- decrease coupling- decrease Ab
titre
*solitary toxic nodule ttt by ipsilateral total lopectomy
*mediasdtinal goiter common in males & may be asymptomatic
*mediasdtinal goiter RLN affection not common
*mediasdtinal goiter ! investigation of choice is C.T
*mediasdtinal goiter ttt by subtotal thyriodectomy after preparation by indral only
*Hashimoto most common type of thyrioditis
*Hashemoto most common type of giotrus hypothrodism
*Hashimoto chch microscopically by ASKANAZY cells
*Hashimoto main ttt is L-thyroxin
*Hashimoto presented by:thyrotocicosis-myxedema-gioter
*Reidle mimic anaplastic carcinoma in differentiated by FNA
*most common malignancy in thyroid is differentiated adenocarcenoma
*follicular adenoma ttt by hemi-thyriodectomy & paraffin section
*follicular adenoma exclude capsular invasion or vascular by paraffin not FNA
*follicular adenoma presented by solitary thyroid nodule
*medullary thyriod carcinoma (MTC):multifocal-Bilateral-c-cell hyperplasia
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III-salivary Gland MCQs
*Contents of ! parotid gland:A:ECA-V:Posterior fascial vien-N:facial nerve-L.N:inside
capsule
*parotid secretes serous but submandipular secrete viscid rich in Ca
*parotid duct opens in upper 2nd molar tooth
*acute bacterial sialoadenitis:most common site:parotid
*acute bacterial sialoadenitis:most common organism:staph
*acute bacterial sialoadenitis:most common PDF post-operative
*acute bacterial sialoadenitis complication:chronicity-abscess-stone-fistula
*80% of all salivary stones occur in submandibular gland
*submandibular stone mainly asymptomatic
*plain x ray occulosal view->stone in submandibular gland appear radio opaque d.t ca
*sialography best in parotid- stones in parotid radio lucent
*salivary neoplasm: most common site parotid
*salivary neoplasm:majority benign
*pleomorphic adenoma:commenest salivary tumor
*pleomorphic adenoma:commonest in males
*pleomorphic adenoma:commonest in parotid
*pleomorphic adenoma:firm or cystic NEVER hard
*pleomorphic adenoma: benign no cervical LN or facial n infiltration
*monomorphic adenoma:10% of parotid tumor-10% bilateral
*monomorphic adenoma:cystic or soft-in front of tragus-not elevateting ear lobule
*monomorphic adenoma: NEVER to turn malignant
*monomorphic adenoma=adenolymphome=warthin=papillary cystadenoma
*monomorphic adenoma appear as cold spot in tc99 scan
*Mucoepedermiod carcinoma:most common malignancy in salivary gland
*Mucoepedermiod carcinoma:low grade differentiation is commonest type
*cylindroma(adenoid cystic carcinoma):most common malignancy affect salivary gland
*operable carcinoma of parotid is ! best ttt by radical parotidectomy with block dissection of
LN
*operable carcinoma of submandibular gland is ! best ttt by commando operation