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The document outlines key medical concepts related to breast health, including the triple assessment for evaluating breast lumps, investigations for breast swelling, and routes of spread for breast carcinoma. It also discusses clinical features, treatment aims, and modalities for breast cancer, as well as classifications of benign breast disorders and treatment principles for acute conditions. Additionally, it covers investigations for the hepatobiliary system, presentation of liver abscess, treatment for amoebic liver abscess, and details on intra-abdominal organ injuries and splenectomy indications and complications.

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4 views

box 3(4)

The document outlines key medical concepts related to breast health, including the triple assessment for evaluating breast lumps, investigations for breast swelling, and routes of spread for breast carcinoma. It also discusses clinical features, treatment aims, and modalities for breast cancer, as well as classifications of benign breast disorders and treatment principles for acute conditions. Additionally, it covers investigations for the hepatobiliary system, presentation of liver abscess, treatment for amoebic liver abscess, and details on intra-abdominal organ injuries and splenectomy indications and complications.

Uploaded by

mohammadjawedignore
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Set 16

a. What is triple assessment?

Triple assessment is a systematic approach for evaluating breast lumps. It consists of:

1. Clinical Examination – Inspection and palpation to assess lump size,


mobility, consistency, skin/nipple changes, and lymph node
involvement.
2. Imaging – Mammography (for older women) or ultrasound (for
younger women) to differentiate solid from cystic lesions.
3. Pathological Analysis – Fine-needle aspiration cytology (FNAC) or
core biopsy for histological diagnosis.

b. What are the investigations for breast swelling?

1. Imaging:
o Mammography (gold standard for >40 years)
o Breast ultrasound (useful in younger women and cystic lesions)
o MRI (for complex cases, high-risk screening)
2. Cytology/Histopathology:
o FNAC (for rapid cytological evaluation)
o Core needle biopsy (for histological diagnosis)
o Excisional biopsy (if other tests are inconclusive)
3. Other Tests:
o Hormone receptor status (ER, PR, HER2 in malignancies)
o Blood tests (tumor markers like CA 15-3 in metastatic cases)
o Genetic testing (BRCA1, BRCA2 in high-risk individuals)

c. Routes of spread of carcinoma breast and sites of metastasis

 Local spread – Direct invasion into adjacent structures (skin, chest


wall, muscles).
 Lymphatic spread – Axillary lymph nodes (common), internal
mammary nodes, supraclavicular nodes.
 Hematogenous spread – Common sites:
o Bones (most common) → Osteolytic lesions, pathological
fractures.
o Lungs → Pleural effusion, pulmonary nodules.
o Liver → Hepatomegaly, jaundice.
o Brain → Neurological symptoms.
Set 17
a. Clinical features of carcinoma breast

1. Breast Lump – Hard, irregular, non-mobile mass.


2. Skin Changes – Peau d’orange, ulceration, skin retraction.
3. Nipple Changes – Retraction, discharge (bloody, serous).
4. Axillary Lymphadenopathy – Enlarged, hard, fixed lymph nodes.
5. Distant Metastatic Symptoms – Bone pain, breathlessness,
jaundice.

b. Aims of treatment of carcinoma breast

1. Cure the disease (if early-stage).


2. Prevent local recurrence.
3. Prevent distant metastasis.
4. Improve quality of life in metastatic cases.

c. Treatment modalities for carcinoma breast

 Surgery – Breast-conserving surgery (BCS) or mastectomy.


 Radiotherapy – After BCS or for advanced cases.
 Chemotherapy – Neoadjuvant (before surgery) or adjuvant (post-
surgery).
 Hormonal Therapy – Tamoxifen (ER-positive cancers).
 Targeted Therapy – Trastuzumab (HER2-positive cancers).

Set 18
a. Classification of benign breast disorders (with examples)

1. Developmental Disorders – Accessory breast tissue.


2. Inflammatory Disorders – Mastitis, breast abscess.
3. Fibrocystic Changes – Fibroadenosis.
4. Benign Tumors – Fibroadenoma, phyllodes tumor.
5. Ductal Disorders – Duct ectasia, intraductal papilloma.

b. Acute and subacute inflammatory conditions of the breast

1. Acute:
o Lactational mastitis
o Breast abscess
o Acute bacterial mastitis (Staphylococcus aureus)
2. Subacute:
o Granulomatous mastitis
o Plasma cell mastitis
o Tuberculous mastitis

c. Principles of treatment of acute bacterial mastitis

1. Antibiotics – Flucloxacillin or clindamycin (if allergic).


2. Breast Drainage – Continue breastfeeding if lactational.
3. Analgesia – NSAIDs for pain relief.
4. Surgical Drainage – If abscess formation occurs.

Set 19
a. Investigations for hepatobiliary system

1. Blood Tests:
o Liver function tests (LFTs)
o Serum bilirubin
o Alkaline phosphatase (ALP) for biliary obstruction
o Tumor markers (AFP for hepatocellular carcinoma)
2. Imaging:
o Ultrasound (first-line for liver pathology)
o CT/MRI (for liver masses, biliary obstruction)
o MRCP/ERCP (for bile duct assessment)
3. Histopathology:
o Liver biopsy (for cirrhosis, malignancy)

b. Presentation of liver abscess

1. Fever with chills and rigors


2. Right upper quadrant pain
3. Hepatomegaly
4. Jaundice (if biliary involvement)
5. Leukocytosis and raised ALP on blood tests

c. Principles of treatment of amoebic liver abscess

1. Metronidazole – 750 mg TID for 7–10 days.


2. Luminal Agents – Diloxanide furoate to clear cysts.
3. Percutaneous Aspiration – If large or non-responding.
4. Surgery – Rare, indicated for rupture or secondary infection.
Set 20
a. Intra-abdominal organs commonly injured by blunt trauma

1. Spleen (most common)


2. Liver
3. Small intestine
4. Kidneys
5. Pancreas
6. Mesentery
7. Bladder (if distended)

b. Indications of splenectomy

1. Trauma – Splenic rupture.


2. Hematological Disorders – Hereditary spherocytosis, ITP,
thalassemia.
3. Malignancy – Lymphoma, leukemia.
4. Hypersplenism – Causing pancytopenia.
5. Chronic Abscess or Cysts – Hydatid cyst, splenic abscess.

c. Complications of splenectomy

1. Immediate:
o Hemorrhage
o Pancreatic injury (fistula)
o Subphrenic abscess
2. Early:
o Thrombocytosis (risk of thrombosis)
o Left lower lobe atelectasis
3. Late:
o Overwhelming Post-Splenectomy Infection (OPSI) – Life-
threatening pneumococcal sepsis.
o Increased susceptibility to encapsulated bacteria (Streptococcus
pneumoniae, Neisseria meningitidis, Haemophilus influenzae).
o Lifelong risk of infections → Requires vaccinations
(Pneumococcal, Meningococcal, H. influenzae B, Influenza).

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