Shared Flashcard Set

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CMS 3 Surgery 1 Lec 5-8
Nova Orlando
149
Health Care
Graduate
04/21/2011

Additional Health Care Flashcards

 


 

Cards

Term
most common head and neck cancer
Definition
squamous cell
Term
causes of laryngeal cancer
Definition
tobacco and alcohol (multiplicative)
chewing tobacco, HPV, EBV, Plummer Vinson, malnutrition, occupational exposure to carcinogens
Term
6 divisions of the aerodigestive tract for staging
Definition
lip and oral cavity
pharynx
larynx
nasal cavity
paranasal sinuses
major salivary glands
thyroid (discussed in endo surgery)
(I know there is 7 but this is what she had in the ppt)
Term
staging system of head and neck cancer
Definition
TNM
Term
what is most beneficial to the dx of laryngeal cancer?
Definition
direct laryngoscopy
Term
any white mucosal lesion
Definition
leukoplakia
Term
what do you use to rule out mets in head and neck cancer?
Definition
CXR, CT, PET scan
Term
treatment for HNSCC (head/neck squamous cell carcinoma)
Definition
surgery
RT
chemo
combo regimens
Term
common surgical practice in HNSCC
Definition
radical neck dissection (RND)
Term
alternative surgery option in HNSCC
Definition
modified radical neck dissection - attempts to preserve the SCM, IJ, or CN XI in any combo
Term
complication of modified radical neck dissection
Definition
loss of CN XI, denervation of the trapezius --> chronic, painful frozen shoulder
Term
MC location for lip cancer? type?
Definition
lower lip
squamous cell carcinoma
Term
if skin cancer occurs on the upper lip what most likely caused it? what kind of cancer is it?
Definition
sun exposure
basal cell carcinoma
Term
what should you be sure to do when assessing a pt for lip cancer?
Definition
assess for nerve involvement of the chin
Term
what are poor prognostic indicators for lip cancer?
Definition
nerve involvement, fixation of the maxilla or mandible, cancer arising on the upper lip or commissure, positive nodal disease, age < 40 years when diagnosed
Term
lip cancer treatment options: early, late
Definition
early: surgery or radiation
late: neck dissection with postop RT
Term
MC oral cancer
Definition
squamous cell
Term
what is closely associated with oral cancer?
Definition
alcohol and tobacco use
Term
most common oropharynx cancer
Definition
squamous cell
Term
tx of oropharyngeal cancer
Definition
chemo and radiation
Term
when is surgery necessary with oropharyngeal cancer?
Definition
primary disease that involve the mandible, resectable recurrent disease, very early, superficial tumors that don't justify a full course of radiation
Term
complications fo oropharyngeal cancer
Definition
altering capablity to swallow, velopharyngeal insufficiency (VPI) or nasal regurgitation of liquids/solids, possible obstructive sleep apnea
Term
who is hypopharyngeal cancer most common in? what is the exception?
Definition
men age 55-70 with a h/o alcohol abuse and smoking
middle aged women with Plummer-Vinson syndrome
Term
what is Plummer-Vinson syndrome?
Definition
combination of dysphagia, hypopharygeal and esophageal webs, weight loss, and iron deficiency anemia (middle aged women)
Term
chronic sore throat, dysphagia, referred otalgia (from 8th cranial nerve) and foreign body sensation in the throat
Definition
hypopharyngeal cancer
Term
what is classified as the hypopharynx?
Definition
begins at the level of the tip of the epiglottis and ends at the level of hte lower border of the cricoid cartilage
Term
how do you diagnose hypopharyngeal cnacer?
Definition
fiberoptic endoscopy
barium swallow
CT
biopsy usually requires direct laryngoscopy under general anesthesia
Term
larynx is divided into 3 regions, what are they?
Definition
supraglottis (epiglottis)
glottis
subglottis
Term
hoarseness, ear pain or sore throat, signs of airway compromise (later in disease), dysphagia that may cause wt loss and malnutrition
Definition
laryngeal cancer
Term
what test is standard for laryngeal lesions and lymph node mets?
Definition
CT
Term
treatment options for laryngeal cancer: low grade, invasive
Definition
low grade = close follow up, repeat laryngoscopy, quit smoking
invasive: surgery, RT, chemo
Term
what is done for pts with laryngeal cancer that fail conservative therapy?
Definition
total laryngectomy
Term
presentation of nasal cavity and paranasal sinus cancers
Definition
usually present late stage and are attributed to more mundane etiologies
Term
epistaxis, nasal congestion, headache and facial pain
Definition
nasal cavity and paranasal sinus cancer
Term
how does optic involvment of nasal/paranasal cancer present?
Definition
proptosis, orbital pain, diplopia, epiphora, and vision loss
Term
what are benign lesions associated with the nasal/paranasal region?
Definition
papillomas, hemagniomas, benign fibrous hisitocytoma, fibromatosis, myxoma, osseous lesions
Term
intranasal lesions may extend into the nasal area as what?
Definition
encephaloceles, meningioceles, or pituitary tumors
Term
treatment for sinonasal malignancies
Definition
surgical resection, radiation or chemoradiation (high grade)
Term
what are the unresectable sinonasal malignancies
Definition
those with brain or bilateral optic nerve involvement, or carotid artery encasement
Term
MC benign tumor of the nasopharynx (often affects young males)
Definition
angiofibroma
Term
nasal obstruction, serous otitis with effusion, conductive hearing loss, epistaxis, nasal drainage
Definition
angiofibroma
Term
what is suggestive of malignancy in the sinonasal region
Definition
cervical mass, headache, otalgiia, trismus, and cranial nerve involvement
Term
how do you diagnose sinonasal malignancies?
Definition
rigid or flexible nasopharyngoscope
CT/MRI to determine bony destruction, soft tissue involvement and intracranial extension
Term
how can you avoid facial incisions with sinonasal surgery?
Definition
endoscopic surgery, also allows for shorter hospital stays
Term
hearing loss, vertigo, eustachian tube dysfunction with serous otitis media, cranial nerve deficits, pulsatile tinnitus, drainage, deep "boring" pain
Definition
ear and temporal bone malignancy
Term
how do you diagnose ear and temporal bone problems?
Definition
audiology and vestibular testing
CT to eval bony involvement
Term
treatment of ear/temporal bone malignancy
Definition
resection of those structures at risk for involvement.
Prosthetic ears provide acceptable rehabilitation when total auriculectomy has to be performed.
Term
acute or chronic inflammation of a salivary gland
Definition
sialadenitis
Term
common causes of sialadenitis
Definition
bacterial = staph aureus
viral = mumps
Term
obstructive calcification in a salivary duct
Definition
sialolithiasis
Term
benign lymphoepithelial lesions are associated with what disease?
Definition
Sjogren's Syndrome
Term
what is sialolithiasis often misdiagnosed as?
Definition
Bell's Palsy
Term
how do you diagnose salivary gland pathology?
Definition
FNA cytology of the salivary gland with excision of the gland
Term
how do you tx salivary gland pathology?
Definition
surgical excision, RT for high grade malignancy, facial nerve preservation
Term
MCC of neck masses in kids?
Definition
inflammatory processes
Term
MCC of neck masses in adults?
Definition
malignancy
Term
form during development of the embryo. They occur when tissues in the neck and collarbone area fail to develop normally.
Definition
brachial cleft cysts
Term
complication of brachial cleft sinus/cyst
Definition
infection
Term
formation of an opening that will close spontaneously (5-7d)
Definition
tracheotomy
refers to the operation itself
Term
formation of a permanent opening that remains open after removal of the tube
Definition
tracheostomy
refers to the opening itself
Term
when is a tracheostomy often placed?
Definition
pts requiring mechanical ventilation (after 3 days of intubation - 2-3 weeks)
other reasons: chronic aspiration, acute airway obstruction, perioperatively during radical cancer ablation
Term
complications of tracheotomy
Definition
bleeding, aspiration, pneumothorax, pneumomediastinum, hypoxia, recurrent laryngeal nerve injury --> vocal cord paralysis
Term
causes of laryngeal muscle paralysis
Definition
CNS lesion, peripheral nerve injury, malignancies of the thyroid, esophagus, or larynx, compression
Term
how do you diagnose vocal cord paralysis?
tx?
Definition
dx: laryngoscopy
tx: intracordal injection, medialization (removal of thyroid cartilage and replacement with silicone to push the cord medially closed)
Term
treatment of bilateral vocal cord paralysis
Definition
immediate reintubation or tracheotomy
Term
general priciples of reconstruction
Definition
reconstruct underlying bony framework, replace skin with skin of matching quality, minimize scar visibility and contracture, reconstruct in zones of facial units
Term
venous drainage from the breast occurs via
Definition
the axillary, subclavian, and intercostal veins
Term
lymph drainage from the breast occurs via
Definition
mostly the axillary nodes (75%), remainder via the internal mammary nodes
Term
how does lymph drainage flow?
Definition
from bottom to top
Term
what is the rationale of sentinel node biopsy?
Definition
lowest node draining the cancer is biopsied, if negative further lymph node dissection is avoided.
Term
contents of the axilla include how many groups of lymph nodes?
Definition
5
Term
subclavicular nodes in the axilla are contiguous with what?
Definition
the supraclavicular nodes in the neck and the interpectoral nodes
Term
how do the internal mammary nodes probably drain?
Definition
independently from the breast
Term
what causes ductal budding and formation of acini
Definition
hormonal production during puberty
Term
what are acini lined with?
Definition
secretory cells for milk production
Term
preovulatory estrogen leads to
Definition
proliferation of the breast ductal system
Term
what happens post ovulation?
Definition
decreasing estrogen and progesterone lead to a decrease in breat ductal proliferation
Term
what happens post-menopausally?
Definition
breast parenchyma is replaced by adipose tissue
Term
this occurs in > 1/2 of adolescent males
Definition
gynecomastia
Term
in aging men this is relative to hyperestrinism as plasma testosterone levels decrease and androgens are increasingly converted to estrogen in peripheral tissues
Definition
gynecomastia
Term
fat secretes ______ that leads to ______.
Definition
estrogen, gynecomastia
Term
MC breast tumor in young women
Definition
fibroadenoma
Term
MCC of bloody nipple discharge
Definition
intraductal papilloma
Term
firm nodular cysts with epithelial hyperplasia
Definition
fibrocystic disease
Term
appears to represent an exaggerated response of breast stroma and epithelium to a variety of hormones
Definition
fibrocystic changes
Term
premenstrual cyclic breast pain, tenderness, nodularity.
mammogram = bilateral symmetrically diffuse or focal radiologically dense tissue
Definition
fibrocystic changes
Term
dull, diffuse, and commonly bilateral upper outer quadrants produced by normal ovarian hormones
Definition
cyclical mastalgia
Term
more likely to be the result of non-breast etiology associated with cervical radiculopathy, costochondritis, or intercostal muscle strain
Definition
noncyclical mastalgia
Term
breast cellulitis that causes pain with skin changes characteristic of a bacterial infection
Definition
mastitis
Term
marker of incresing risk of developing ductal or lobular carcinoma
Definition
lobular carcinoma in situ (LCIS)
Term
pre-invasive form of ductal cancer
Definition
ductal carcinoma in situ (DCIS)
Term
MC invasive breast cancer
Definition
infiltrating ductal carcinoma
Term
presents with Peau d'orange and has poor prognosis
Definition
inflammatory carcinoma
Term
Paget's disease is associated with
Definition
malignancy (usually, not always)
Term
risk factors for malignant disease (8)
Definition
increasing age, +FHx, HRT, alcohol consumption, early menarche, late menopause, nulliparity, radiation exposure,
Term
how do you dx breast cancer?
Definition
FNA
Mammography (most sensitive and specific)
US
CT
MRI (good for dense breasts, scar tissue, and implants)
Term
staging system for breast cancer
Definition
TNM
Term
other factors to consider when treating breast cancer
Definition
ER+ status
histopathologic grade of the tumor
mitotic index
Her-2-Neu oncogen (if + = poorer prognosis, tx with herceptin)
Term
treatment for breast cancer
Definition
surgery
radiation
adjuvent therapy to decrease systemic recurrence (chemo and hormone)
Term
goal of breast cancer surgery
Definition
excision of the malignancy with wide margin of normal tissue
Term
when is a lumpectomy used?
Definition
DCIS, invasive carcinoma
followed by RT
Term
removal of the entire breast, axillary dissection is performed (removing level 1 and 2 nodes), no muscle removed
Definition
modified radical
Term
removal of the entire breast, level 1, 2 and 3 lymph nodes, and chest wall muscle
Definition
radical masectomy
Term
duration of normal RT for breast cancer
Definition
used after lumpectomy to prevent recurrence
x 6 wks
Term
what is used to treat ER+ breast cancer?
Definition
tamoxifen x 5 years
Term
what medication decreases circulating estrogen levels?
Definition
aromatase inhibitors
Term
complications of breast cancer surgery
Definition
lymphedema
poor cosmetic result
wound infection
seroma/hematoma
local recurrence
Term
complications of bresat cancer chemo/hormonal/RT
Definition
N/V, leukopenia, thrombocytopenia, alopecia, cardiotoxicity, sepsis, hemorrhagic cystitis
Term
breast cancer follow up treatment
Definition
bilateral mammograms 6m post RT completion, yearly thereafter
after modified radical: contralateral mammogram yearly
PE q 3-6m x 3 yrs then annually
Term
breast reconstruction doesn't have ______.
Type done depends on ________.
Definition
doesn't have natural sensation.
type depends on your body type, age, and cancer treatment.
Term
phase of tumor transformation described as a series of sequential genetic mutations
Definition
initiation phase
Term
phase of tumor transformation described as "initiated cells become tumor cells. Exposure to promoting agents or conditions is required."
Definition
promotion phase
Term
phase of tumor transformation described as "invasive growth of the lesion into a highly metastatic tumor."
Definition
progression stage
Term
external (somatic) factors of tumor formation
Definition
exposure to physical or chemical carcinogens
Term
germline mutations in tumor formation
Definition
morphologic changes from normal mucosa to cancer
Term
2 methods of cancer mets
Definition
intravasation: detachment of some tumor cells from the primary tumor and infiltration into the bloodstream or lymphatics.
extravasation: reciprocal process occurs in other areas of the body
Term
strong link exists between _____ and skin cancer
Definition
sun exposure (particularly UVB)
Term
MC type of skin cancer
Definition
BCC, followed by SCC
Term
other changes caused by solar radiation
Definition
wrinkling, telangiectasias, actinic keratosis, solar elastosis
Term
where are most skin cancer changes noted?
Definition
head, neck, and dorsum of the hands
Term
this type of cancer grows slowly and is non-aggressive
Definition
basal cell carcinoma
Term
3 types of basal cell carcinoma
Definition
nodular: smooth, dome shaped or round, pearly papule, develops central necrosis, bleeds with trauma.
pigmented: has melanocytes that give it a dark brown or blue-black color. Easily confused with melanoma
Fibrosing: indurated yellow plaque with poorly defined borders, looks shiny & taut, scarlike
Term
treatment of BCC
Definition
correctly ID the lesion, complete tumor removal (<0.5cm = cryotherapy), electrodessication, curretage.
optimal surgery = excision with a 1cm margin
Term
what causes SCC of the lip and mouth?
Definition
smoking
Term
what has graeter potential for mets, BCC or SCC?
Definition
SCC
Term
where do most SCC occur?
Definition
head and neck
MC site = lower lip
Term
erythematous firm papule, forms a nodule with central ulceration, crusts and scabs
Definition
SCC
Term
difference in tx of BCC and SCC
Definition
with SCC lymph node dissection may be necessary.
Term
SCC prognosis
Definition
2/3 of pts with mets into sc tissue may die.
nearly all pts with lymph node involvement will die.
Term
follow up tx for SCC
Definition
skin check every 6 months
Term
surgery performed for areas where wide excision is not possible, usually done out pt with local anesthetic, has the highest cure rate for BCC
Definition
Mohs surgery
Term
causes 77% of deaths from skin cancer
Definition
melanoma
Term
has the greatest malignant potential
Definition
melanoma
Term
50-60% of this arises from or near benign nevi
Definition
melanoma
Term
how do you dx melanoma?
Definition
excisional biopsy is preferred (full thickness skin and sc tissue are excised)
incisional biopsy if done must include some of the thickest part of the pigmented lesion for micostaging.
Term
treatment for melanoma
Definition
total lesion removal
staging
skin graft prn
sentinel node biopsy
RT for brain mets
Term
what is ineffective in the tx of melanoma?
Definition
chemotherapy
Term
type of lymphoma with a bimodal presentation
Definition
Hodgkins, late 20's and mid 70's
Term
Dx of Hodgkin lymphoma
Definition
asx cervical LAD, Reed Sternberg cells.
Term
what indicates a worse prognosis in Hodgkins lymphoma?
Definition
"B" symptoms: fever, night sweats, wt loss
Term
treatment of Hodgkin lymphoma
Definition
RT for early stage disease
chemo, RT for advanced disease
Term
type of lymphoma associated with asx diffuse LAD
Definition
Non-Hodgkin lymphoma
Term
B-cell lymphoma
Definition
Non-Hodgkins
Term
dx of Non-Hodgkin lymphoma
Definition
labs, CXR, CT of chest, abd, pelvis, bone marrow biopsy
Term
rx of Non-Hodgkin lymphoma
Definition
depends on stage
surgery, RT, chemo
Term
rare tumor derived from the embryonic mesoderm
Definition
sarcoma
Term
most common sites for sarcoma
Definition
extremities (66%)
trunk (20%)
retroperitoneum (13%)
Term
presentation of sarcoma
Definition
usually asx so they grow quite large.
don't usually invade tissue but rather push on other structures
Term
treatment of sarcoma
Definition
surgical resection with a 2cm margin of normal tissue.
RT
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