Tiêu đề 10. Mentors Note_Breast and Endocrine_Feb2023.pdf ✅

PART-A COURSE MRCS (UK) Lecture Note 10. Breast & Endocrine
MRCS (UK) PART-1 COURSE 10. Breast & Endocrine New Edition: February, 2023 About The DrAcademy The Best Medical Academy for Postgraduate Medical Exams of The Royal Colleges of UK. The DrAcademy [Experienced 12+years] is led by a group of talented doctors from all over the world & managed by a very skillful administrative staff. Our mission is to provide the best quality medical education with a very convenient fees structure to all the doctors who are preparing for MRCP(UK) | MRCS(UK) | MRCOG(UK) | MRCPCH(UK) | FCPS | MD | MS | PLAB & OET. Published by The DrAcademy ! 25/2, Level-3, Green Road, Dhanmondi, Dhaka-1205, Bangladesh " Web: www.thedracademy.com # Facebook: www.facebook.com/thedracademy ✉ Email: [email protected] ☎ Hotline: +88 0173355 2110 ☎ Office: +88 0179905 0606 The DrAcademy, 25/2 Green Road (Level-3), Dhanmondi, Dhaka-1205 Web: www.thedracademy.com | Email: [email protected] | facebook:fb.com/thedracademy Mobile: +88-017 3355 2110 Page | 1 Contents Topic 1 | Adrenal Gland 2 Topic 2 | Thyroid Lumps 5 Topic 3 | Thyroid Drugs 7 Topic 4 | MEN Syndrome 8 Topic 5 | Abberations of Normal Development and Involution- Breast 9 Topic 6 | Benign Breast Lesions 11 Topic 7 | Nipple Discharge 13 Topic 8 | Gynaecomastia 16
Topic 9 | Breast Cancer 19 Topic 10 | Management of the axilla- breast cancer 25 Topic 11 | Breast cancer management 26 Topic 12 | Nottingham Prognostic Index 31 Topic 13 | Complications of Breast Surgery 33 Topic 14 | Lymphoedema 34 Topic 15 | Breast Cancer Treatment 36 Topic 16 | Tamoxifen 38 Topic 17 | Parathyroid glands and disorders of calcium metabolism 39 Topic 18 | Thyroid disease 48 Topic 19 | Thyroid malignancy 57 Topic 20 | Hyperthyroidism 60 Topic 21 | Radioiodine vs. Surgery 62 Topic 22 | Thyroid disease 62 Topic 1 | Adrenal Gland Qustion-13 Theme: Causes of secondary hypertension A Acromegaly B Adrenal hyperplasia C Chronic pyelonephritis D Coarctation of the aorta E Conn â€TMs syndrome F Cushingâ€TMs syndrome G Diabetes mellitus H Glomerulonephritis I Hyperparathyroidism J Oral contraceptive pill K Phaeochromocytoma L Polyarteritis nodosa
M Polycystic kidneys N Pre-eclampsia O Renal artery stenosis P Renin-secreting tumours Q Steroid therapy R Systemic sclerosis The following scenarios describe various patients with secondary hypertension. From the list above choose the single most appropriate cause for their secondary hypertension. Each item may be chosen once, more than once, or not at all. In approximately 90% of cases of hypertension no cause can be elucidated and patients are said to have essential hypertension. In the remaining minority an underlying cause can be found, which can be classified into renal, endocrine and miscellaneous, reflecting the control centres of normal blood pressure. An important endocrine pathway to remember is that of the hypothalamic–pituitary–adrenal axis. Corticotrophin-releasing factor (CRF) is produced by the hypothalamus and prompts the pituitary gland to produce adrenocorticotrophic hormone (ACTH). This in turn stimulates the adrenal cortex to produce cortisol, aldosterone and, in smaller amounts, sex hormones. Each of these end-organ hormones feedback in a negative way to the hypothalamus and pituitary gland. Other environmental factors, such as stress, can also stimulate the hypothalamus to release ACTH. Any young (< 35 years old) patient or individual failing to respond to antihypertensive treatment should be screened for secondary causes. Although rare, they are important conditions with surgically correctable outcomes, resulting in a dramatically improved clinical outcome in otherwise pharmaceutically refractory hypertension. Scenario 1 A 35-year-old woman presents to clinic with episodic headaches, sweating and palpitations. Her blood pressure is 205/100 mmHg and her 24-h urinary collection demonstrates elevated metanephrines. Phaeochromocytoma « CORRECT ANSWER This is a rare (0.1% of hypertension) catecholamine-producing tumour of the sympathetic system (90% are benign). Between 10 and 20% of these tumours are inherited as an autosomal dominant trait, half of these are bilaterally occurring. They can be associated with other tumours such as MEN (multiple endocrine neoplasia) syndromes, neurofibromatosis, von Hippel–Lindau syndrome, Sturge–Weber syndrome and also tuberous sclerosis. Metanephrines (eg vanillomalleic acid or VMA) are the metabolic by-product of normal catecholamine breakdown and 24-h urine collection is used as a screening tool. Diagnosis can be confirmed on plasma measurement of catecholamine, with localisation by computed tomography or metaiodobenzylguanide (MIBG) scan. Treatment is ideally surgical, under a- and β-blockade with phenoxybenzamine and propanolol commenced pre-operatively. These drugs can also be used in patients who are not fit for surgery.
Scenario 2 A 26-year-old man presents with haematuria, recurrent episodes of non-specific abdominal pain and melaena. He often wakes up with night sweats and describes diffuse myalgia. He takes no regular medication and has a blood pressure of 195/90 mmHg. Hyperparathyroidism « CORRECT ANSWER Hyperparathryoidism causes hypercalcaemia leading to renal stones - and haematuria, gastric ulcers - and haematemesis, and myalgia. "Groans, stones and moans." Scenario 3 A 45-year-old woman attends Casualty with muscular cramps and tetany, polyuria and nocturia. Her electrocardiogram demonstrates a prolonged PR interval and on questioning she describes occasional palpitations. She is noted to be hypertensive and takes no regular medication. Her potassium is 3.1 mmol/litre. Connâ€TMs syndrome « CORRECT ANSWER Connâ€TMs syndrome is a constellation of symptoms resulting from a unilateral adenoma in the adrenal cortex. It accounts for over 75% of hyperaldosteronism, the remainder being related to bilateral adrenocortical hyperplasia and adrenal adenocarcinoma. Unregulated excess aldosterone causes reduced renal losses of sodium and water, and abnormal potassium and hydrogen ion losses. A subsequent increase in circulating volume with a concomitant rise in blood pressure is seen. Negative feedback, via baroreceptors in the juxtaglomerular apparatus, results in low circulating levels of renin and angiotensin. Patients present with hypertension, polyuria, nocturia and polydipsia, muscle cramps, tetany and cardiac arrhythmias related to the resultant hypokalaemic alkalosis. Screening is performed on three separate plasma potassium measurements, and if at least one measurement is < 3.7 mmol/litre then serum aldosterone, renin, angiotensin and urea & electrolytes should be measured again on three separate occasions. Treatment for Connâ€TMs syndrome consists of surgical excision following spironolactone 300 mg/24 h for 4 weeks preoperatively. Scenario 4 A 55-year-old man is due to undergo an inguinal hernia repair but in pre-assessment clinic is noted to have a blood pressure of 220/95 mmHg. On examination he has excessive fat deposition around the nape of his neck and multiple striae across his abdomen. He takes no regular medication. Cushingâ€TMs syndrome « CORRECT ANSWER Cushingâ€TMs syndrome is caused by persistently and inappropriately elevated adrenal glucocorticoid levels, the many metabolic effects of which are manifested in Cushingâ€TMs syndrome. Cushingâ€TMs disease should be distinguished from Cushingâ€TMs syndrome; the former being a specific reference to excess production of glucocorticoids resulting from inappropriate ACTH secretion from the pituitary. Cushingâ€TMs syndrome is a general term used to describe all of the abnormalities caused by elevated glucocorticoid production regardless of cause. Cushingâ€TMs syndrome therefore encompasses both ACTH-dependent and non-independent causes as given below. -nee