Breast and Endocrine Surgery
Core concepts
Understand breast anatomy, lymphatic drainage, and the evaluation of a breast mass (clinical exam, imaging, tissue diagnosis). Know the management of benign disease (fibroadenoma, cysts, mastitis) and breast cancer by stage, including breast-conserving surgery versus mastectomy, sentinel lymph node biopsy, and adjuvant therapy principles. Understand the axilla and lymphedema risk. For endocrine surgery, know thyroid nodules and cancer types (papillary, follicular, medullary, anaplastic), parathyroid disease and calcium regulation, adrenal incidentalomas, and the workup of hyperaldosteronism and pheochromocytoma.
Traps in questions
Questions often test whether a thyroid nodule needs biopsy based on size and ultrasound features. Distinguish follicular adenoma from carcinoma, which requires histology. Another trap is confusing primary hyperparathyroidism with malignancy-related hypercalcemia. Watch for questions about pheochromocytoma; never operate without alpha blockade first. Be careful with breast cancer in pregnancy and with male breast cancer.
Worked rule of thumb
For a thyroid nodule, use ultrasound risk features and size to decide fine-needle aspiration. For suspected pheochromocytoma, biochemical testing (metanephrines) precedes imaging, and alpha blockade precedes surgery to avoid hypertensive crisis.
Exam strategy
Tie management to diagnosis. Sentinel node biopsy is for clinically node-negative disease; axillary dissection is for proven nodal disease.