04b: The Breast Flashcards
T/F: Progesterone plays role in pubertal breast development.
True, but only AFTER menses
List the hormones that play role in pubertal breast development
- Estrogen, progesterone
- GH
- Prolactin
- Adrenal steroids
- Insulin
Early pregnancy: (X) hormone(s) causes (Y) changes in breast tissue.
X = beta-hCG Y = alveolar development
Late pregnancy: (X) hormone(s) causes (Y) changes in breast tissue.
X = prolactin, E, P, GH, glucocorticoids, insulin Y = secretory differentiation (increase number of glands)
Colostrum synthesis/accumulation begins in (early/late) pregnancy. What are the components of colostrum?
Late (secretory differentiation);
Lactose, milk proteins (casein, whey, a-lactalbumin), IgG, IgA
Maternal benefits to breastfeeding: decreased risk for which disease(s)?
Breast and ovarian cancer and DM II
Lactation is regulated by (nervous/endocrine) system.
Both!
Lactation: Suckling triggers (X) which stimulates (Y).
X = 4-6th intercostal n (signal travels up SC) Y = anterior pit (prolactin secretion) and post pit (oxytocin secretion)
List some short-term maternal benefits of breastfeeding.
- Decrease post-partum blood loss
- Weight loss
- Prolongs post-partum anovulation (high prolactin)
Direct benefits of breastfeeding on infant.
Decreased risk of illness (diarrhea, U/LRT infections, otitis media, UTIs)
Long-term benefits of breastfeeding on infant.
Decreases risk of:
Acute illnesses, obesity, allergies, GI infections, leukemia, DM I
Recommended length of breastfeeding.
At least 6 mo exclusively; then up to 1 year afterwards non-exclusively
T/F: HIV positive mothers cannot breastfeed unless they are on antiretroviral meds.
False - can’t breast feed, even if on meds
29 yo 2-day postpartum woman presents with swollen, lumpy, tender breasts. She reports that she has been breastfeeding her newborn. What is the likely cause?
Engorgement (baby isn’t latching adequately; edema and accumulated milk)
29 yo postpartum woman presents with swollen, lumpy, tender breasts. She reports that she has been breastfeeding her 7 month-old child. What is the likely cause?
Engorgement (likely due to weaning kid off breastmilk and producing more than he/she needs)
Breastfeeding: Rx for engorgement
Empty breasts (more feeding/pumping) and cool/warm compress
29 yo postpartum woman presents with swollen, erythematous, tender R breast and fever of 102o. She reports that she has been breastfeeding her 3 month-old child. What is the likely cause?
Mastitis (due to abrasion/cut from breastfeeding)
Most common organisms that cause mastitis:
- S. aureus
- Strep
- E. coli
Mastitis Rx:
- Antibiotics (dicloxicillin, keflex, clindamycin)
- NSAIDs
- Keep breast feeding to empty breast
1% of breastfeeding women may develop (X) complication from mastitis. What’s the Rx?
X = abscess
Serial drainage with GS/culture, along with antibiotics
T/F: Non-proliferative breast lesions do not increase risk for breast cancer.
True
T/F: Proliferative breast lesions without atypia do not increase risk for breast cancer.
False - some may
Which imaging modalities would you use to evaluate breast lump in 25 yo woman?
Ultrasound (if between ages 21-30);
Note: Add mammogram if patient over age of 30
Breast imaging rating: BIRADS (X) for lump that’s highly suggestive of malignancy. Next step is (Y).
X = 5 Y = biopsy
Breast imaging rating: BIRADS (X) for lump that’s benign. Next step is (Y).
X = 2 Y = annual follow-up
Breast imaging rating: lump is BIRADS 3. What’s the next step?
Probably benign, but short interval (6 mo) repeat imaging recommended
Breast imaging rating: lump is BIRADS 4. What’s the next step?
Suspicious abnormality;
Biopsy should be considered
Pt with proven breast malignancy undergoes imaging to stage/evaluate cancer after round of chemo. She would be placed in BIRADS (X).
X = 6
Nipple discharge: which characteristics make it concerning for cancer?
- Bloody/purulent
- Unilateral
- Spontaneous
- Breast mass
- Woman over 40
Pt presents with L nipple discharge. On ultrasound, you see fluid-filled duct with extensions/growths extending into lumen. Likely diagnosis is (X) and Rx is (Y).
X = intraductal papilloma (common cause of unilateral nipple discharge) Y = excision
T/F: Intraductal papilloma is cancer.
F - but increases risk of cancer
What are some peripheral causes of galactorrhea?
Nerve stimulation!
- Shingles (activating 4-6th intercostal nerve)
- Poorly fitting bra
- Nipple stimulation
T/F: One risk of mammography is radiation exposure.
False - very low dose that does not increase risk of cancer
Rx GOALS of premature ovarian failure includes:
- Psychosocial support
- Prevent osteoporosis (HRT, Ca, vit D, exercise)
- Yearly screening for endocrine abnormalities (hypothyroid, adrenal insuff)
- Contraception to prevent spontaneous conception
- Fertility (IVF)
Physiology of menopause: what’s the first step?
Follicular depletion in ovary
Menopause: follicular depletion causes (rise/fall) in (X) levels, which causes (rise/fall) in (Y) levels.
Fall
X = inhibin B
Rise
Y = FSH (fluctuates)
Best Rx hot-flashes/vasomotor Sx in peri-menopausal woman.
Estrogen (short duration, low dose; give with progestin if uterus present)
T/F: Female sexual dysfunction is more common with increased age (ex: 65 y or older).
False - more common in 45-64 yo women (likely due to menopause)
List the four forms/complaints that can cause F sex dysfunction.
- Lack of sex desire
- Impaired arousal
- Inability to orgasm
- Pain
T/F: Lab evaluation is not useful to F sex dysfunction.
True
First FDA-approved drug for F sex dysfunction:
Flibanserin
Flibanserin MOA and side effects.
Unknown (maybe impacting DA and SA neurotransmitters?)
Hypotension, syncope
T/F: Flibanserin has been shown to be effective in up to 60% of women.
False - only 10%
When prescribing your 50 yo F patient Flibanserin, it’s important that she takes it every (X) hours for (Y) weeks before it takes effect. She should also avoid (Z).
X = 24y (daily) Y = 4-8 Z = alcohol
