Benign breast disorders

Question 1

What nodes receive most of the drainage from the breast

Answer 1

Axillary (sentinel)

Question 2

Which nodes are most commonly involved with breast cancer metastases

Answer 2

Axillary nodes

Question 3

What is the top cause of fever in post partum females

Answer 3

Mastitis

Question 4

What are some risk factors for mastitis

Answer 4

first time nursing
difficulty nursing
oversupply of milk
maternal stress/fatigue
illness of mother or child
cracks / nipple sores

Question 5

What is mastitis

Answer 5

infection of the breast

Question 6

What is the most common cause of mastitis

Answer 6

S. aureus

Question 7

What are some s/sx of mastitis

Answer 7

unilateral
indurated, erythematous, edematous tender area on breast
fever

Question 8

How do you diagnose mastitis

Answer 8

Mostly clinical
*if persistent -> culture MIDSTREAM milk sample

Question 9

How do you treat mastitis

Answer 9

breast feeding
bedrest
breast massage
supportive bra
pain control (NSAIDs / Tylenol)

Question 10

What is the first line abx for mastitis

Answer 10

Dicloxacillin (7-14 days)

Question 11

What is the treatment for mastitis if there is a PCN allergy or MRSA is suspected

Answer 11

Clindamycin

Question 12

What are the risk factors for breast abscess

Answer 12

material age (>30)
Primparity
gestational age +41weeks
mastitis

Question 13

What are some causes of a breast abscess that are unrelated to breast feeding

Answer 13

DM
Smoker
hidranitis suppurativa
trauma
*inflammatory complication

Question 14

What is the primary cause of a breast abscess

Answer 14

worsening of mastitis
*S. aureus

Question 15

What are the s/sx of a breast abscess that are different from mastitis

Answer 15

palpable fluctuant mass
+/- spontaneous drainage

Question 16

What is diagnostic for a breast abscess

Answer 16

aspiration (possible I&D)

Question 17

What antibiotics can be used for breast abscess

Answer 17

Bactrim
Clindamycin
Doxycycline

Question 18

What is a galactocele

Answer 18

Milk retention cyst

Question 19

When do galactoceles commonly present

Answer 19

typically 6-10 months after lactation

Question 20

What is the most common lesion in lactating women

Answer 20

galactocele

Question 21

What are the s/sx of galactocele

Answer 21

palpable mass that is soft, non-tender, and mobile
*no systemic symptoms

Question 22

What is the imaging test of choice for galactocele

Answer 22

Ultrasound

Question 23

How can you make a definitive diagnosis of a galactocele

Answer 23

Needle aspiration

Question 24

How can you treat a galactocele

Answer 24

warm compress (should resolve on own)
*if not = aspiration

Question 25

What are breast cysts often associated with

Answer 25

larger spectrum of fibrotic disease

Question 26

When do fibrocystic diseases typically peak

Answer 26

30-50 y/o

Question 27

What are breast cysts most commonly related to

Answer 27

hormones (overproduction of estrogen)

Question 28

What is the best initial test for breast cysts

Answer 28

US *helps differentiate between cystic vs solid

Question 29

What will a cyst look like on US

Answer 29

round, well circumscribed, anechoic

Question 30

When should mammography be considered with breast cysts

Answer 30

>35years old

Question 31

What are the 3 types of breast cysts

Answer 31

simple complicated complex

Question 32

What are the properties of a simple breast cyst

Answer 32

smooth, thin, regular walls completely fluid filled always benign

Question 33

What are the properties associated with complicated breast cysts

Answer 33

some debris but not real solid and no thick walls

Question 34

What are the properties of complex breast cysts

Answer 34

irregular or scalloped with thick walls some solid components and debris may be malignant

Question 35

How do you get a definitive diagnosis for breast cysts

Answer 35

FNA (cytology and culture)

Question 36

What is the treatment for a simple breast cyst

Answer 36

aspiration +/- excision *no monitoring necessary

Question 37

How do you treat complicated breast cysts

Answer 37

Aspiration +/- cytology/culture Re-image and/or bx q6m x 2 yr

Question 38

How do you treat complex breast cysts

Answer 38

FNA or excision biopsy follow-up q6m x 2yr

Question 39

What are 2 types of fibrocystic changes that can occur

Answer 39

Non-proliferative proliferative

Question 40

What are the characteristics of non-proliferative fibrocystic changes

Answer 40

no epithelial hyperplasia in ducts No increase in risk for Brest cancer development

Question 41

What is the most common presenting system with fibrocystic changes in the breast

Answer 41

Mastalgia that is exacerbated by menstruation, chocolate, caffeine

Question 42

How do you assess fibrocystic changes in women >35

Answer 42

mammogram

Question 43

How do you assess fibrotic changes in women <35 and why

Answer 43

US because the breast tissue is too dense for mammo

Question 44

What are the treatment options for fibrocystic breast changes

Answer 44

reassurance and a supportive bra *if more severe, can use tamoxifen

Question 45

What is the most common benign tumor of the breast

Answer 45

fibroadenoma

Question 46

Who usually gets fibroadenoma

Answer 46

usually females <30 *higher rates in those who took OCP before age 20

Question 47

Which breast tissue is usually effected by fibroadenomas

Answer 47

stromal and epithelial cells

Question 48

Where on the breast do fibroadenomas present

Answer 48

Can be bilateral *upper/outer quadrant most common

Question 49

When are core needle biopsies needed for fibroadenomas

Answer 49

suspicious lesion high risk women rule out malignancy

Question 50

Which patients will have a fibroadenoma removed

Answer 50

Rapid growth uncertain diagnosis size >2cm patient request

Question 51

When are intraductal papillomas general present

Answer 51

35-55years old

Question 52

What are the risk factors for intraductal papilloma

Answer 52

contraception hormone replacement therapy lifelong estrogen exposure +FH

Question 53

What is an intraductal papilloma

Answer 53

benign tumor of ductal epithelial cells

Question 54

Where are solitary papillomas most common

Answer 54

central and posterior to the nipple *effects central duct

Question 55

What type of discharge can occur with an intraductal papilloma

Answer 55

bloody or clear and spontaneous

Question 56

What type of imaging can be done to show a filling defect in the milk ducts

Answer 56

Galactography

Question 57

What is the treatment for an intraductal papilloma

Answer 57

Lumpectomy due to the high risk of becoming cancerous