Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3A Revision > Breast > Flashcards

Breast Flashcards

1
Q

Three positions to inspect breasts in

A
  1. Relaxed with arms by sides
  2. Hands pressed into hips (tenses chest wall –> look for tethering)
  3. Hands placed behind head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Peau d’orange

A

May be associated with inflammatory breast cancer
Blocked lymphatic drainage –> superficial oedema –> skin thickened
Sweat ducts cause dimpling in thickened skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Presentation of Paget’s disease of the nipple

A

Erythematous, scaly rash of the nipple
Resembles eczema
Usually unilateral
Can be itchy, inflamed or ulcerated
Burning sensation
Discharge from affected area
Inverted nipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differentiating Paget’s and Eczema

A

Paget’s: starts at nipple + works outwards
Eczema: starts at periphery of areolar and works inwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What disease is Paget’s disease of the nipple associated with

A

Ductal carcinoma in situ, or invasive carcinoma in the underlying breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Findings on examination of fibroadenoma

A

Painless
Smooth
Round
Well circumscribed
Firm
Mobile
Usually up to 3cm in diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When would a fibroadenoma be surgically removed

A

If >3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical features suggestive of breast cancer

A

Hard, irregular, painless or fixed lumps
Lumps may be tethered to skin or chest wall
Nipple retraction
Skin dimpling or oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

NICE guidelines for 2WW breast referral

A

Unexplained breast lump in patients aged 30+
Unilateral nipple changes in patients aged 50+

Consider in:
Unexplained lump in axilla in patients aged 30+
Skin changes suggestive of breast cancer

Consider non-urgent referrals for unexplained breast lumps in patients <30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of fibrocystic breast changes

A

Common in women of menstruating age - symptoms often occur prior to menstruation, and resolve once menstruation begins
Symptoms usually improve or resolve after menopause

Lumpiness
Breast pain or tenderness
Fluctuation of breast size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Options for management of cyclical breast pain

A

Wearing a supportive bra
NSAIDs e.g. ibuprofen
Recommend avoiding caffeine
Applying heat to the area
Hormonal treatments e.g. danazol + tamoxifen, under specialist guidance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Features of breast cysts

A

Most common cause of breast lumps
Typically occur aged 30-50, more so in perimenopausal period
Can be painful and may fluctuate in size over menstrual cycle

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigation of breast cysts

A

Require further assessment to exclude cancer
Imaging +/- aspiration or excision
Aspiration can resolve pain symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is fat necrosis of the breast

A

A benign lump formed by localised degeneration + scarring of fat tissue
May be associated with an oil cyst
Commonly triggered by localised trauma, radiotherapy or surgery
Inflammatory reaction –> fibrosis + necrosis
No associated risk of breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Features of fat necrosis of the breast lump

A

Painless
Firm
Irregular
Fixed in local structures
May be skin dimpling or nipple inversion
More common in obsese women with large breasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations + management of fat necrosis of the breast

A

USS or mammogram can appear similar to breast cancer
Histology (fine needle aspiration, or core biopsy) may be required to exclude cancer diagnosis

May resolve spontaneously with time
Surgical excision may be required for symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Presentation of lactational mastitis

A

Breast pain + tenderness
Erythema in focal area of breast tissue
Local warmth + inflammation
Nipple discharge
Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of lactational mastitis

A

Obstruction in ducts + accumulation of milk –> regular expression can help prevent this
Infection: back-track of bacteria. Most common = staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of lactational mastitis

A

Blockage: continue breastfeeding, express milk,, breast massage
- Heat packs
- Warm showers
- Simple analgesia
Infection suspected/conservative management not effective: flucloxacillin (or erythromycin). Fluconazole if suspected candida
Encourage women to continue breastfeeding (will not harm baby) + express excess milk

20
Q

Adjuvant hormonal therapy for oestrogen receptor +ve breast cancer

A

Pre/peri-menopausal women = tamoxifen
Post-menopausal women = anastrozole

21
Q

Adjuvant biological therapy for HER2 positive breast cancer

A

Herceptin (trastuzumab) - not used in patients with history of heart disorders

22
Q

Causative organisms of breast abscess

A

Staphylococcus aureus (most common)
Streptococcal spp
Enterococcal spp
Anaerobic bacteria

23
Q

Presentation of mastitis with infection in breast tissue

A

Acute onset
Nipple changes
Purulent nipple discharge
Localised pain
Tenderness
Warmth
Erythema
Hardening of skin or breast tissue
Swelling
Generalised symptoms of infection

24
Q

Key feature suggesting breast abscess

A

Swollen, fluctuant, tender lump in the breast
Infection without abscess –> hardness of tissue, forming a lump, but not fluctuant as not filled with fluid

25
Q

Management of breast abscess

A

Referral to on-call surgical team in hospital
Antibiotics
USS - confirm diagnosi + exclude other pathology
Drainage: needle aspiration, or surgical incision + drainage
MC+S of drained fluid

26
Q

Antibiotics used for non-lactational mastitis

A

Co-amoxiclav, or
Erythromycin/clarithromycin + metronidazole
Necessary to have broad-spectrum to cover anaerobes

27
Q

What is mammary duct ectasia

A

Ectasia = dilation of large ducts in the breasts
Inflammation of ducts –> intermittent discharge from the nipple

28
Q

Features of mammary duct ectasia

A

Nipple discharge: may be white, grey or green
Tenderness or pain
Nipple retraction/inversion
A breast lump - pressure on this may produce discharge
Most common in perimenopausal women
Smoking is significant risk factor

29
Q

Diagnosis of mammary duct ectasia

A

Triple assessment to exclude breast cancer:
- Clinical assessment
- Imaging
- Histology
Micro-calcifications seen on mammogram (not specific)

May perform:
- Ductography
- Nipple discharge cytology
- Ductoscopy

30
Q

Management of mammary duct ectasia

A

May resolve without treatment
Not associated with increased risk of cancer

Reassurance
Symptomatic management of mastalgia
Antibiotics if required
Surgical excision of duct if necessary

31
Q

What is an intraductal papilloma

A

Warty lesion
Grows within one of the ducts of the breast
Due to proliferation of epithelial cells
Benign tumour, but can be associated with atypical hyperplasia or breast cancer

32
Q

Presentation of intraductal papillomas

A

Most commonly occur between 35-55 years
Often asymptomatic
Nipple discharge: clear or blood-stained
Tenderness or pain
Palpable lump

33
Q

Management of intraductal papilloma

A

Complete surgical excision
Examine for atypical hyperplasia or cancer that may not have been picked up on the biopsy

34
Q

Risk factors for breast cancer

A

Female
Increased oestrogen exposure i.e. earlier menarche, later menopause
More dense breast tissue
Obesity
Smoking
FHx (first-degree relatives)

Small increased risk with COCP (returns to normal 10 years after stopping)
HRT (especially combined)

35
Q

BRC gene mutations

A

BRCA1 - found on chromosome 17
- 70% breast cancer by aged 80
- 50% ovarian cancer
- Increased bowel + prostate cancer risk
BRCA2 - found on chromosome 13
- 60% breast cancer by aged 80
- 20% ovarian cancer

36
Q

Breast cancer screening

A

Mammogram
Every 3 years (annually if higher risk, potentially starting aged 30)
Women aged 50-70 years old

37
Q

Screening post-breast cancer

A

Annual mammograms for 5 years following treatment, then resumption of normal screening (if appropriate)

38
Q

What features of a family history are particularly concerning for breast cancer

A

1st degree relative with breast cancer <40
1st degree male relative with breast cancer
1st degree relative with bilateral breast cancer, first diagnosed <50
Two 1st degree relatives with breast cancer

39
Q

Common mestasis sites for breast cancer

A

2Ls + 2Bs
Lung
Liver
Bones
Brain
Can spread anywhere

40
Q

Indications for wide local excision of breast cancer

A

Solitary lesion
Peripheral tumour
Small lesion in large breast
Ductal carcinoma in situ <4cm

41
Q

Indications for mastectomy for breast cancer

A

Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm

42
Q

Screening in patients treated for breast cancer

A

Annual surveillance mammograms
For 5 years
Done for longer if not yet old enough for regular breast screening programme

43
Q

Tumour marker associated with breast cancer

A

CA 15-3

44
Q

Common metastasis sites for breast cancer

A

Lungs
Liver
Bones
Brain

NB: can spread to any region of the body

45
Q

Non-invasive breast cancer

A

Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS) - more commonly bilateral, and in pre-menopausal women

Tumour cells have not invaded basement membrane –> may progress to invasive breast cancer

46
Q

Invasive breast cancer

A

Invasive ductal carcinoma = most common type, cancer cells have no particular features under microscope
Invasive lobular carcinoma

Phase 3A Revision (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions