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Y3 Surgery > Breast > Flashcards

Breast Flashcards

1
Q

What is assessed during inspection in a breast examination ?

A

Check for any masses, scars or asymmetry
Skin changes or ulceration
Nipple Discharge or inversion
Inspect axillae

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2
Q

What is assessed for in palpation in a breast exam ?

A

Examine each quadrant of breast including axillae tail
Press the breast against the chest wall
Palpate any lumps
Examine both axillae
Assess for lymphadenopathy
Palpate the spine for tenderness, abdomen for hepatomegaly
Percuss and auscultate the lungs

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3
Q

How would you complete a breast exam ?

A

Mammography and / or USS if necessary
Biopsy if necessary

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4
Q

What is galactorrhoea ?

A

Defined as copious bilateral multi-ductal milky discharge not associated with pregnancy or lactation.

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5
Q

What is the physiology of lactation ?

A

It is predominantly regulated by the hormone prolactin which is produced and secreted by the anterior pituitary gland.
Prolactin secretion is controlled by dopamine and released by the hypothalamus acting to inhibit prolactin.

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6
Q

What are some causes of galactorrhoea ?

A

Idiopathic
Pituitary adenoma
Drug induced - SSRI’s, anti-psychotics
Neurological
Hypothyroidism
Renal failure

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7
Q

What are some investigations for galactorrhoea and their results ?

A

Exclude pregnancy
Serum prolactin levels - raised
TFT’s - hypothyroidism
Renal tests
MRI head with contrast

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8
Q

What is the management of galactorrhoea ?

A

Treat underlying cause
Pituitary tumours - dopamine agonist ( Cabergoline and bromocriptine )

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9
Q

What is mastitis ?

A

Inflammation of the breast tissue both acute and chronic.
Most commonly caused by infection - staph aureus

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10
Q

What are the classes of mastitis ?

A

Lactational mastitis
Non-Lactational mastitis

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11
Q

What is a risk factor for non-Lactational mastitis ?

A

Tobacco smoking

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12
Q

What are some clinical features of mastitis ?

A

Tenderness
Swelling
Erythema

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13
Q

What is the management of mastitis ?

A

Simple analgesia and warm compress
For Lactational mastitis continue milk drainage
If symptoms dont improve after 12-24 hours start abx

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14
Q

What is a complication of mastitis and how is it treated ?

A

Breast abscess - needle aspiration

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15
Q

What is a breast cyst ?

A

Epithelial lined fluid filled cavities which form when lobules become distended due to blockage - usually in Perimenopause.

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16
Q

What are the clinical features of breast cysts ?

A

Singularly or with multiple lumps
Distinct smooth masses
Tender

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17
Q

What investigations are performed when suspecting breast cysts ?

A

Mammography - halo shape
Aspiration

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18
Q

What is the management of breast cysts ?

A

No management and resolve by themselves

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19
Q

What are some complications of breast cysts ?

A

Carcinoma
Fibroadenosis

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20
Q

What is mammoth duct ectasia ?

A

Dilation and shortening of the major lactiferous ducts

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21
Q

What are some clinical features of mammary duct ectasia ?

A

Coloured green / yellow nipple discharge
Palpable mass
Nipple retraction

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22
Q

What are some investigations for mammary duct ectasia ?

A

Mammography - dilated calcified ducts
Biopsy

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23
Q

What is the treatment of mammary duct ectasia ?

A

Manage conservatively

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24
Q

What is fat necrosis ?

A

Acute inflammatory response in the breast leading to ischaemic necrosis of fat lobules.

25
What are the clinical features of fat necrosis ?
Asymptomatic or presents as a lump Solid irregular lump if chronic fibrotic changes
26
What are some investigations for fat necrosis ?
Positive traumatic history Hyper echoic mass on USS
27
What is the management of fat necrosis ?
Self limiting Analgesia Reassurance
28
What are some types of benign breast lumps ?
Fibroadenoma Adenoma Papilloma Lipoma Phyllodes tumour
29
What is a Fibroadenoma ?
Common benign growth in the breast Usually occurs in women of reproductive age They are proliferations of stromal and epithelial tissue of the ductal lobules.
30
What is found of examination of Fibroadenomas ?
Highly mobile lesions that are well defined and rubbery
31
What is an adenoma of the breast ?
Benign glandular tumour Nodular and mimic malignancy
32
What are some differences between being and malignant breast lumps ?
Benign - more mobile, smoother borders, single mass Malignant - craggy, firm and fixed, may have multiple lumps
33
What are some investigations for benign lumps ?
Triple assessment - examine, imaging and histology Reassurance and routine check up
34
What is gynaecomastia ?
A condition by which males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity.
35
What is the pathophysiology of physiological gynaecomastia ?
Most commonly occurs in adolescence resulting from delayed testosterone surge relative to oestrogen in puberty.
36
What are some causes of pathological gynaecomastia ?
Lack of testosterone - Klinefelter’s syndrome, androgen insensitivity Increased oestrogen - liver disease, hyperthyroidism and obesity Medication - digoxin, Spironolactone Idiopathic
37
What are some clinical features of gynaecomastia ?
Insidious onset Rubbery or firm mass Starts from under the nipple
38
What investigations should be performed when suspecting gynaecomastia ?
Tests are only necessary if the cause is unknown U&E’s LFTs Hormone profile
39
What is given if gynaecomastia to relieve symptoms ?
Tamoxifen
40
What are the 2 types of breast carcinoma in situ ?
Ductal carcinoma in situ Lobular carcinoma in situ
41
What is ductal carcinoma in situ ?
Malignancy of the ductal tissue of the breast that is contained within the basement membrane.
42
What is seen on mammography in someone with ductal carcinoma in situ ?
Suspicious microcalcifications
43
What is the management of ductal carcinoma in situ ?
Surgical excision - breast conserving surgery or mastectomy
44
What is lobular carcinoma in situ ?
Non-invasive lesion of the secretory lobules of the breast that is contained within the basement membrane.
45
When is lobular carcinoma in situ usually diagnosed ?
Incidental finding on biopsy
46
What is the management of lobular carcinoma in situ ?
Low grade - monitoring If the patient has BRCA1 and BRCA2 genes - bilateral prophylactic mastectomy
47
What are the 2 common types of breast cancer ?
Invasive ductal carcinoma Invasive lobular carcinoma
48
What are some risk factors for breast cancer ?
Female Age Family history - BRCA1 or BRCA2 gene Early menarche, late menopause Nullparity Long term use of HRT Obesity Previous breast disease Alcohol consumption Smoking
49
What are some clinical features of breast cancer
Can be asymptomatic Breast and axillary lump Asymmetry or swelling Abnormal nipple discharge Nipple retraction Skin changes Mastalgia
50
What are some investigations for breast cancer ?
Triple assessment - examine, imaging and histology Surgery, radiotherapy, chemotherapy, hormonal therapy
51
At what age are you invited to the breast cancer screening programme ?
50 -71 mammogram every 3 years
52
When is breast conserving treatment used ?
Localised operable disease with no evidence of metastatic disease Focal smaller cancers
53
What is a mastectomy ?
Removal of all the tissue of the affected breast along with a significant portion of overlying skin.
54
When are hormonal treatment used in treating breast cancer ?
In malignant non-metastatic disease as an adjuvant after surgery
55
How does tamoxifen work ?
It acts through blockade of oestrogen receptors and therefore also has a role in prophylaxis of breast cancer
56
What are some complications of tamoxifen ?
Risk of VTE Increases risk of uterine carcinoma
57
How does immunotherapy work ?
It is used in patients whose cancer express specific growth factor receptors
58
What is herceptin and what does it target ?
It is a monoclonal antibody that targets the human epidermal growth factor receptor ( HER-2 positive malignancies ).

Y3 Surgery (8 decks)

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