Brainscape's Knowledge GenomeTM

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


See full index

Finals > Breast > Flashcards

Breast Flashcards

1
Q

what is the standard practice to exclude or diagnose breast cancer

A
  • Clinical assessment (history and examination)
  • Imaging (ultrasound or mammography)
  • Histology (fine needle aspiration or core biopsy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical features that may suggest breast cancer

A

-> Lumps that are hard, irregular, painless or fixed in place
-> Lumps may be tethered to the skin or the chest wall
-> Nipple retraction
-> Skin dimpling or oedema (peau d’orange)

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

NICE recommendations for a two week wait referral for suspected breast cancer

A
  • Unexplained breast lump in patients aged 30 or above
  • Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Presentation of a fibroadenoma

A
  • Painless
  • Smooth
  • Round
  • Well circumscribed (well-defined borders)
  • Firm
  • Mobile (moves freely under the skin and above the chest wall)
  • Usually up to 3cm diameter
  • NO increased risk of malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a fibroadenoma and who does it usually affect

A
  • Benign breast tumours of stromal / epithelial breast duct tissue
  • Younger women (20-40) as respond to female hormones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the most common cause of breast lumps and who do they usually affect

A
  • Breast cyst
  • 30-50 yrs
  • Small increased risk of malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of breast cyst

A

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

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

Management of breast cyst

A

Aspiration

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

Presentation of fat necrosis

A
  • History of localised trauma causing degeneration and scarring of fat = benign lump
  • Painless
  • Firm
  • Irregular
  • Fixed in local structures
  • There may be skin dimpling or nipple inversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of fat necrosis

A
  • USS or mammogram and core biopsy to exclude breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of cyclical breast pain

A
  • Wearing a supportive bra
  • NSAIDs
  • Avoiding caffeine
  • Applying heat to the area
  • Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Definition of gynaecomastia

A
  • Abnormal amount of breast tissue in males
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Possible causes of gynaecomastia

A
  • Hormonal imbalance between oestrogen and androgens
  • Hypoprolactinaemia
  • Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What conditions can cause increased oestrogen and in turn gynaecomastial

A
  • Obesity (aromatase is an enzyme found in adipose tissue that converts androgens to oestrogen)
  • Testicular cancer (oestrogen secretion from a Leydig cell tumour)
  • Liver cirrhosis and liver failure
  • Hyperthyroidism
  • Human chorionic gonadotrophin - (hCG) secreting tumour, notably small cell lung cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What conditions can reduce testosterone and in turn cause gynaecomastia

A
  • Testosterone deficiency in older age
  • Hypothalamus or pituitary conditions that reduce LH and FSH levels (e.g., tumours, radiotherapy or surgery)
  • Klinefelter syndrome (XXY sex chromosomes)
  • Orchitis (inflammation of the testicles, e.g., infection with mumps)
  • Testicular damage (e.g., secondary to trauma or torsion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What medications can cause gynaecomastia

A
  • Anabolic steroids (raise oestrogen levels)
  • Antipsychotics (increase prolactin levels)
  • Digoxin (stimulates oestrogen receptors)
  • Spironolactone (inhibits testosterone production and blocks testosterone receptors)
  • Gonadotrophin-releasing hormone (GnRH) agonists (e.g., goserelin used to treat prostate cancer)
  • Opiates (e.g., illicit heroin use)
  • Marijuana
  • Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give 2 treatment options for gynaecomastia

A

Tamoxifen
Surgery

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

what disorders can cause hyperprolactinaemia and in turn galactorrhea

A

-> Idiopathic (no cause can be found)
-> Prolactinomas (hormone-secreting pituitary tumours)
-> Endocrine disorders, particularly hypothyroidism and polycystic ovarian syndrome
-> Medications, particularly dopamine antagonists (i.e., antipsychotic medications)

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

What AD condition can prolactinomas be associated with

A
  • Multiple endocrine neoplasia (MEN) type 1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what 2 mass effects do macroprolactinomas cause

A
  • Headaches
  • Bitemporal haemianopia due to sitting on the optic chiasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the management options of galactorhoea?

A
  • Symptoms : dopamine agonists (bromocriptine/cabergoline)
  • Pituitary tumour : trans-sphenoidal surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is mammary duct ectasia ?

A

Dilation of the large ducts in the breasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentation of mammary duct ectasia

A

Nipple discharge (cheese like)
Tenderness or pain
Nipple retraction (slit like) or inversion
A breast lump (pressure on the lump may produce nipple discharge)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Who does mammary duct ectasia occur most commonly in?

A
  • Perimenopausal women
  • SMOKERS (big RF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Assessing mammary duct ectasia

A

Rule out breast cancer with triple assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is often seen on mammogram in mammary duct ectasia but is not specific to it

A

Microcalcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Clear or blood stained nipple discharge

A

Intraductal papilloma

28
Q

Common presentation of intraductal papilloma

A

~ 35-55 yrs old
~ Nipple discharge (clear/blood-stained)
~ Tenderness or pain
~ Palpable kump

29
Q

Diagnosis of intraductal papilloma

A
  • Triple assessment
  • Ductography may be used = “filling defect”
30
Q

Management of intraductal papilloma

A

Surgical excisions

31
Q

Presentation of mastitis

A
  • Breast pain and tenderness (unilateral)
  • Erythema in a focal area of breast tissue
  • Local warmth and inflammation
  • Nipple discharge
  • Fever
32
Q

Management of mastitis

A
  • 1st : conservative = continued breastfeeding, expressing milk.
  • 2nd : Flucloxacillin (erythromycin if penicllin allergic)
33
Q

Complication and resultant treatment of mastitis

A
  • Breast abscess
  • Incision and drainage
34
Q

what can cause recurrent mastitis

A

Candidal infection of the nipple after a course of antibiotics

35
Q

Presentation of candida of the nipple

A
  • Sore nipples bilaterally, particularly after feeding
  • Nipple tenderness and itching
  • Cracked, flaky or shiny areola
  • Symptoms in the baby, such as white patches in the mouth and on the tongue, or candidal nappy rash
36
Q

Define a breast abscess

A

-> Collection of pus within an area of the breast, usually caused by a bacterial infection. May be :
- Lactational abscess
- Non-lactational absces

37
Q

Key RF for infective mastitis and breast abscess

A

Smoking

38
Q

Most common bacterial causes of infective mastitis / breast abscess

A
  • Staphylococcus aureus (the most common)
  • Streptococcal species
  • Enterococcal species
  • Anaerobic bacteria (such as Bacteroides species and anaerobic streptococci)
39
Q

Presentation of infective mastitis

A
  • Nipple changes
  • Purulent nipple discharge (pus from the nipple)
  • Localised pain
  • Tenderness
  • Warmth
  • Erythema (redness)
  • Hardening of the skin or breast tissue
  • Swelling
40
Q

Key feature suggest breast abscess over infective mastitis

A
  • Swollen, fluctuant, tender lump
41
Q

Management of non-lactational mastitis

A
  • Analgesia
  • Antibiotics (either co-amoxiclav or erythromycin + metronidazole)
    T- reatment for the underlying cause (e.g., eczema or candidal infection)
42
Q

Management of a breast abscess

A
  • Referral to the on-call surgical team in the hospital for management
  • Antibiotics
  • Ultrasound (confirm the diagnosis and exclude other pathology)
  • Drainage (needle aspiration or surgical incision and drainage)
  • Microscopy, culture and sensitivities of the drained fluid
43
Q

RF for breast cancer

A
  • Female
  • BRCA1, BRCA2 genes
  • Increased oestrogen exposure (earlier onset of periods and later menopause)
  • COCP and HRT
  • More dense breast tissue (more glandular tissue)
  • Obesity
  • Smoking
  • First-degree premenopausal relative
44
Q

Explain the genes involved in an increased risk of breast cancer

A
  • BRCA1 on chromosome 17 (70% breast cancer by 80, 50% ovarian cancer)
  • BRCA2 on chromosome 13 (60% breast cancer by 80, 20% ovarian cancer)
45
Q

Give the different types of breast cancer

A
  • Ductal carcinoma in situ
  • Invasive ductal carcinoma
  • Lobular carcinoma in situ
  • Invasive lobular carcino,e
  • Pagets disease of nipple
  • Inflammatory breast cancer
46
Q

Explain breast cancer screening in the UK

A

-> Mammogram every 3 years to women aged 50-70.

47
Q

How does breast screening differ for higher risk women

A
  • Annual mammogram
  • Chemoprevention (Tamoxifen if premenopausal, anastrozole if postmenopausal)
  • Risk reducing bilateral mastectomy or bilateral oophorectomy
48
Q

2 week wait referral for suspected breast cancer

A
  • An unexplained breast lump in patients aged 30 or above
  • Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)
49
Q

Assessment following 2 week wait referral

A
  • Clinical assessment (history and examination)
  • Imaging (ultrasound or mammography)
  • Biopsy (fine needle aspiration or core biopsy)
50
Q

Imaging used in breast cancer

A
  1. USS = younger women
  2. Mammograms = older women, better at picking up calcifications
  3. MRI scans = higher risk women and further assessing features of a tumour
51
Q

What is done in breast cancer surgery if the initial USS does not show any abnormal nodes ?

A

Sentinel lymph node biopsy

52
Q

What 3 types of receptor may be seen in breast cancer ?

A
  • Oestrogen receptors (ER)
  • Progesterone receptors (PR)
  • Human epidermal growth factor (HER2)

Triple negative breast cancer = no cancer cells express any. of these receptors

53
Q

what is gene expressing profiling >

A
  • Assessing which genes are present within breast cancer on histology sample
  • Done for women with early breast cancers that are ER positive but HER2 & lymph node negative
  • Helps guide whether to give additional chemotherapy as predicts the risk of breast cancer recurrence as a distal met
54
Q

Common breast cancer mets

A

L : Lungs
L : Liver
B : Bone
B : Brain

55
Q

Explain the surgical options for breast cancer

A
  1. Breast conserving (coupled with radiotherapy)
  2. Mastectomy
56
Q

5 common SE of radiotherapy

A
  • General fatigue from the radiation
  • Local skin and tissue irritation and swelling
  • Fibrosis of breast tissue
  • Shrinking of breast tissue
  • Long term skin colour changes (usually darker)
57
Q

3 types of chemotherapy scenarios

A
  • Neoadjuvant therapy – intended to shrink the tumour before surgery
  • Adjuvant chemotherapy – given after surgery to reduce recurrence
  • Treatment of metastatic or recurrent breast cancer
58
Q

when can hormone treatment be given for breast cancer ?

A
  • Oestrogen receptor (ER) positive
59
Q

what are the 2 hormonal treatment options for breast cancer and when are they given ?

A

1.Tamoxifen for premenopausal women
2. Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)

60
Q

Method of action of tamoxifen and therefore its SE

A
  • Blocks oestrogen receptor in breast tissue and stimulates them in the uterus and bones
  • Helps prevent osteoporosis BUT increases risk of endometrial cancer
61
Q

Give 3 targeted treatments for women with HER2 positive breast cancer

A
  1. Trastuzumab (Herceptin) is a monoclonal antibody that targets the HER2 receptor.
  2. Pertuzumab (Perjeta) is another monoclonal antibody that targets the HER2 receptor.
  3. Neratinib (Nerlynx) is a tyrosine kinase inhibitor, reducing the growth of breast cancers.
62
Q

SE of herceptin

A
  • Can affect heart function and therefore pots require initial and close monitoring of heart function
63
Q

3 flap reconstruction options following a mastectomy

A
  1. Latissmus Dorsi Flap (Pedicled or free flap)
  2. Transverse Rectus Abdominis Flap (Pedicled or free flap)
  3. Deep Inferior Epigastric Flap (Free flap)
64
Q

Difference between pedicled and free flap in breast reconstruction surgery

A
  • Pedicled : keep original blood supply and move tissue under the skin to new location
  • Free : cutting away the tissue completely and transplanting to a new location
65
Q

Risk of TRAM Flap

A
  • Abdominal hern ia due to weakend abdo wall

Finals (92 decks)

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