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Breast Flashcards

1
Q

What is polythelia?

A

extra nipple

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2
Q

What is polymastia?

A

accessory breast

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3
Q

What is galactrohhea?

A

milky bilateral discharge

POSSIBLE ADR from meds

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4
Q

What is fibrocystic changes?

A

nodular, ropelike
benign
d/t increase caffeine intake

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5
Q

What is the next step when palpating fibrocystic changes?

A

US

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6
Q

What is inverted nipple?

A

depressed below the areolar surface

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7
Q

What is gynecomastia?

A

firm GLANDULAR enlargement - NOT adipose

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8
Q

What is ductal extasia?

A

dilation of the mammary ducts, periductal fibrosis, inflammation

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9
Q

What is mastitis?

A

infxn of the breast tissue

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10
Q

Nursing mom has a fever? -ddx?

A

mastitis

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11
Q

Nonlactating women that has sudden onset of mastitis?

A

suspect cancer

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12
Q

Average risk for screening?

A

annual mammogram @ 40yo

encourage self exam

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13
Q

High risk pts for screening?

A 
family hx
radiation
etoh
obesity
immunosppressant therapy
hormone replacement therapy
early onset of menses
null parity (no children) or late first birth (>30yo)
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14
Q

What family hx can cx high risk?

A

1st degree relative
breast OR ovarian cancer
include both maternal and paternal

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15
Q

Pt has Crohn’s dz - average or high risk?

A

high risk

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16
Q

Pt’s mother died at 35yo of age - when does daughter start screening?

A

25yo

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17
Q

What imaging is available?

A

1) US or microcalcificatinos w/ sterotactic bx

2) bx

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18
Q

Why is US guided bx better?

A

pt is comfortable

able to evaluate axillary nodes

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19
Q

What is concordance?

A

what you expect from what you see is what the dx is

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20
Q

What is the controversy re: screening?

A

whether to continue screening after 50yo

whether to use mammogram to screen

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21
Q

What is oregon dense breast law?

A

if you have dense breast –> get a letter to get screened d/t high risk of breast cancer

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22
Q

What is breast cyst?

A

fluid filled
round and mobile
influenced by hormonal fxn

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23
Q

When do you have to FNA-breast cyst?

A

> 2cm

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24
Q

When do you excise breast cyst?

A

3rd recurrence

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25
What is usually associated with breast cyst?
axillary and sebaceous gland
26
Can breast cyst disappear?
yes but can come up again | must excise after 3rd recurrence
27
What is fibroadenomas?
benign tumors | involves glandular and fibrous tissue
28
What is the age range for fibroadenomas?
15-35yo
29
When to excise fibroadenomas?
if childbearing age b/c it can grow during pregnancy and can get painful if old/post menopause - don't excise
30
PE on fibroadenomas - next step?
NON tender mass | 1) US 2) bx
31
What is phyllodes tumor?
LARGE and FAST GROWING fibroadenomas - MUST excise
32
What are the types of breast abscess?
lactational | non lactional
33
Pt has DM, smokes, and has high BMI?
non lactional breast abscess
34
TENDER, palpable mass + fever, malaise?
breast abscess
35
How to tx breast abscess?
I&D + abx | culture bug
36
What bug for breast abscess?
s aures
37
Breast abscess + retracted nipple + suareolar abscess -tx?
I&D + abx + flagyl
38
What is papilloma?
intraductal growth made up of stroma
39
Bloody discharge?
papilloma | culture b/c it may be cancerous
40
Benign discharge vs cancer?
benign: blue-green/milky cancer: clear/bloody
41
What breast cancer can have skin involvement?
paget dz
42
What is peau d orange?
looks like orange peel on breasts - be on the lookout for cancer
43
Flaky, burnig, itching of the nipple?
paget dz
44
What is paget dz associated with?
Ductal carcinoma in situ
45
How to tx paget dz?
mastectomy
46
What is paget dz?
infiltrative, intraductal in nipple and ducts of nipple
47
What are the benign lesions that can increase risk of cancer?
atypical ductal hyperplasia atypia + sclerosing adenosis radial scar lobar carcinoma in situ
48
What to do w/ the benign lesions?
surgical excision bx
49
What are the classic cancer lesions?
single lesion hard non mobile irregular borders
50
What are the different molecular profiles for cancer?
recurrence risk score NCCN guidelines mammaprint
51
Recurrence risk score - low, intermediate, high?
low - endocrine therapy only inter - +/-chemo high - chemo
52
NCCN guidelines used when?
hormone positive early stages node negative
53
Mammaprint - low, high risk?
low - no chemo | high - yes chemo
54
In situ - tx?
stage 0 | NO chemo
55
What are the two invasive cancer?
ductal | lobular cancer
56
Which is seen on mammography (invasive)?
ductal - seen | lobular - not seen; can cx increased contralateral risk
57
What are hormone positive?
the tumor is feeding off the estrogen and progesterone --> able to tx w/ hormone supressors
58
What is HER 2 neu positive?
there is too much HER 2 epidermal growth factor receptor
59
What is the prob of HER 2 neu positive?
the GENE of the tumor, NOT gene of the patient
60
Tx for HER 2 neu positive?
herceptin/trastuzamab + perjeta
61
How to stage cancer?
tumor size nodes metastasis
62
How to stage tumor size?
stage 1 - 5cm
63
How to stage nodes?
number of nodes and location
64
How is metastasis staged?
STAGE 4 AUTOMATIC + skin involvement
65
How to tx breast cancer?
chemo + radiation IF lumpectomy | chemo THEN mastectomy, NO radiation
66
When is lumpectomy used?
small lesions
67
F/u for lumpectomy?
Q 6mo for 2 yrs
68
When is mastectomy used?
large lesions: small breast + >5cm tumor multifocal disease: 1+ tumor young age: NCAA --> bilateral mastectomy to decrease reoccurence family hx
69
F/u for mastectomy?
chest wall exam
70
What are complications for surgical management?
infxn from staph
71
How to tx staph infxn complication?
cephalexin 500 QID or clinndamycin 300 mg TID +/-culture
72
What are the different radiation?
external beam | brachytherapy
73
External beam radiation ADR?
erythema fatigue tissue changes
74
When is brachytherapy used?
smaller lesions good prognostic features older
75
What is brachytherapy?
inserting balloon during surgery
76
65yo female with 2cm tumor - what type of radiation is ideal?
brachytherapy
77
What are complications of radiation?
erythema --> aloe skin breakdown --> delay in tx damage in organs ie) pneumonitis, scarring tissue edema/contracture --> vit E secondary malignancy --> angiosarcoma can occur
78
What are systemic/chemo complications?
chemotherapy --> neutropenic fever, neuropathy, fatigue, chemo brain Tamoxifen --> uterine cancer Aromotase inhibitor --> osteoporosis
79
What is recommended for survivors?
low fat diet exercise 30min/daily acupuncture psychosocial suppor
80
When to do breast exam?
5-7days AFTER menstruation
81
What does patient do while you inspect during breast exam?
arms at side arms over head hands on hip - flex to pectoralis muscles are bulging and breast tissue pushes off the chest wall leaning forward to check asymmetry of breast/nipple
82
What to check for on inspection?
``` dimples asymmetry skin changes nipple masses ```
83
What position should patient be in when palpating axilla vs breast - breast exam?
axilla - prone | breast - supine
84
What is the most important thing during palpation on breast exam?
cover all areas of the tissue
85
How to palpate breast?
rule of 3: 3 fingerpads 3min/breast
86
What are you checking for on palpation during breast exam?
consistency nodules - location, tenderness, mobility spontaneous discharge
87
What to check for in male breast?
nipple, areola
88
What is the breast cancer screening tool of choice for a high risk female patient under the age of 35?
US/MRI

Women's Health (10 decks)

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