BREAST Flashcards
How common are breast abscesses?
a) 1 in 3
b) 1 in 30
c) 1 in 300
d) 1 in 3000
c) 1 in 300
which age group does breast abscesses mostly affect?
child-bearing females
what physiological state can predispose to breast abscesses
breastfeeding
what is the most common cause and organism of breast abscesses?
bacterial infection (s. aureus) causing collection of pus underneath the skin
What breast condition is breast abscess a severe complication of?
Breat mastitis usually of a lactating women
What history and examination would indicate breast abscess?
History of mastitis
Fever and general malaise
A painful, swollen lump in the breast, with redness, heat, and swelling of the overlying skin.
What is the management of breast abscess after confirmation from history and physical examination?
Urgent refferal:
1) Confirmation of the diagnosis (by ultrasound).
2) Drainage of the abscess (by ultrasound-guided needle aspiration or surgical drainage).
3) Culture of fluid from the abscess (which will be used to guide the choice of antibiotic).
name a complication for breast abscesses
can be pre-malignant
what antibiotics would you commonly give for
a) Lactating breast mastitis
b) Non lactating breat bastitis
+ analgesia and bath in warm water to relieve pain
a) 10-14 days of flucloxacillin ( cla/erythromycin is alternative)
b) Co Amoxiclav 10-14 days ( Cla/erythromycin + metrionadazole )
what antibiotics would you give for a MRSA breast abscess
clindamycin
trimethroprim
what proportion of all female cancers is breast carcinoma?
a) 1/100
b) 1/3
c) 1/50
d) 1/10
b) 1/3
among which group is breast carcinoma the most common cancer?
non-smokers
name 5 risk factors for breast carcinoma
female Previous breast cancer age >50 late age for first pregnancy >30 early menarche <13 Late menopauce >51 COCP/HRT family history obesity radiation Absent breast feeding Mastitis is severe or recurrent.
Which of these is not a genetic mutation/syndrome responsible for breast cancer?
a) BRCA1/2
b) li Fraumeni
c) Cowden’s
d) familial hyperlipidaemia
e) TP53 mutation
d) familial hyperlipidaemia
what is HER2 ?
proto-oncogene
what is an acquired HER2 mutation associated with in terms of breast carcinoma?
worse outcome
how are HER2 mutations treated?
herceptin
what type of breast carcinoma is most common?
adenocarcinomas - ductal
name 4 symptoms that may be present with breast carcinoma
tethering dippling ulceration New palpable mass (lumo) Discharge from nipple = blood stained Unilateral breast stize peau d'orange Rash around nipple Eczema = Paget disease No pain
what is the triple assessment for breast cancer?
palpation
imaging (mammography/US/MRI)
needle aspiration cytology
which receptor status brings the best prognosis in breast cancer?
a) oestrogen positive, progesterone positive
b) oestrogen positive, progesterone negative
c) oestrogen negative, progesterone negative
c) oestrogen negative, progesterone positive
a) both positive
why would radiotherapy be given in breast cancer?
reduce recurrence
why would chemo be given in breast cancer?
high risk cases
what is tamoxifen?
oesterogen supressor
when is tamoxifen used?
oestrogen receptive cancer= it suppresses the receptors and prevent proliferative actions
name 2 drugs that can be used in post-menopausal women to reduce circulating oestrogen
anastrozole
letrozole
exemestane
which 3 places do breast cancers commonly metastasise
lungs
liver
bone
how many diagnosed breast cancer patients have NO evidence of nodal mets?
a) 5%
b) 20%
c) 50%
d) 80%
b) 20%
what type of women do ductal papillomas normally affect?
a) young 20s
b) middle aged
c) post-menopausal
d) elderly
b) middle aged
is breast ductal papilloma more or less common than fibroadenoma?
less
where does breast ductal papilloma occur?
large ducts
what feature might you see in the nipple discharge of a patient with breast ductal papilloma
clear or blood stained discharge
name an observable feature of breast ductal papilloma during investigation
palpable mass= Either one large lump near nipple
or
Lots of small lumps away from the nipple
what is microdochectomy and when is it used?
removal of affected duct in ductal papilloma
what is Hadfield’s procedure and when is it used?
removal of all ducts in breast in ductal papilloma
name a complication for duct papilloma
Generally non pre malignant
Unless contain atypical cells then slight increase in risk of developing breast cancer = as you have atypical hyperplasia
how many women of childbearing age are affected by fibrocystic disease of the breast?
a) 5%
b) 20%
c) 50%
d) 80%
c) 50%
how would you describe fibrocystic disease to a layman?
non-cancerous breast lump
how is the texture of the breast described in fibrocystic disease?
lumpy/cobblestone
describe 3 features of a fibrocystic breast lump and potential symptoms patient might have?
a) smooth, defined edges, free moving
b) Aching, tenderness thickening and breast pain especially in the affected area.
where in the breast are fibrocystic lumps most commonly found?
upper outer quadrant
how is fibrocystic disease affected by women’s hormonal cycle?
follows menstrual cycle- peaks just before period
subsides after menopause
is breast fibrocystic disease likely to increase risk of breast cancer?
no, unless family history already exists
What is mastitis?
A condition that causes breast pain and swelling (inflammation), and usually affects women who are breastfeeding.
Where does lactation abscesscommonly occur?
A lactational abscess is usually located in the peripheral region of the breast, more commonly in the upper and outer quadrant.
When does a patient a with lactation mastitis have there breast milk sampled for microsopy, culture and antibiotic sensitivity?
Mastitis is reccurent or severe
Hospital acquired infection is liekly
There is a deep burning breast pain ( ductal infection)
What is Li-Fraumeni Syndrome?
rare inherited genetic cancer disorder that greatly increases one’s risk of developing cancer during their lifetime
What is Cowden syndrome?
It is a rare autosomal dominant inherited disorder characterized by multiple non-cancerous tumor-like growths called hamartomas= Increase the chance of breast cancer
Where is HER2 normally found?
It is found on the surface of normal breast cells.
What is the function of HER2 and what is the name for high levels of the protein?
Extra number of HER2 stimulates growth and differentiation of breast cancer
In this stage it is called= HER2 positive breast cancer.
What is the staging of breast cancer?
Stage 0= Non invasive breast cancer= for example ductal carcinoma in situ
Stage 1= Cancer cells have brocken through the breast tissue and starting to invade the surrounding tissue
Stage 2= Further invasion of surrounding tissue and tumour growth of less than <5cm
Stage 3= Further growth and lymph involvement
Stage 4= Mets
what is a very common benign breast conidtion in young females?
• Fibroadenoma
When is MRI used for breast screening?
When you have high risk of breast cancer due to bRCA genes
Lobular breast cancer
What is the advantage of mamogram screening?
Can look at the whole breast
Eczema like rash on the breast can be a indication of what condition?
Paget disease of breast
What does paget disease of the breast indicate?
is often associated with an underlying in-situ or invasive carcinoma of the breast
What is breat ductal papilloma?
Benign epithelial tumor growth in the breast
How do you diagnose breast ductal papilloma?
Triple assessment
palpation
imaging (mammography/US/MRI)
needle aspiration cytology
What history would be indicative of breast mastitis?
A painful breast.
Fever and/or general malaise.
A tender, red, swollen, and hard area of the breast, usually in a wedge-shaped distribution.
When is it more likely for a mastitis to be infected?
If they have nipple fissure or are lactating?
What is the advice for a breast feeding patient if they have mastitis or breast abscess?
To keep breast feeding
What is HER2?
Human epidermal growth factor
