Breast Flashcards
Eczema of breast
Paget’s disease
Painless, firm, freely moveable nodule in breast?
Fibroadenoma
A 25-year-old G1P1 woman presents with complaints of a white, watery nipple discharge for four months. She discontinued breastfeeding six months ago. A white nipple discharge is noted on manual expression. She was sent for a serum prolactin level which was 45 ng/ml (normal below 40 ng/ml). What is the most appropriate next step in the management of this patient?
Obtain fasting prolactin level
- stimulation during exam can increase prolactin levels
- If elevated after fast…
Get TSH and then MRI
Bloody discharge from single breast duct. How dx?
Ductogram
42yo G3P3 breast mass; famhx 1st & 2nd degree relatives w/ breast CA. 2cm dominant breast mass. Mammogram negative. Next step?
Biopsy: either FNA or core
24yo w/ cyclic mastalgia since monarche at 12
Less troublesome when on contraceptives
What contributes to increasing this pain?
Caffeine
Fibrocystic changes assoc w/ cyclic mastalgia (poss hormone related)
Not alcohol, age of menarche
A 54-year-old woman presents with a breast mass she noticed two months ago. She has no family history of breast cancer. On exam, there is a 2 cm mass palpable in the upper outer quadrant of the left breast. There are no other masses noted and no palpable lymphadenopathy. A fine needle aspiration returns bloody fluid and reduces the size of the mass to 1 cm. In addition to obtaining a mammogram, what is the most appropriate next step?
Excisional biopsy
- bloody d/c obligates excisional biopsy to r/o breast CA
Clear d/c w/ mast resolution - reexamine in 2 months to make sure cyst has not recurred.
Normal mammogram does NOT r/o breast CA in presence of bloody d/c
A 23-year-old woman presents with complaints of a bilateral nipple itchy sensation for six months. There is no nipple discharge or dry skin. She reports her nipple appears to be swollen at times and there is an erythematous fine rash. She had breast implants placed five years ago. What is the most likely cause of her symptoms?
Chemical irritants
A 25-year-old G1P1 woman comes to the office due to left breast pain and fever. She is breastfeeding her 2 ½-week-old infant. The symptoms began earlier in the day and are not relieved by acetaminophen. Her vital signs are: blood pressure 120/60; pulse 64; temperature 99.9° F (37.7° C). On exam, she has erythema on the upper outer quadrant of the left breast which is tender to touch. There are no palpable masses. In addition to starting oral antibiotics, what is the most appropriate next step in the management of this patient?
Begin ibuprofen & acetaminophen
- likely puerperal mastitis
- occurs weeks 2-4 after delivery
- mastitis usually treated outpatient
Oral or IV antibiotics based on severity of infection
When do breast U/S?
If suspicion of breast abscess
To differentiate btwn cyst and solid mass
A 25-year-old G1P1 woman who is breastfeeding her 2 ½-week-old comes to the office with left breast pain and fever. The symptoms began earlier today and are not relieved by acetaminophen. She has no known drug allergies. Her vital signs are: blood pressure 120/60; pulse 64; temperature 99.9° F (37.7° C). On exam, there is erythema on the upper outer quadrant of the left breast, which is tender to touch; there are no palpable masses. What is the most appropriate antibiotic therapy for this patient?
Dicloxacillin
- usually staph aureus
- use penicillin-type drug
- if allergic, go to Erythromycin
(azithrymycin, clarithromycin, erythro)A 42-year-old G3P3 woman comes to the office after noticing a breast mass while performing a breast self-exam. She is in good health and has normal menstrual cycles. Physical exam is significant for a 2 cm dominant breast mass. The remainder of the exam is normal. A mammogram obtained today shows no abnormalities. A fine needle aspiration was negative, and the mass persisted. What is the most appropriate next step in the management of this patient?
Excisional biopsy
- possible false negative result from FNA
Normal mammogram does not rule out breast cancer
