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Medicine > Breast > Flashcards

Breast Flashcards

1
Q

fibroadenoma

A

30-40 years old, asymptomatic, incidental finding, discrete, non-tender, highly mobile, smooth, rubbery, common

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2
Q

<30 years old, asymptomatic, incidental finding, discrete, non-tender, highly mobile, smooth, rubbery, common

A

fibroadenoma

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3
Q

fibroadenosis aka

A

fibrocystic DZ, benign mamary dysplasia

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4
Q

fibrocystic DZ, benign mamary dysplasia aka

A

fibroadenosis

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5
Q

fibroadenosis/fibrocystic DZ/benign mamary dysplasia

A

middle ages, lumpy, painful, worse pre-menstruation, rubbery, well-circumscribed, mobile

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6
Q

middle ages, lumpy, painful, worse pre-menstruation, rubbery, well-circumscribed, mobile

A

fibroadenosis/fibrocystic DZ/benign mamary dysplasia

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7
Q

paget’s disease of the breast

A

intraductal carcinoma associated with retracting + thickening of nipple/areola, may resemble eczematous change, most commonly associated with high grade DCIS

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8
Q

intraductal carcinoma associated with retracting + thickening of nipple/areola, may resemble eczematous change

A

paget’s disease of the breast

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9
Q

breast cancer features O/E

A

hard, irregular, nipple inversion, skin tethering

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10
Q

hard, irregular, nipple inversion, skin tethering

A

breast cancer

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11
Q

mammary duct ectasia

A

dilation of large breast ducts (ageing process), menopause/>50 years old, tender lump around areola, +/- thick green nipple discharge (single or multiple ducts), rupture –> local infection (plasma cell mastitis)

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12
Q

dilation of large breast ducts, menopause/>50 years old, tender lump around areola, +/- thick green nipple discharge (single or multiple ducts)

A

mammary duct ectasia

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13
Q

plasma cell mastitis

A

rupture of mamarry duct ectasia –> local infection

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14
Q

rupture of mamarry duct ectasia –> local infection

A

plasma cell mastitis

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15
Q

duct papilloma aka

A

intraductal papilloma

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16
Q

intraductal papilloma aka

A

duct papilloma

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17
Q

duct papilloma/intraductal papilloma

A

local areas of epithelial proliferation in large mammary ducts, hyperplastic lesions (not malignant), clear/blood stained discharge (single duct), sm mass, not always palpable

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18
Q

clear/blood stained discharge (single duct)

A

duct papilloma/intraductal papilloma

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19
Q

fat necrosis

A

obese, large breasts, trivial/unnoticed trauma, firm, round, hard, irregular, rare, may mimic breast cancer

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20
Q

obese, large breasts, trivial/unnoticed trauma, firm, round, hard, irregular, rare, may mimic breast cancer

A

fat necrosis

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21
Q

breast abscess

A

lactating, red, hard, swollen, tender, pain, fever, rapid enlargement, breast fluctuance, associated mastitis

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22
Q

lactating, red, hard, swollen, tender, pain, fever, rapid enlargement, breast fluctuance, associated mastitis

A

breast abscess

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23
Q

inflammatory breast cancer

A

progressive, erythema, oedema in absence of infection

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24
Q

progressive, erythema, oedema in absence of infection

A

inflammatory breast cancer

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25
Q

periductal mastitis

A

inflammation, abscess, mamary duct fistula, smoking

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26
Q

inflammation, abscess, mamary duct fistula, smoking

A

periductal mastitis

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27
Q

periductal mastitis management

A

antibiotics, incision + drainage

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28
Q

galactocoele

A

recently stopped breastfeeding, occlusion of lactiform duct, build up of milk –> cystic lesion, painless, nil systemic illness

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29
Q

recently stopped breastfeeding, cystic lesion, painless, nil systemic illness

A

galactocoele

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30
Q

breast lump DD

A

fibroadenoma, fibrocystic breast, fat necrosis, intraductal papilloma, breast abscess, atypical ductal hyperphasia/atypical lobular hyperplasia, invasive breast DZ, ductal carcinoma in situ, phylloides tumour, adenoma, radial scar

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31
Q

breast pain DD

A

cyclical hormonal changes, HRT, COCP, large pendulous breasts, smoking, ductal ectasia, mastitis, breast abscess, inflammatory breast ca, hidradenitis suppurativa, pregnancy, thrombophlebitis, trauma, macrocysts, prior breast Sx, iatrogenic, referred pain, fibrocystic breast

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32
Q

fibroadenoma investigations

A

mammogram, US, biopsy

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33
Q

fibrocystic breast investigations

A

US, mammogram, breast aspiration

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34
Q

fat necrosis investigations

A

US, mammography, biopsy

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35
Q

breast abscess investigations

A

US, aspiration

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36
Q

atypical ductal hyperplasia (ADH)/atypical lobular hyperplasia (ALH) presentation

A

incidental finding, rarely presents as mass

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37
Q

atypical ductal hyperplasia (ADH)/atypical lobular hyperplasia (ALH) investigations

A

mammogram, US, biopsy

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38
Q

invasive breast ca presentation

A

gradual breast enlargement, personal/FH

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39
Q

invasive breast ca O/E

A

hard, fixed mass, nipple inversion, nipple discharge, skin retraction, peau d’orange, lymphadenopathy

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40
Q

invasive breast ca investigations

A

mammography, US, biopsy, MRI, CT CAP, bone scan

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41
Q

ductal carcinoma in situ (DCIS) presentation

A

usually asymptomatic, pre + post menopausal, ux, unifocal, ?clinically palpable, ?microcalcifications

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42
Q

ductal carcinoma in situ (DCIS) O/E

A

mass palpable/not, nipple discharge, breast tenderness, cracking of skin (paget’s)

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43
Q

ductal carcinoma in situ (DCIS) investigations

A

mammography, biopsy

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44
Q

phylloides tumour presentation

A

40-60 y.o., recent onset, rapid breast enlargement, rare

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45
Q

phylloides tumour O/E

A

well deliniated, large breast mass

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46
Q

phylloides tumour investigations

A

mammography, US, biopsy

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47
Q

adenoma presentation

A

painless, slow growing, rare

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48
Q

adenoma O/E

A

well-circumscribed, mobile

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49
Q

adenoma investigations

A

mammogram, US, biopsy

50
Q

lobular carcinoma in situ (LCIS) presentation

A

incidental, rare, premenopausal, bx, multifocal, not clinically/mammographically detectable

51
Q

lobular carcinoma in situ (LCIS) O/E

A

rarely presents as a palpable mass

52
Q

lobular carcinoma in situ (LCIS) investigations

A

mammography, US, biopsy

53
Q

hard, fixed mass, nipple inversion, nipple discharge, skin retraction, peau d’orange, lymphadenopathy

A

invasive breast ca O/E

54
Q

gradual breast enlargement, personal/FH

A

invasive breast ca presentation

55
Q

mass palpable/not, nipple discharge, breast tenderness, cracking of skin (paget’s)

A

DCIS O/E

56
Q

40-60 y.o., recent onset, rapid breast enlargement, rare

A

phylloides tumour presentation

57
Q

well deliniated, large breast mass

A

phylloides tumour O/E

58
Q

painless, slow growing, rare

A

adenoma presentation

59
Q

ductal ectasia is

A

distension of the subareolar ducts due to inflammation

60
Q

ductal ectasia preentation

A

fever, acute local pain, tenderness

61
Q

mastitis presentation

A

lactating females, first 1/12 postpartum, pain, swelling, erythema

62
Q

referred pain to the breast from

A

chest wall: pec major, costochondritis, ribs, arthritis

spinal/paraspinal DZ: m spasms, impingements,

63
Q

breast ca breast changes to look out for

A

change in size/shape, lump/thickening in breast/axilla, change in skin texture, redness/rash, nipple change, nipple discharge, breast/axilla pain

64
Q

one stop breast clinic/triple assessment

A

Hx, O/E, mamography/US, FNA/biopsy

65
Q

breast ca risk factors

A

FH, female, age, early menarche, late menopause, atypical hyperplasia, unopposed oestrogen, obesity, late first pregnancy, nulliparity, not breastfeeding, COCP, HRT, inactivity, EtOH, radiation exposure

66
Q

grading of breast ca physical examination/mammography/US/biopsy etc

A 
1 - N
2 - benign
3 - probably benign
4 - probably malignant
5 - malignant
67
Q

mammography vs US

A

US for women <40 y.o.

68
Q

views for mammography

A

MLO (medial lateral oblique), CC (craniocaudal)

69
Q

signs on mammogram that indicate malignancy

A

irregular, spiculated high density, microcalcification

70
Q

FNA vs biopsy

A

FNA less invasive, if suspect benign DZ (nipple discharge, LN)
biopsy if suspect malignancy, under LA, leaves scar

71
Q

breast ca screening programme

A

47-73 y.o. females, 3 yearly mammogram

72
Q

high risk females for breast ca criteria

A

genetic predisposition, sig FH, Hx of supradiaphragmatic radiation

73
Q

high breast ca risk females receive mammography

A

annually

74
Q

types of breast ca

A

ductal vs lobular, invasive vs in situ, grade I, II, III, ER+, PR+, HER2

75
Q

T staging for breast ca

A 
T1 = in situ
T2 = <5cm
T3 = >5cm
T4 = spread
76
Q

management of breast ca

A

Sx, radiotherapy, chemotherapy, hormonal therapy, HER2 targeted therapy, bisphosphonates

77
Q

sentinal LN

A

is the first draining LN from the affected organ

78
Q

identification of the sentinal LN in breast ca Sx

A

radioactive isotope, pigmented dye

79
Q

breast ca surgery techniques

A

wide local excision, therapeutic mammoplasty, mastectomy

80
Q

indications for wide local excision in the management of breast ca

A

small singular lesion, large breasts, peripheral lesion

81
Q

indications for mastectomy in the management of breast ca

A

large lesion, multifocal, small breasts, central lesion, patient choice

82
Q

usually asymptomatic, pre + post menopausal, ux, unifocal, ?clinically palpable, ?microcalcifications

A

DCIS presentation

83
Q

incidental, rare, premenopausal, bx, multifocal, not clinically/mammographically detectable

A

LCIS presentation

84
Q

in situ vs invasive carcinoma in breast ca

A

invasive means that it has breached the BM

85
Q

spread of invasive breast ca

A

direct (overlying skin, underlying m), lymphatic (axillary, other LN groups), blood (L, liver, bone, brain)

86
Q

grade used for breast ca

A

modified Bloom + Richardson

87
Q

modified Bloom + Richardson

A

used to grade breast ca

88
Q

bx, sm V, pale/colourless nipple discharge, teenager is most likely due to

A

hormonal changes

89
Q

green nipple discharge

A

ectasia

90
Q

blood stained discharge

A

duct papilloma

91
Q

breast cyst

A

common, smooth, discrete lump, ?fluctuant, halo sign on mammography

92
Q

breast cyst management

A

aspirate, excision

93
Q

sclerosing adenosis

A

breast lump/pain, mammographic changes mimic carcinoma

94
Q

breast lump Hx

A

when notice lump, how notice, change, pain, changes with cyclical change, previous personal Hx, FH (breast + ovarian ca)

95
Q

nipple discharge Hx

A

ux vs bx, spontaneous, colour, breast feeding

96
Q

general breast Hx questions

A

skin changes, nipple changes, weight loss, fever, lethargy, symptoms elsewhere, gland swelling

97
Q

breast examination

A

WIPERQQ, chaperone, cover breasts when not examining, inspection, palpation

98
Q

breast examination inspection positions

A

sitting up, raise arms, hands against hips, lean forwards

99
Q

breast examination inspection looking for

A

skin appearance, colour, discolourations, oedema, erythema, scars, puckering, peau d’orange, blemishes, size of breasts, contour, visible lumps, pulsation, symmetry, nipple inversion, discharge, ulceration

100
Q

breast examination palpation position

A

lie on back with 1 pillow, hand behind head when examining breast

101
Q

breast examination palpation

A

briefly inspect again, start on asymptomatic breast, axillary examination, supraclavicular fossa

102
Q

describing findings of a breast exam - lump location

A

R vs L, use clock face + distance from nipple

103
Q

breast clinical nurse specialist

A

provide continuity of care, improve staffing, ensuring quality of care

104
Q

breast MDT

A

breast care nurse, surgeon, radiologist, pathologist, medical oncologist, clinical oncologist, therapeutic radiographer, research nurse

105
Q

post wide local excision for breast ca managment

A

radiotherapy

106
Q

post mastectomy for breast ca management

A

radiotherapy for T3/4 tumours

107
Q

tamoxifen

A

pre + perimenopausal women only

108
Q

post menopausal women hormonal therapy

A

aromatase inhibitors

109
Q

example of an aromatase inhibitor

A

anastrozole (ER +ve)

110
Q

SE of tamoxifen

A

endometrial ca, VTE, menopausal symptoms

111
Q

herceptin is used in

A

HER2 +ve breast ca

112
Q

herceptin is a

A

biological therapy

113
Q

radiotherapy is used in breast ca when

A

post wide local excision, post mastectomy in T3/4 DZ

114
Q

pre + perimenopausal women only hormonal Rx for breast ca

A

tamoxifen

115
Q

aromatase inhibitors are used for

A

post menopausal women, hormonal breast ca Rx

116
Q

anastrole is an example of

A

aromatase inhibitor (ER +ve)

117
Q

HER2 +ve breast ca biological Rx

A

herceptin

118
Q

mucinous carcinoma

A

grey, gelatinous surface when cut in 1/2

119
Q

eczema of the nipple

A

primarily just affects the areola

120
Q

grey, gelatinous surface when cut in 1/2

A

mucinous carcinoma

121
Q

eczematous rash that primarily just affects the areola

A

eczema of the nipple

Medicine (30 decks)

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