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General Surgery > Breast > Flashcards

Breast Flashcards

1
Q

What 5 symptoms of breast disease are red flags and need urgent attention?

A 
A new discrete lump
Nipple discharge - blood stained, unilateral or persistent 
Nipple retraction or distortion
altered breast contour or dimpling 
Suspected pagets disease
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2
Q

What can cause blood stained discharge from the nipple?

A

Duct papilloma
Intraduct carcinoma
Pagets disease
Invasive carcinoma

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3
Q

What can cause non cyclical breast pain?

A

Abscess
Carcinoma
Tietze’s syndrome - chondritis of the costal cartilage
Chest wall lesions such as herpes zoster

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4
Q

What medications can help with cyclical breast pain?

A

Gamma - linolenic acid
danazol
Tanoxifen
LHRH analogues

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5
Q

What is duct ectasia?

A

Involutional change in the ducts associated with the menopause. The terminal ducts become dilated and angorged with secretions . Seondary infection can lead to retroareolar absecess and fibrosis may result in nipple retraction

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6
Q

Painless irregular firm lump in the breast with a history of trauma

A

fat necrosis

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7
Q

How would you investigate a painless irregular firm lump in the breast with a history of trauma?

A

Ultrasound

Core biopsy

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8
Q

What organism most commonly causes acute bacterial mastitis?

A

Staph aureus (this infection most commonly occurs during lactation)

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9
Q

What antibiotics are used for mastitis?

A

Flucloxacillin or clindamycin (if not improving after 12 - 24 hours) for 7 - 10 days

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10
Q

How do you treat a breast abscess?

A

Drain pus and send for culture

Flucloxacillin + Clindamycin for 7 - 10 days

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11
Q

What is periductal mastitis?

A

An inflammatory proces sthan occurs around the dilated milk dutcs near the nipple. It occurs in pre menopausal woman

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12
Q

When are breast cysts most common?

A

Perimenopause (rare after the menopause

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13
Q

Short history of a painful, tender sweilling that fluctuates in size

A

Breast cyst

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14
Q

How owuld you investigate and treat a suspected breast cyst?

A

Ultrasound

Aspiration +/- cytology

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15
Q

What is a fibroadenoma?

A

Lumps that arise from an entire lobule and have both stromal and epithelila components

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16
Q

What is a breats hamartoma?

A

A lump that is a welld efined capsule that apear to be a ‘breast within the breast’ as theuy are a mix of breast lobules, stroma and fat

17
Q

What are some causes of gynocomastia?

A 
Drugs - digoxin, spironolactone, cimetidine, oestrogens or androgens
Liver cirrhosis 
Renal failure
Hypogonadism 
Suprrenal tumours
Testicular tumours
idiopathic
18
Q

What cells do phyllodes tumours arise from?

A

Stromal cells - classified as low, medium or high grade depending on their characteristics

19
Q

How are phyllodes tumours treated?

A

Wide exision

May need mastectomy with immediate reconstruction

20
Q

What is your lifetime risk of developing breast cancer if you have a premenopausal first degree relative with breast cancer?

A

25%

21
Q

What is your lifetime risk of developing breast cancer if you have a premenopausal first degree relative with breast cancer?

A

14%

22
Q

What is the inheritence pattern of BRCA1 and BRCA2?

A

Autosmal dominant

23
Q

What is your risk of breast cancer if you have a BRCA1 or 2 gene?

A

80 - 90%

24
Q

What does breasr cancer in situ mean?

A

the cancer has not penetrated the basement membrane

25
Q

What is ductal carcinoma in situ?

A

Arises within the duct epithelium and is completely retained within the ducts
Most common type of non invasive breast cancer
Generally invasive and found on a mammogram with microcalcification. Treatment is usually with excision

26
Q

What is lobular carcinoma in situ?

A

Arises within the lobular epithelium. It is a marker of icnreased risk of breast cancer. An incidental finding on biopsy requires no surgery but if it is found on a core biopsy of ana rea of calcification it may be associated with invasive lobular carcinom and should be treated.

27
Q

How does invasive lobular carcinom tend to present?

A

Area of thickening - tends to present late

28
Q

What prognostic factors are important in breast cancer?

A

Axilalry node spread
Tumour size
Tumour grade
Nottingham prognostic index

29
Q

How do you calculate the nottingham prognositc index?

A

Tumour size x 0.2 + Lymph node score + Grade

30
Q

What is inflammatory breast cancer?

A

A rare but rapidly progressive for, of breastcancer caused by ostructionof lymph drainage causing erythem and oedema. It is usually a primary cancer and is manged with neo adjuvant chemotherapy firast like followed by total mastectomy +/- radotherapy

31
Q

What are the signs and symptoms of inflammatory breast cancer?

A

Progressive erythem and oedeam of the breastin the abseence of signs of infection such as fever, discharge or elevated WCC. The CA 15 - 3 will be elevated

General Surgery (10 decks)

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