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MedEd Lectures > Breast > Flashcards

Breast Flashcards

1
Q

Define (lactational) acute mastitis

A

Acute inflammation of breasr tissue

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2
Q

What is the aetiology/risk factors for (lactational) acute mastitis

A
  1. Cause: Staph aureus (usually)
  2. Post-partum, breastfeeding patient
    ‘puerpural’ = pregnancy-related
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3
Q

What is the clinical features of (lactational) acute mastitis

A
  1. Painful, erythematous swelling of the breast

2. Skin is ‘hot to touch’

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4
Q

What is the management for (lactational) acute mastitis

A

Antibiotics

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5
Q

What are the complications of (lactational) acute mastitis

A
  1. Abscesses
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6
Q

Define periductal mastitis

A

inflammation around dilated milk ducts

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7
Q

What is the aetiology/risk factors for periductal mastitis

A
  1. Smoker

2. Non-lactating young woman (30 years)

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8
Q

What are the clinical features of periductal mastitis

A
  1. Painful, erythematous subareolar mass

2. inverted nipple

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9
Q

What is the management for periductal mastitis

A
  1. Antibiotics

2. Stop smoking

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10
Q

What are the complications for periductal mastitis

A
  1. Abscesses
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11
Q

Define breast abscess

A

collection of pus in the breast

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12
Q

What are the clinical features of breast abscess

A
  1. febrile patient

2. Painful, erythematous lump near nipple

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13
Q

What is the management for breast abscess

A
  1. Aspirate (FNA)
    OR
  2. Surgical drainage
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14
Q

Define fibroadenoma

A

benign neoplasm of a lobule arising from stroma (‘fibro’) and glandular epithelium (‘adenoma’)

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15
Q

What is the aetiology/risk factors of fibroadenoma

A
  1. Young women - aged 20-30 years old
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16
Q

What are the clinical features of fibroadenoma

A
  1. breast mouse

2. Painless, smooth, well circumscribed, mobile mass

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17
Q

What is the management for fibroadenoma

A
  1. Observe. Excision if in doubt
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18
Q

What is the prognosis for fibroadenoma

A
  1. most regress
  2. some stay the same
  3. some may enlarge ( lead to excision)
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19
Q

Define breast cyst

A

fluid-filled cavity in the breast

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20
Q

What are the risk factors for breast cyst

A
  1. peri-menopausal women

2.

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21
Q

What are the risk factors for breast cyst

A
  1. peri-menopausal women (around 40-50)
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22
Q

What are the clinical features for breast cyst

A
  1. fluctuant, distinct round mass

2. Often tender (painful)

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23
Q

What is the management for a breast cyst

A

May resolve naturally or Aspirate (FNA)

- aspirate is usually clear/green/brown/yellow

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24
Q

What are the buzzwords for breast cysts

A
  1. Fluctuant

2. Tender

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25
Q

Define Duct ectasia

A

Dilation of ducts due to blockage. clogging of lactiferous ducts

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26
Q

What are the risk factors for duct ectasia

A
  1. peri- or post-menopausal women 50-60 y/o
27
Q

What are the clinical feature s of duct ectasia

A
  1. Can appear similar to cancer (so exclude)
  2. Nipple retraction/slit-like nipple
  3. Cheesy, thick discharge (white/green/yellow)
  4. subareolar mass
  5. Micro-calcification on imaging
28
Q

What is the management for duct estasia

A
  1. reassure and discharge

2. surgical duct excision if mass present

29
Q

What are the buzz words for duct ectasia

A
  1. Cheesy thick white/green nipple

2. slit-like nipple

30
Q

Define ductal carcinoma in-situ

A

Ductal carcinoma that has yet to invade the basement membrane

31
Q

what are the risk factors for breast cancer (including ductal carcinoma in-situ

A
  1. previous Hx (breast, ovarian Ca)
  2. FHx (which may include mutations in BRCA 1 and 2 genes)
  3. Irradiation to chest wall (for example in the treatment of Hodgkins lymphoma)
  4. Increased exposure to oestrogen:
    - early menarche <13 years
    - Late menopause >51 years
    - nulliparity
    - Not breast-feeding
    - HRT
    - OCP
    - obesity
32
Q

What are the clinical features of ductal carcinoma in-situ

A
  1. impalpable (no lump)

2. micro-calcification on imaging (mammography)

33
Q

What is the management for ductal carcinoma in-situ

A
  1. surgery (lumpectomy) + radiotherapy
34
Q

What are the buzzwords for ductal carcinoma in-situ

A
  1. Micro-calcification

2. Impalpable

35
Q

What are the 2 types of invasive breast cancer

A
  1. infiltrative ductal carcinoma (75%))

2. infiltrative lobular carcinoma

36
Q

What are the clinical features of breast cancer

A
  1. painless, immobile, irregular and hard lump
  2. Axillary lymphadenopathy
  3. Skin changes e.g. Peau d’orange, skin dimpling, nipple retraction, clear/bloody discharge from the nipple
37
Q

What is the management of invasive breast cancer

38
Q

What is the investigation for invasive breast cancer

A

Triple assessment

  1. Breast history + examination
  2. Imaging: Ultrasound (<35 years old)
  3. Histology: core biopsy
39
Q

What are the surgery options for breast cancer

A
  1. wide local excision (breast conserving)

2. modified radical mastectomy

40
Q

If a tumour is oestrogen receptor (ER) +ve what drug can be administered

A

Tamoxifen (Oestrogen antagonist)

41
Q

If a tumour is Her2 receptor +ve what drug can be administered

A

Trastuzumab (Herceptin)

42
Q

What is Paget’s disease of the breast

A

Presence of Paget’s cells in the nipple

Essentially it is the spread of cancer cells to the skin

43
Q

Which types of cancers is paget’s disease of the breast seen in

A
  1. DCIS

2. Invasive breast carcinoma

44
Q

What are the clinical features of Paget’s disease of the breast

A
  1. Eczematous lesion of the nipple

2. Itchy, erythematous, crusty scaly skin

45
Q

What is the management of Paget’s Disease of the Breast

46
Q

What is triple assessment

A
  1. Clinical assessment
  2. Imaging:
    USS - age <35 y/o
    Mammogram - age >35 y/o
  3. Biopsy
    Fine Needle Aspiration (FNA) - cytology (fluid)
    Tru-Cut Core Biopsy - Histology (solid)
47
Q 
22 year old woman presents to clinic with a three-month history of a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
A

Fibroadenoma

48
Q 
A 54 year old patient who is febrile, presents with an irregular, firm mass in her left breast. The overlying skin appears red and is warm to touch. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
A

Breast Abscess

49
Q 
A 31 year old presents with an ill-defined, tender mass in her left breast, 2 weeks after giving birth. The affected segment is diffusely red and hot. Fine needle aspiration cytology (FNAC) of the mass shows neutrophils and inflammatory debris. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
A

Acute Mastitis

50
Q 
A 56 year old female presents with thick creamy discharge from the right nipple. USS shows dilated subareolar ducts. Cytology of discharge shows macrophages and debris but no epithelial cells. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
A

Duct Ectasia

51
Q 
A 55 year old presents with a firm, irregular, painless lump in her left breast. On examination you find an enlarged apical lymph node. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
A

Invasive Breast Cancer

52
Q 
A 48 year old woman presents with red, scaly lesions around the nipple of the right breast. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
A

Paget’s Disease of the Breast

53
Q 
A 25 year old woman is seen in breast clinic as she has noticed a small lump in her right breast. This is confirmed on examination and she is sent for further investigation. What is the next investigation she should have?
Core Biopsy
Fine Needle Aspiration
Mammography
None Needed – Send Home
Ultrasound
A

Ultrasound

54
Q

What is fat necrosis and what are the risk factors

A

Post trauma of fatty breast tissue
Hx of trauma
e.g. Car accident, surgery, needle biopsy (iatrogenic)

55
Q

What are the clinical features of fat necrosis

A
  1. Painless, irregular hard lump

2. bruising or redness of overlying skin

56
Q

What is the management for fat necrosis

A
  1. analgesia + discharge
57
Q

What is fibroadenosis/fibrocystic breast disease and what are the risk factors

A

Normal and physiological changes in breast tissue leading to fibrous tissue and cyst formation

risk factors:
due to hormonal chnages in women aged 30-50s
cyst rupture leads to fibrosis

58
Q

What are the clinical features of fibroadenosis/fibrocystic breast disease

A
  1. Cyclical - premenstrual breast nodularity

2. Painful, multiple lumps

59
Q

What is the management for fibroadenosis/fibrocytic breast disease

A

Reassure and discharge

60
Q

What is intraductal papilloma and what are the risk factors

A

Benign neoplasm growing within the ducts of the breast

Risk Factors include Peri-/post-menopausal women

61
Q

What are the clinical features of intraductal papilloma

and what is the management

A
  1. Bloody or Clear nipple discharge
  2. Subareolar mass

Surgical excision of duct and papilloma

62
Q

What is phyllodes tumour

A

Phyllodes = ‘leaf-like’
Fibroepithelial tumour formed of periductal stromal cells
can be malignant or benign

63
Q

What are the clinical features of a phyllodes tumour

A
  1. Rapidly growing
  2. Tear drop appearance of the breast
  3. Slit-like-nipple
  4. Warm shiny erythematous skin
64
Q

What is the management for a phyllodes tumour

A

Aggressive treatment including wide excision

MedEd Lectures (15 decks)

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