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SG F3 E5 > Breast > Flashcards

Breast Flashcards

1
Q

Where might a congenital supernumerary nipple occur?

A

along milk lines

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2
Q

Difference between screening mammogram and Diagnostic mammogram

A
  • Screening= asymptomatic patient
  • Diagnostic= if pt c/o lump, etc (or if screening mammo is abnl)
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3
Q

What is a BI-RADS score used for

A

Used to score findings found on diagnostic mammorgram-

helps to determine if findings are normal/benign/concerning and helps determine next steps (When to follow-up or if you shoudl refer to surgeon)

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4
Q

Why is it important to correlate an abnormal mammogram with a prior study?

A

This could tell you if the finding has been present and stable for many years and therefore does not require further work-up

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5
Q

What is the initial diagnostic study for a young, low-risk woman with suspected fibroadenoma

A

Ultrasound

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6
Q

Fibroadenoma:

  • MC young or old?
  • MC in which race?
  • solitary mass or numerous?
A

young

black

solitary mass

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7
Q

CPx of what?

  • Round/ovoid
  • rubbery
  • movable
  • non-tender
A

Fibroadenoma

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8
Q

How do you dx Fibroadenoma?

A

Core needle biopsy

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9
Q

What is definitive tx for Fibroadenoma

A

excision

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10
Q

What is the name of a large fibroadenoma that grows rapidly? Why is this concerning

A

Phyllodes tumor

Can be malignant

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11
Q

How do you treat a Phyllodes Tumor

A

Excision required

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12
Q

What condition?

  • MC 30-50y/o
  • Increased risk with alcohol use
A

Cyst/fibrocystic changes

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13
Q

Fibrocystic breast disease is dependent on what hormone

A

estrogen dependent

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14
Q

Which condition?

  • Painful
  • Single or multiple
  • Bilateral
  • Rapid changes in size and appearance
  • Nodular breast tissue
  • Mobile
A

Fibrocystic breast disease

(breast cysts are usually single but can have the same characteristics as fibrocystic breast disease)

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15
Q

How do you diagnose Cyst/Fibrocystic changes of the breast?

A
  • mammogram/ultrasound
  • Fine needle aspiration
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16
Q

How do you treat Cyst/Fibrocystic changes of the breast?

A
  1. Breast support
  2. Rx: Danazol (only if severe)- was not on slide

Use of evening primrose oil, low fat diet, avoiding caffeine and vit E does NOT have great evidence

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17
Q

Cyst/Fibrocystic changes will subside with what

A

Menopause

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18
Q

Are cysts or fibroadenomas usually tender?

A

Cysts

(fibroadenomas are usually nontender)

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19
Q

MC age to have a fibroadenoma? Cysts?

A
  • Fibroadenoma_- 15-25y/o_ (usu. puberty and young adulthood)
  • Cysts- 30-50y/o (regresses after menopause except w/ estrogen therapy)
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20
Q

What is the MC female cancer and the 2nd MCC of cancer death in women in the US ?

A

Breast cancer

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21
Q

Risk factors of what?

  • Female
  • White race
  • Postmenopausal obesity
  • High estrogen levels
  • BRCA1/BRCA2 genes
  • Personal/FHx ovarian, peritoneal or breast cancer
  • Radiotherapy to chest b/w age 10-30
A

Breast Cancer

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22
Q

What are the 5 protective factors for breast cancer

A
  1. Breastfeeding
  2. Higher parity
  3. Physical activity
  4. Oophorectomy < 35y/o
  5. ASA use
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23
Q

What is the risk calculator used for breast cancer in average risk women

A

Gail model

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24
Q

What are the USPSTF breast cancer screening guidelines for average risk women

A

50-74y/o, every 2 years

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25
What are the ACOG breast cancer screening guidelines for average risk women
**50-74** y/o, every **1-2 years** (use Gail model risk calculator to decide 1 vs 2)
26
What are the breast cancer screening guidelines for high risk individuals
* **annual screening mammogram**, starting at **25y/o** (or **5-10 yrs before** age of dx in affected relative) * Supplemental screening breast **MRI** 6 months later
27
The following are indications for what type of testing: * Breast cancer before 50y/o * Bilateral Br cancer * Breast and ovarian cancer in same woman or same family * Male breast cancer * Ashkenazi Jewish ethnicity
BRCA1/2 genetic testing
28
Which is the MC breast cancer to be found incidentally on a screenining mammogram? (patient is asymptomatic)
Ductal Carcinoma in situ (DCIS)
29
How do you treat Ductal Carcinoma in situ? (DCIS
excision
30
What is the MC breast cancer
Infiltrating ductal carcinoma
31
Infiltrating cancer: Which molecular subtypes make up the majority of **ER-positive** cancers?
Luminal A/ Luminal B
32
Infiltrating cancer: Which molecular subtypes are often **ER and PR _negative_** cancers?
HER2-enriched
33
Infiltrating breast cancer: Which molecular subtypeis the most aggressive with very few tx options?
Basal: "Triple Negative" breast cancer ER/PR/HER-2 negative
34
What are the 3 MC locations that breast cancer metastasises to?
1. Lung 2. Liver 3. Bone (so might complain of back pain, abd pain, jaundice, SOB, cough)
35
Is it more concerning if a breast mass is fixed or mobile? Tender or nontender? Well-defined or nondiscrete margins?
Concerning for cancer if: Fixed, non-tender, nondiscrete margins
36
If a mammogram report says soft tissue mass and "**clustered microcalcification**s" what dx are you thinking
**_Ductal Carcinoma in situ_** (if you see those findings on mammogram then you should order a diagnostic mammogram)
37
# POPCORN If you see the following on mammogram report what must you do? **_"Spiculated soft tissue mass"_**
Must biopsy
38
What are the 3 surgical treatment options for breast cancer?
* **Lumpectomy + radiation** ("breast conservation therapy") * **Mastectomy** * **Modified radical mastectomy** (includes axillary lymph nodes)
39
What medical therapy (3) could be used for **ER-positive** breast cancers?
_**Chemo** + **Tamoxifen** + **Aromatase inhibitors**_
40
What is primary adjunct therapy to Tamoxifen in the medical treatment of ER-positive breast cancers and what is its purpose?
_Aromatase inhibitors_ * Prevents estrogen production * Extends survival with mets * concurrent w/ tamoxifen for **prevention of recurrence**
41
What is the medical therapy for HER-2 breast cacners
Chemo + Trastuzumab
42
What are the 3 severe **side effects of Trastuzumab** (used in the medical treatment of HER-2 cancers)
* Heart failure * Respiratory problems * Life threatening allergic reactions
43
What is the follow up regimen for Breast cancer?
* F/U **q3-6months** x**2 years**, then **annually** * **Annual mammogram** and **clinical breast exam** indefinitely
44
Within how many years do most recurrences of breast cancers occur?
within **5 years** | (after this, recurrence is low)
45
If a patient is **35-40y/o** and **done having kids**, what surgery can be performed to reduce risk of breast cancer if she is a **BRCA1/2 carrier**?
Bilateral salpingo-oophorectomy
46
What is an alternative to prophylactic mastectomy in a patient that is a BRCA1/2 carrier?
Chemoprevention with tamoxifen
47
Which breast cancer is characterized by **diffuse dermatologic erythema and edema (peau d'orange)**
Inflammatory breast cancer
48
Which breast cancer: * **_Rapid_** onset of breast **pain** and **itching**
Inlammatory breast cancer
49
# POPCORN If the following is seen on pathology after a **full thickness skin punch biopsy**, what condition are you thinking? **_Dermal lymphatic invasion by tumor cells_**
Inflammatory breast cancer
50
What type of biopsy do you use to dx inflammatory breast cancer
Full thickness skin punch bx
51
How do you tx Inflammatory breast cancer?
**Chemo + mastectomy w/ axillary node dissection + radiation** (CANT do breast conservation therapy)
52
Which breast cancer is characterized by: * **scaly,** vesicular or ulcerated lesion that begins on **nipple** and spreads to the areola
Paget disease of breast
53
What is the **initial presentation of Paget disease of Breast**
Pain, **burning** or **_pruritis_** **(**before you see scaly rash on/around nipple)
54
Is Paget Disease of breast usually bilateral or unilateral? What type of nipple discharge is occasionally a/w this conditions
unilateral bloody discharge
55
How do you diagnose Paget Disease of breast?
* Full thickness wedge or **punch bx of the nipple** * Bilateral mammogram
56
Tx for Paget Disease of breast?
Mastectomy or BCT followed by radiation
57
What are 4 worrisome signs a/w nipple discharge
* Spontaneous * Bloody * Unilateral, uniductal * A/w a mass
58
What color is the nipple discharge a/w fibrocystic changes or ductal ectasia
green, yellow or brown; sticky
59
What 5 things can be done to eval nipple discharge
* Focused ultrasound, mammogram if \>30y/o * Ductography * MRI/ MR ductography * Labs- HCG, prolactin, etc
60
What are the 3 tx options for Nipple discharge
* If related to meds- reassurance * Terminal ductal excision * If malignancy- appropriate cancer sx
61
What type of patient is mastitis usually seen in?
Usually a primiparous nursing patient
62
Which bacteria is the MC etiology of Mastitis/abscess?
S. aureus
63
What is the MCC of Mastitis
Disrupted flow of milk causing engorgement
64
CPx of what? * Fever, swelling * **Painful, erythematous lobule in outer breast quadrant**
Mastitis
65
How do you dx mastitis?
* **_Clinical_** * If refractory to tx- Ultrasound to look for abscess
66
How do you treat mastitis? (3)
* **_Continue breastfeeding_** or use breast pump * Local heat, breast support * 1st line abx: **_Dicloxacillin_**
67
If a patient with mastitis is refractory to tx what should you be concerned for
abscess
68
What are 4 risk factors for breast abscess in breastfeeding patients
1. \>30y/o 2. Primiparity 3. Gestational age \> 41 wks 4. Tobacco use
69
How do you dx a breast abscess
* Clinical findings + ultrasound * Breast milk cultures (if severe)
70
How do you treat a breast abscess?
Drainage and abx | (usu. will need repetitive drainage)
71
What condition: * Bilateral * **_Symmetric distribution_** of glandular breast tissue around areolar-nipple complex * Males
Gynecomastia
72
What 8 meds have good evidence that they cause gynecomastia
1. Estrogens 2. Spironolactone 3. Cimetidine 4. Ketoconazole 5. Growth horone 6. Gonadotropins 7. Antiandrogen therapies 8. 5 alpha-reductase inhibitors
73
T/F: Hyperthyroidism can cause gynecomastia in men
true
74
The following are pathologic causes of what? * Drugs (exogenous estrogen, etc) * Hypogonadism (Klinefelters, cryptorchidism, defect in testosterone synthesis, hyperprolactinemia) * Tumor (testicular cancer, feminicing adrenal tumor, hCG-producing tumor)
Gynecomastia
75
Physiologic gynecomastia regresses spontaneously in \> 70% of patients after how long? When is regression rare?
* Most regresses spont. after **_1 year_** * Rare if persists over 1 year or after 17y/o

SG F3 E5 (23 decks)

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