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GK F3E5 > 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
Q

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

A

50-74 y/o, every 1-2 years

(use Gail model risk calculator to decide 1 vs 2)

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26
Q

What are the breast cancer screening guidelines for high risk individuals

A
  • 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
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27
Q

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
A

BRCA1/2 genetic testing

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28
Q

Which is the MC breast cancer to be found incidentally on a screenining mammogram? (patient is asymptomatic)

A

Ductal Carcinoma in situ (DCIS)

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29
Q

How do you treat Ductal Carcinoma in situ? (DCIS

A

excision

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30
Q

What is the MC breast cancer

A

Infiltrating ductal carcinoma

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31
Q

Infiltrating cancer:

Which molecular subtypes make up the majority of ER-positive cancers?

A

Luminal A/ Luminal B

32
Q

Infiltrating cancer:

Which molecular subtypes are often ER and PR negative cancers?

A

HER2-enriched

33
Q

Infiltrating breast cancer:

Which molecular subtypeis the most aggressive with very few tx options?

A

Basal:

“Triple Negative” breast cancer

ER/PR/HER-2 negative

34
Q

What are the 3 MC locations that breast cancer metastasises to?

A
  1. Lung
  2. Liver
  3. Bone

(so might complain of back pain, abd pain, jaundice, SOB, cough)

35
Q

Is it more concerning if a breast mass is fixed or mobile? Tender or nontender? Well-defined or nondiscrete margins?

A

Concerning for cancer if:

Fixed, non-tender, nondiscrete margins

36
Q

If a mammogram report says soft tissue mass and “clustered microcalcifications” what dx are you thinking

A

Ductal Carcinoma in situ

(if you see those findings on mammogram then you should order a diagnostic mammogram)

37
Q

POPCORN

If you see the following on mammogram report what must you do?

“Spiculated soft tissue mass”

A

Must biopsy

38
Q

What are the 3 surgical treatment options for breast cancer?

A
  • Lumpectomy + radiation (“breast conservation therapy”)
  • Mastectomy
  • Modified radical mastectomy (includes axillary lymph nodes)
39
Q

What medical therapy (3) could be used for ER-positive breast cancers?

A

Chemo + Tamoxifen + Aromatase inhibitors

40
Q

What is primary adjunct therapy to Tamoxifen in the medical treatment of ER-positive breast cancers and what is its purpose?

A

Aromatase inhibitors

  • Prevents estrogen production
  • Extends survival with mets
  • concurrent w/ tamoxifen for prevention of recurrence
41
Q

What is the medical therapy for HER-2 breast cacners

A

Chemo + Trastuzumab

42
Q

What are the 3 severe side effects of Trastuzumab (used in the medical treatment of HER-2 cancers)

A
  • Heart failure
  • Respiratory problems
  • Life threatening allergic reactions
43
Q

What is the follow up regimen for Breast cancer?

A
  • F/U q3-6months x2 years, then annually
  • Annual mammogram and clinical breast exam indefinitely
44
Q

Within how many years do most recurrences of breast cancers occur?

A

within 5 years

(after this, recurrence is low)

45
Q

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?

A

Bilateral salpingo-oophorectomy

46
Q

What is an alternative to prophylactic mastectomy in a patient that is a BRCA1/2 carrier?

A

Chemoprevention with tamoxifen

47
Q

Which breast cancer is characterized by diffuse dermatologic erythema and edema (peau d’orange)

A

Inflammatory breast cancer

48
Q

Which breast cancer:

  • Rapid onset of breast pain and itching
A

Inlammatory breast cancer

49
Q

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

A

Inflammatory breast cancer

50
Q

What type of biopsy do you use to dx inflammatory breast cancer

A

Full thickness skin punch bx

51
Q

How do you tx Inflammatory breast cancer?

A

Chemo + mastectomy w/ axillary node dissection + radiation

(CANT do breast conservation therapy)

52
Q

Which breast cancer is characterized by:

  • scaly, vesicular or ulcerated lesion that begins on nipple and spreads to the areola
A

Paget disease of breast

53
Q

What is the initial presentation of Paget disease of Breast

A

Pain, burning or pruritis

(before you see scaly rash on/around nipple)

54
Q

Is Paget Disease of breast usually bilateral or unilateral? What type of nipple discharge is occasionally a/w this conditions

A

unilateral

bloody discharge

55
Q

How do you diagnose Paget Disease of breast?

A
  • Full thickness wedge or punch bx of the nipple
  • Bilateral mammogram
56
Q

Tx for Paget Disease of breast?

A

Mastectomy or BCT followed by radiation

57
Q

What are 4 worrisome signs a/w nipple discharge

A
  • Spontaneous
  • Bloody
  • Unilateral, uniductal
  • A/w a mass
58
Q

What color is the nipple discharge a/w fibrocystic changes or ductal ectasia

A

green, yellow or brown; sticky

59
Q

What 5 things can be done to eval nipple discharge

A
  • Focused ultrasound, mammogram if >30y/o
  • Ductography
  • MRI/ MR ductography
  • Labs- HCG, prolactin, etc
60
Q

What are the 3 tx options for Nipple discharge

A
  • If related to meds- reassurance
  • Terminal ductal excision
  • If malignancy- appropriate cancer sx
61
Q

What type of patient is mastitis usually seen in?

A

Usually a primiparous nursing patient

62
Q

Which bacteria is the MC etiology of Mastitis/abscess?

A

S. aureus

63
Q

What is the MCC of Mastitis

A

Disrupted flow of milk causing engorgement

64
Q

CPx of what?

  • Fever, swelling
  • Painful, erythematous lobule in outer breast quadrant
A

Mastitis

65
Q

How do you dx mastitis?

A
  • Clinical
  • If refractory to tx- Ultrasound to look for abscess
66
Q

How do you treat mastitis? (3)

A
  • Continue breastfeeding or use breast pump
  • Local heat, breast support
  • 1st line abx: Dicloxacillin
67
Q

If a patient with mastitis is refractory to tx what should you be concerned for

A

abscess

68
Q

What are 4 risk factors for breast abscess in breastfeeding patients

A
  1. >30y/o
  2. Primiparity
  3. Gestational age > 41 wks
  4. Tobacco use
69
Q

How do you dx a breast abscess

A
  • Clinical findings + ultrasound
  • Breast milk cultures (if severe)
70
Q

How do you treat a breast abscess?

A

Drainage and abx

(usu. will need repetitive drainage)

71
Q

What condition:

  • Bilateral
  • Symmetric distribution of glandular breast tissue around areolar-nipple complex
  • Males
A

Gynecomastia

72
Q

What 8 meds have good evidence that they cause gynecomastia

A
  1. Estrogens
  2. Spironolactone
  3. Cimetidine
  4. Ketoconazole
  5. Growth horone
  6. Gonadotropins
  7. Antiandrogen therapies
  8. 5 alpha-reductase inhibitors
73
Q

T/F: Hyperthyroidism can cause gynecomastia in men

A

true

74
Q

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)
A

Gynecomastia

75
Q

Physiologic gynecomastia regresses spontaneously in > 70% of patients after how long? When is regression rare?

A
  • Most regresses spont. after 1 year
  • Rare if persists over 1 year or after 17y/o

GK F3E5 (19 decks)

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