Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SURGERY - vascular + breast > breast > Flashcards

breast Flashcards

1
Q

define mastalgia and the different kinds

A

breast pain can be cyclical = associated with menstrual cycle

  • usually bilateral
  • caused by hormonal changes, starts a few days before period and end when it ends
  • seen in menstruating and HRT using women

non- cyclical = unrelated to menstrual cycle

  • can be medical = hormonal contraceptives, antidepressants (sertraline), antipsychotics (haloperidol)
  • extramammary pain = chest or shoulder pain -
  • gallstones
  • angina
  • Tietze’s syndrome
  • Bornholm disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What investigations do you do when you have breast pain

A
  • pregnancy test
  • mammography/mammogram
  • US
  • ductogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How would you manage breast pain?

A

Conservative

  • topical NSAIDS, paracetamol, ibuprofen
  • firm better fitting bra (cyclial pain)
  • reassurance
  • Danazol (anti-gonadogrophin agent)
    • (SE = dizziness, nausea, weight gain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the 2 kinds of invasive carcinoma of the breast

A

invasive ductal carcinoma (80%)

invasive lobular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does invasive breast carcinoma present?

A
  • Asymmetry = Breast lump or swelling
  • abnormal nipple discharge
  • nipple retraction
  • skin changes eg. dimpling, paget’s (ulceration of nipple), peau d’orange
  • mastalgia
  • palpable lump in axilla
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What increases your risk of developing invasive breast carcinoma?

A
  • female
  • old age
  • BRCA1/2
  • FHx of 1st degree relative
  • previous benign disease
  • obesity
  • alcohol
  • increased exposure to oestrogen eg. early menarche + late menopause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How would you manage invasive breast cancer?

A
  • 50-70 y/o women have a mammogram every 3 years
    • triple assessment for investigation (exam, imaging, histology)

MEDICAL

  • check for receptor status for targeted therapy options (HER2, Oestrogen receptor, Progesterone receptor sensitivity)
  • hormonal therapy after surgery or for those unfit for surgery
    • tamoxifen
      • premenopauseal women, blocks oestrogen receptors BUT i_ncreases risk of thromboembolism and uterine cancer_
    • aromatase inhibitors eg. letrozole, anastrozole
      • post-menopausal women, binds to oestrogen receptors BUT expensive
  • Immunotherapy = HER2 positive cancers treated with Herceptin (Trastuzumab)

SURGICAL

  • Wide Lobe excision (leave 1cm margin of normal tissue)
  • curative Mastectomy (remove whole breast)
  • prophylactive mastectomy (BRCA1/2, previous Hx, FHx)
  • axillar surgery (sentinal node biopsy or axillary node clearance sent for histology)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the different options for breast reconstruction after surgery?

A
  • Wide lobe excision + breast reduction technique (nipple and areola preserved + blood supply)
  • Flap formation
    • Latissimus dorsi flap (smaller breast)
    • Transverse Rectus Abdominus Muscle flap (uses abdo fat, muscle, skin)
    • Deep Inferior Epigastric Perforator Flap (uses abdo tissue and skin, no muscle)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

define a carcinoma in situ, and the two most common types in breast.

A

a carcinoma that is contained within the basement membrane tissue (pre-malignant)

1) ductal carcinoma in situ (most common)
2) lobular carcinoma in situ (greater risk of developing into invasive breast malignancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you manage carcinoma insitu in breasts?

A

DCIS

  • appears as microcalcifications on mammography, confirm with biopsy.
  • complete wide excision or complete mastectomy if widespread.

LCIS

  • monitored first
  • bilateral prophylactic mastectomy for those with BRCA1/2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define mastitis and how is it classified

A

inflammation of the breast tissue, commonly from S.Aureus

  • Lactational mastitis
    • presents in first 3 months of breastfeeding. associated with cracked nipples, milk stasis, poor feeding technique
  • Non lactational mastitis
    • presents in women with other conditions eg. duct ectasia (per-ductal mastitis)
    • smoking is a huge risk as it damages sub-areolar duct walls, predisposing to bacterial infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does mastitis present?

A

tender, swollen, erythematous irritated breast.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some complications of mastitis?

A
  • breast abscess = collection of pus in breast lined with granulation tissue
  • confirm via US guided aspiration
  • incise + drain + local anaesthetic + antibiotics
  • complications = mammary duct fistulas can form on drainage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How would you manage mastitis?

A
  • antibiotics
  • analgesics
  • dopamine agonists like cabergoline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a breast cyst and how do they present?

A
  • benign epithelial lined fluid filled cavities that form usually in perimenopausal women
  • single or multiple
  • smooth, fluid filled, not fixed
  • may be tender
  • halo shaped on mammography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How would you diagnose and manage a breast cyst?

A
  • US and aspiration
  • Send cystic fluid to cytology exclude cancer if there is no blood or lump disappears
  • cysts can be fully aspirated for cosmetic reasons, but most self-resolve.
17
Q

What complications can happen from breast cysts?

A

fibroadenosis due to multiple small cysts and fibrotic areas

It is benign but associated with asymmetry and can mask malignancy

18
Q

define mammary duct ectasia

A
  • dilation and shortening of the major lactiferous ducts
  • common in perimenopausal women
  • Occurs because the ducts become blocked and secretions stagnate
19
Q

How does mammary duct ectasia present?

A
  • yellow/green nipple discharge (any blood stained discharge sent for triple assessment)
  • palpable mass
  • nipple retraction
  • dilated calcified ducts on mammography
  • multiple plasma cells (plasma cell mastitis) on histology
20
Q

How would you manage mammary duct ectasia?

A
  • stop smoking
  • duct excision if nipple discharge does not stop
21
Q

what is fat necrosis of the breast?

A
  • due to an acute inflammatory response, ischaemic necrosis of fat lobules occurs.
  • usually a response to blunt trauma of the breast
  • results in fibrosis and calcification after breast tissue injury.
22
Q

How does fat necrosis present?

A
  • asymptomatic
  • a lump
  • fluid discharge
  • skin dimpling
  • pain
  • nipple inversion
  • sometimes a solid irregular lump due to chronic fibrotic change caused by the inflammatory response
  • positive traumatic Hx
  • hyperechoic mass on US
  • on mammogram mimics the way a carcinoma would look (calcified, irregular masses) so biopsy to rule out
23
Q

define gynaecomastia

A

males develop breast tissue due to an imbalanced ratio of oestrogen & androgen activity

enlarged hyperplasia of breast tissue

24
Q

What are some common causes of gynaecomastia

A

physiological gynaecomastia:

  • delayed testosterone surge relative to oestrogen at puberty
  • decreasing testosterone levels in old age

pathological gynaecomastia:

  • lack of testosterone eg. androgen insensitivity, renal disease, testicular atrophy
  • increased oestrogen levels eg. Leydig cell tumours, liver disease, obesity, adrenal tumours, hyperthyroidism
  • medication eg. digoxin, metronidazole, spironolactone, chemo, antipsychotics, anabolic steroids
25
Q

How do you manage gynaecomastia?

A
  • triple assessment if malignancy suspected
  • LFTs, U&Es if unknown cause
  • check hormone profile (LH and Testosterone)
  • reasurance
  • fix underlying cause
  • tamoxifen can alleviate symptoms eg. tenderness
  • if later stages of fibrosis = surgery
26
Q

Define galactorrhoea

A

copious bilateral multi-ductal milky white discharge that isn’t associated with pregnancy or lactation

27
Q

Why does galactorrhoea happen?

A
  • Hyperprolactinaemia!!!
  • pituitary adenoma = prolactinomas causing excessive prolactin secretion
  • drug induced = SSRIs, antipsychotics, H2 antagonists stimulate prolactin release
  • neuro = dopamine level inhibition eg. varicella zoster, spinal cord injury
  • hypothyroidism = excess Thyrotropin Releasing Hormone eg. Cushings, acromegaly, Addisons -
  • Renal failure, Liver failure
  • damage to pituitary stalk causing reduced dopamine eg. from MS, TB, sarcoidosis, surgical resection
28
Q

What investigations would you do for galactorrhoea?

A
  • serum prolactin levels (>1000mU/L without any drug cause = prolactinoma)
  • exclude pregnancy
  • check thyroid, liver, renal function
  • MRI head with contrast = pituitary tumour?
  • Breast imaging if palpable lumps or lymph nodes
29
Q

How would you manage galactorrhoea?

A
  • pituitary tumours:
    • dopamine agonist therapy = cabergoline and bromocriptine
    • refer to neuro for potential trans-sphenoidal surgery
  • idiopathic normoprolactinaemic galactorrhoea
    • low dose dopamine agonist
    • usually resolves spontaneously
    • bilateral total duct excision for those intolerant to meds
30
Q
A

SURGERY - vascular + breast (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions