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FINALS medicine > breast > Flashcards

breast Flashcards

1
Q

Mobile, firm lump in a 27 year old woman

A

Fibroadenoma

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2
Q

Fibroadenoma may be mistaken for what?

A

Phyllodes tumour- fast growing fibroepithelial tumour

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3
Q

Fibroadenomas arise from what?

A

Breast lobule

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4
Q

Smooth, discrete fluctuant lump

A

Cyst

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5
Q

Management of fibroadenoma

A

Excise if >3cm

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6
Q

Investigation/management of breast cyst

A

aspirate, if blood stained or persistently refilling then biopsy and/or excise

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7
Q

Woman presents with a painful breast lump. A mammogram doesn’t rule out malignancy. What benign condition could it be?

A

Sclerosing adenosis

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8
Q

Does sclerosing adenosis increase risk malignancy?

A

Not premalignant lesion but may increase risk

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9
Q

What are the types of epithelial hyperplasia?

A

Ductal/Lobular

Typical/atypical

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10
Q

Does epithelial hyperplasia= increased risk breast cancer?

A

if atypical and FHx breast ca yes

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11
Q

Green discharge from nipple and tender lump around areola?

A

Mammary duct ectasia

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12
Q

What can occur if mammary duct ectasia ruptures?

A

Plasma cell mastitis (local inflammation)

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13
Q

Blood stained discharge from nipple

A

Duct papilloma

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14
Q

Eczematous reddening and thickening of areola/nipple

A

Paget’s disease- intraductal carcinoma

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15
Q

What is fibroadenosis/fibrocystic disease/benign mammary dysplasia?

A

Lumpy breasts

35-50yo

Spectrum of histological changes

May be normal overgrowth

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16
Q

Does fibroadenosis/fibrocystic disease/benign mammary dysplasia have increased risk Ca?

A

Only if marked epithelial hyperplasia

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17
Q

Obese woman with history of trauma to breast presents with a growing tethered lump

A

Fat necrosis (or cancer- image and biopsy)

18
Q

Differentials for bloody discharge from nipple?

A

Duct papilloma

DCIS (incl paget’s)

Mammary duct ectasia

19
Q

What is a common cause of mastitis?

A

Milk stasis

20
Q

What is an important non-pharmacological step in the management of mastitis?

A

frequent and regular milk removal- may avoid need for antibiotics

21
Q

Most common pathogen in masititis

A

staph aureus

22
Q

Painful swollen lump in breast with red, hot overlying skin (and history of mastitis)

A

Abscess

23
Q

Severe, deep, burning pain in mastitis might indicate what?

A

Ductal infection

24
Q

When should you send a breast milk M,C and S in mastitis?

A

If severe, deep, burning pain (ductal infection), severe or recurrent mastitis or if hospital acquired infection

25
Q

Management of breast abscess

A

Urgent referral to surgeon for USS, drainage and culture for Abx

26
Q

Should women with mastitis/abscess continue breast feeding?

A

Yes if pain allows, if not then express milk

27
Q

What is the oestrogeny risk factor for breast ca?

A

Uninterrupted oestrogen exposure

28
Q

What might peau d’orange indicate?

A

Mastitis

Inflammatory breast cancer- v bad!

29
Q

Where is oestrogen produced pre and post menopause?

A

Pre- ovaries

Post- fat/muscle/liver/skin/breast

30
Q

How does tamoxifen work and who is it given to (pre/post menopause)

A

Given to all

Competitively binds to the oestrogen receptor site on the cancer

31
Q

What is a pre-menopause hormonal therapy for breast ca?

A

Oophorectomy (stop oestrogen production)

32
Q

What is a post-menopause hormonal therapy for breast cancer?

A

Aromatase inhibitors- block extra-ovarian oestrogen production e.g. anastrazole

33
Q

what do HER2 receptors do?

A

Tell cancer to grow

34
Q

How does herceptin work?

A

Blocks HER2 receptors

35
Q

What type of therapy is herceptin?

A

Targeted

36
Q

SE of herceptin?

A

cardiotoxic

37
Q

What is the ‘best’ cancer to have in terms of ER/PR/HER positivity/negativity?

A

ER/PR positive- responds to hormone Rx

38
Q

What is the ‘worst’ cancer to have in terms of ER/PR/HER positivity/negativity?

A

Triple negative - ER/PR/HER neg. Harder to treat. Often BRCA1

39
Q

pros/cons of a HER2 positive cancer?

A

Aggressive cancer but responds to herceptin

40
Q

Is phyllodes tumour malignant?

A

Can be benign/borderline/malignant but all have malignant potential so excise

41
Q

In whom does phyllodes tumour present?

A

40-50yo

FINALS medicine (8 decks)

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