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Year 3 Conditions > Breast > Flashcards

Breast Flashcards

1
Q

What are 4 most common diagnoses for a breast lump

A

Benign cystic change
Fibroadenoma
Cyst
Carcinoma

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2
Q

Most common breast lumps in under 30s

A 
Physiologically normal lumpy breast
Benign cystic change
Fibroadenoma
Abscess
Galactocele if breast feeding
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3
Q

Most common breast lumps 30-45s

A

Benign cystic changes
Cyst
Abscess
Carcinoma

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4
Q

Most common breast lump in 45-60

A

Cyst
Abscess
Carcinoma

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5
Q

Who are breast abscesses especially prevelant in

A

Smokers

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6
Q

In what ages do fibroadenomas occur

A

Teenagers to mid 30s mainly

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7
Q

In what ages do breast cysts occur

A

Any age but peak at 55

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8
Q

What breast lump do you get after cessation of lactation

A

Galactocele

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9
Q

Where do galactoceles tend to appear on breasts

A

Subareolar

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10
Q

How do galactoceles form

A

Caused by obstruction in duct which leads to build up of milk and epithelial cells

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11
Q

How can galactoceles become complicated

A

Secondary abscess

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12
Q

What do galactoceles appear like

A

Cysts

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13
Q

What is mastitis

A

Superficial infection of breast by commensal staph aureus and staph epididermis

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14
Q

What is periductal mastitis

A

Inflammation of periductal ducts under the skin

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15
Q

Who is at risk of mastitis

A

Breast feeding

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16
Q

Difference in infective cause mastitis vs periductal mastitis

A

Periductal will include anaerobic bacteria

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17
Q

What are main risk factors for breast cancer

A 
Previous breast cancer
Family history of breast cancer
Any previous endometrial cancer, bowel or ovarian
Irradiation to chest wall
Increased exposure to oestrogens
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18
Q

Risk factors where get increased exposure to oestrogen

A 
Early menarche
Late menarche
Having first child after 30
Not breast feeding
HRT
COCP
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19
Q

Difference in onset of breast lumps

A

Abscess or cyst rapid

Fibroadenoma or cancer insidious

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20
Q

What would trauma or iatrogenic to breast suggest

A

Abscess or fat necrosis

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21
Q

What does breast lump that changes shape or size cyclically suggest

A

Benign cystic change

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22
Q

Which breast lumps tend to be more painful

A

Abscess
Benign cystic changes
Acute mastitis
Carcinoma rarely painful

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23
Q

Tender breast lumps

A

Abscess
Benign cystic changes
Acute mastitis
Potentially a cyst

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24
Q

What does warm skin above lump suggest

A

Inflammatory or infection
Mastitis
Abscess

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25
Q

What is peau d’orange

A

Skin resembling an orange where looks like holes in skin

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26
Q

What is peau d’orange indicative of

A

Cancer

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27
Q

What does change in nipple appearance suggest

A

Cancer

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28
Q

What does milky discharge with lump suggest

A

Galactocele

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29
Q

What does green or yellow discharge suggest about breast lump

A

Preductal mastitis

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30
Q

What does bloody discharge from nipple suggest

A

Cancer

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31
Q

What does serous discharge from nipple suggest

A

Intraductal papilloma

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32
Q

What is intraductal papilloma

A

Benign lump that grows inside ducts close to nipple

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33
Q

What does recent distortion of nipple suggest

A

Cancer

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34
Q

Do breast cancer tend to present with b sx

A

No

35
Q

What other symptoms should you ask about in breast lumps

A

Back pain or any other common met site

36
Q

What to look for in inspection of breasts on examination

A 
Asymmetry
Contours
Skin changes
Nipple changes or discharge
Radiotherapy tattoos
37
Q

What radiation is particularly relevant for breast cancer

A

Mantle radiotherapy seen in Hodgkins lymphoma

38
Q

What does highly mobile breast lump suggest

A

Fibroadenoma

39
Q

What does solitary cyst feel like

A

Smooth
Distinct borders
Firm to lax

40
Q

What does fibroadenoma feel like

A

Smooth
distinct borders
Rubbery

41
Q

What lumps are very mobile

A

Fibroadenomas

42
Q

What does cancer lump feel like in breast

A

Irregular
Indistinct
Hard

43
Q

What does fixation to skin always suggest

A

Cancer

44
Q

What assessments must be done if breast lump pt presents

A

Full examination
Imaging depending on age
FNA or core biopsy

45
Q

How does age affect imaging of breast

A

Under 35 do US

Over do mammogram

46
Q

Why cant mammograms be done on under 35s

A

Breast tissue too thick

47
Q

Treatment options for fibroadenoma

A

Harmless so ideally watchful waiting

Excision

48
Q

What are indications for removal of fibroadenoma

A

Patient choice
Growing in size
Beginning to cause discomfort

49
Q

What does term breast mouse refer to

A

Fibroadenomas

50
Q

4 most common sites of breast mets

A

Liver
Bone
Lung
Brain

51
Q

What breast mets are always investigated regardless of clinical signs and how are they investigated

A

Liver- CT

Bone- bone scintilligraphy, calcium ALP etc can be good adjunct

52
Q

Which breast mets are sometimes only investigated based on clinical presentation

A

Brain

Lungs

53
Q

What are the majority of breast cancers

A

Infiltrating duct carcinoma

54
Q

What are some local treatment options for breast cancer

A

Surgery

Radiotherapy

55
Q

What treatment is always given to ladies whos tumours are ER positive

A

Hormonal
80% are ER positive which means that mutation on ER leads to growth of these lobule cells themselves whereas they should just act as beacon

56
Q

How to differentiate between lobular and medullary breast cancer histologically

A

Lobular – the tumour has some resemblance of the architecture of the gland (there are tubules of some form)
Medullary – the tumour cells don’t look anything like the epithelial cells from the mammary gland

57
Q

Systemic treatments for breast cancer

A

Hormonal therapy
Chemotherapy
Monoclonal antibodies

58
Q

Examples of hormonal therapy for breast cancer

A

Aromatase inhibitors

ER blockers

59
Q

What is ER blocker used in breast cancer and what is its main side effect

A

Tamoxifen

Increased risk of endometrial cancer

60
Q

Monoclonal antibody therapy used in breast cancer

A

Herceptin

61
Q

How does breast abscess present and appear on examination

A 
Painful sudden onset lump
Skin tethering
Erythema
Fever
May also be lymphadenopathy
62
Q

Management of breast abscess

A

ABx with anaerobic cover
Surgical drainage
If there is a mass left over will require triple assessment

63
Q

How does a cyst appear on US

A

Hypoechoic (solid mass will be hyperechoic)

64
Q

Are cysts painful in breast

A

Yes

65
Q

What colour is fluid if drain the cyst

A

Normally green

66
Q

After draining breast cyst what should be done if mass persists

A

Triple assessment again as tumour can be present within the cyst

67
Q

Presentation of benign cystic change

A

Diffuse nodularity

Cyclical variance in prominence and tenderness

68
Q

Management of benign cystic changes

A

Triple assessments as are signs of nodularity

69
Q

What percentage of breast cancers occur in men

A

10%

70
Q

When is gyaecomastia common in men

A

Occurs at times of hormonal fluctuation

Neonatal, puberty and old age

71
Q

Most common causes of gynaecomastia in men

A 
Liver disease
Primary testicular therapy
Acquired testicular failure
Secondary testicular failure
Endocrine tumours
Ectopic production from other tumours
72
Q

Drugs causing gynaecomastia

A

Spironalactone
Finasteride
Anabolic steroids
Cimetidine

73
Q

What are fibroadenomas caused by

A

Increased sensitivity to oestrogen

74
Q

Who do fibroadenomas normally appear in

A

Under 30s

75
Q

What causes cysts in breasts

A

Proliferation of terminal ducts

76
Q

How does mastitis with lactation present

A

Erythema streaking away from the nipple
Breast tenderness
Axillary lymphadenopathy
Can also have fever and malaise

77
Q

Management of mastitis with lactation

A

10 day course of flucoloxacillin

78
Q

What is an intraductal papilloma

A

Wart like lump that is normally found behind nipple

It is a benign growth

79
Q

Difference in presentation of intraductal papilloma with age

A

Older women likely to have just 1 whereas under 40s can have many

80
Q

Examination finding from intraductal papilloma

A

Sticky or bloody discharge that can be spontaneous

Small lump

81
Q

What is atypical duct hyperplasia

A

Genetic condition that leads to hyperplasia of cells in ducts and lobes which comes with increased risk of carcinoma- must be screened regularly

82
Q

What does fat necrosis feel like on examination

A

Tender firm lump

Skin changes- red, bruised and dimpled

83
Q

Who does fat necrosis occur in

A

People with bigger breasts and obese

Always post trauma

Year 3 Conditions (33 decks)

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