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ΩΩ 3a Bateman - Obs and Gynae > Breast > Flashcards

Breast Flashcards

1
Q

WHAT IS LACTATION MASTITIS?

A

Mastitis is an inflammation of breast tissue that sometimes involves an infection

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2
Q

What is important to determine when looking at lactation mastitis?

A
  1. Accumulation of milk in breast tissue causes an inflammatory response (non-infectious mastitis)
  2. With inadequate milk removal predisposing to bacterial growth (infectious mastitis)
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3
Q

What are the symptoms of infectious mastitis?

A

Clinically this presents as a painful breast

  1. Fever
  2. Malaise
  3. Tender, red, swollen and hard area of the breast, usually in a wedge-shaped distribution.
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4
Q

What is the management of mastitis?

A
  1. ‘if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal or if culture indicates infection’.
  2. The first-line antibiotic is flucloxacillin for 10-14 days.
  3. Breastfeeding or expressing should continue during treatment.
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5
Q

When would antibitoics be given in mastitis?

What is the treatment?

A

Infected nipple fissure

Symptoms do not improve or are worsening after 12-24 hours despite effective milk removal

Bacterial culture is positive.

Fucloxacillin

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6
Q

WHAT IS RAYNAUD’S DISEASE OF THE NIPPLE?

A

Pain is often intermittent and present during and immediately after feeding

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7
Q

What are the symptoms of Raynauds disease of the nipple?

A
  1. Pain is often intermittent and present during and immediately after feeding.
  2. Blanching of the nipple may be followed by cyanosis and/or erythema.
  3. Nipple pain resolves when nipples return to normal colour.
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8
Q

What is the treatment for Raynaud’s disease of the nipple?

A

Minimising exposure to cold, use of heat packs following a breastfeed, avoiding caffeine and stopping smoking

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9
Q

What are examples of drugs which can be used whilst breast feeding?

A

antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines

psychiatric drugs: tricyclic antidepressants, antipsychotics**

hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin

digoxin

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10
Q

What are example of drugs which cannot be used whilst breast feeding?

A

Antibiotics
Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

Psychiatric drugs
Lithium, benzodiazepines

  1. Aspirin
  2. Carbimazole
  3. Methotrexate
  4. Sulfonylureas
  5. Cytotoxic drugs
  6. Amiodarone
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11
Q

WHAT IS A GALACTOCELE?

A

Galactocele typically occurs in women who have recently stopped breastfeeding and is due to occlusion of a lactiferous duct

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12
Q

How can a galatocele be differentiated from an abscess

A

The lesion can be differentiated from an abscess by the fact that a galactocele is usually painless, with no local or systemic signs of infection.

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13
Q

WHAT IS THE MOST COMMON TYPE OF BREAST CANCER?

A

Invasive ductal carcinomas

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14
Q

What are the risk factors for breast cancer?

A
  1. BRCA1, BRCA2
  2. 1st degree realtive with breast cancer
  3. Nulliparity
  4. Early menarche, late menopause
  5. Combined hormone replacement therapy
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15
Q

What is the clinical presentation of breast cancer?

A
  1. Asymptomatic
  2. Breast lump
  3. Skin changes
    Dimpling
    Peau d’orange
    Nipple ‘eczema’ in Paget’s
  4. Recent nipple inversion
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16
Q

What are the investigations for breast cancer?

A

Prior to surgery, the presence/absence of axillary lymphadenopathy determines management:

  • women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery
    • if positive then they should have a sentinel node biopsy to assess the nodal burden
  • in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery
    • this may lead to arm lymphedema and functional arm impairment
  1. Imaging
    Mammography
    Ultrasound
  2. Biopsy
    Fine needle aspiration
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17
Q

Where can breast cancer spread to?

A
  1. Bone
  2. Lung
  3. Liver
  4. Brain
  5. Ovaries
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18
Q

What staging systems are commonly used for breast cancer?

A
  1. Manchester
  2. TNM
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19
Q

What is the management of breast cancer?

A
  1. Surgery
    Mastectomy
  2. Radiotherapy + Chemotherapy
20
Q

What nerve is commonly damaged during breast surgery?

A

Intercostobrachial

21
Q

What determines whether to do a mastectomy or wide local excision?

22
Q

What should be offered to all women who have recieved at wide-local excision and some masectomy patients?

A
  1. Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds.
  2. For women who’ve had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes
23
Q

Who is invited to breast cancer screening?

A

50-70 year olds for three-yearly reviews

24
Q

What is tamoxifen?

A

Blocks oestrogen

Used in breast cancer

25
Q

WHAT ARE THE TWO TYPES OF BREAST IMPLANTS?

A

Silicone + Saline

26
Q

WHAT ARE THE TWO TYPES OF IN SITU CARCINOMA?

A
  1. Ductal carcinoma
  2. Lobular cacinoma
27
Q

What are the clinical features of in situ ductal carcinoma?

A
  1. Asymptomatic - normally detected by screening mammography
  2. Only one breast affected
28
Q

What is the management for in situ ductal carcinoma?

A
  1. Local resection with pathologically clear margins
    • radiotherapy
29
Q

WHAT IS PAGET’S DISEASE OF THE NIPPLE?

A

Presentation of breast cancer that invariably, is associated with ductal carcinoma in situ (DCIS) or invasive carcinoma in the breast.

30
Q

What are the clinical features for paget’s disease of the nipple?

A

Unilateral

  1. Itching
  2. Tingling
  3. Discomfort

Later

  1. Small patch of redness or roughening
31
Q

What is the management of paget’s disease of the nipple?

A
  1. Concentrated on detecting and treating any associated malignancy
  2. Radical surgery
32
Q

WHAT IS A BREAST ABSCESS?

A

Inflammatory condition of the breast, may or not be infected

33
Q

What are the symptoms of a breast abscess?

A

Red, hot tender swelling

34
Q

Who are breast abscesses more common in?

A

Lactating women

35
Q

WHAT ARE THE CLINICAL FEATURES OF A BREAST CYST?

A
  1. Smooth discrete lumps which may be painful
  2. More common in peri-menopausal women
36
Q

What are the investigations for a breast cyst?

A
  1. Diagnosis - fine needle aspiration
  2. Ultrasound/mammography - characteristic halo
37
Q

What is the management for a breast cyst?

A
  1. Fine needle aspiration
  2. Send fluid off for cytology
38
Q

WHAT IS A FIBROADENOMA?

A

Aberrations of normal development

39
Q

What are the clinical features of a fibroadenoma?

A
  1. Discrete
  2. Firm
  3. Non-tender
  4. Highly mobile nodule
  5. BREAST MICE
40
Q

What are the investigations for a fibroadenoma?

A
  1. Ultrasonography
  2. Fine needle aspiration cytology
41
Q

What is the management for fibroadenomas?

A
  1. Over 40 years old - removed
  2. Under 40 - judgement call
42
Q

Which contraceptive is best used for women with breast cancer?

43
Q

WHICH ANTIEPILEPTICS ARE CONSIDERED SAFE TO USE WHILST BREASTFEEDING?

A

All of them

44
Q

Best SSRI for breastfeeding?

A

Sertraline or paroxetine

45
Q

What is fibroadenosis?

A
  1. Most common in middle-aged women
  2. ‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
46
Q

WHAT IS FAT NECROSIS?

A
  1. More common in obese women with large breasts
  2. May follow trivial or unnoticed trauma
  3. Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
  4. Rare and may mimic breast cancer so further investigation is always warranted
47
Q

WHAT IS DUCT PAPILLOMA?

A
  1. Local areas of epithelial proliferation in large mammary ducts
  2. Hyperplastic lesions rather than malignant or premalignant
  3. May present with blood stained discharge

ΩΩ 3a Bateman - Obs and Gynae (6 decks)

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