Breast Flashcards
Differential of <30?
Mastitis, galactocele, benign cystic change, fibroadenoma, normal lumpy breast
Differentials of 30-45?
Benign cystic change, cyst, abscess and carcinoma, fibroadenoma
Differentials of 45-60?
Duct ectasia, carcinoma, abscess, cyst
Differentials >60?
Carcinomas
Time differentials?
Abscess and cysts = rapid
Firboadenoma and carcinoma = slow
What do seatbelt injuries cause?
Fat necrosis
Pain differentials?
Benign cystic change, acute mastitis, abscess +/- cysts
Cancer ends to be painless
Signs on breast?
peau d’orange, nipple inversion, bloody nipple, scaling, serous discharge, red erytherma, palpable lump
Breast cancer RFs?
Breat feeding, pregnancy, late menses, early menopause
PMH of existing benign disease, previous cancer and hereditary conditions
Age
Ionising radiation and smoking
Caucasian
What hereditary conditions to know for breast cancer?
Breast cancer (BRCA1/2), ovarian cancer
Klinefelters, peutz-jeghers, corden, li-fraumeni
How to assess brain Lump?
Straps need tightening
Size, shape, skin
Nipple, meNstruation, Nodes
Time, texture, tethering, temperature, trauma, tender
What causes mastitis and abscess?
Clogged ducts with milk stasis, nipple injury, bacteria enter damaged breast (staph Aureus)
If mastitis but no infection?
Duct ectasia
mastitis symptoms?
Palpable hard wedge, red and swollen
Nipples may eb cracked ana d lactation
1-2 months breastfeeding, painful and hot
Fever + general malaise
Abscess symptoms?
Palpable single lump, red swollen
Nipples may be cracked
Very painful, fluctuant, hot and often breastfeeding for a month. Difficulty sleeping
+-fever, coryzal, myalgia
Management of mastitis + abscess?
If lactating: reassure, analgesia, encourage milk and Abx only if worsening
Non-lactating: reassure, analgesia, co-amoxiclav
Abscess: referral, USS + aspiration, surgical draimage, fluid culture and Abx
Causative organisms of Mastitis/abscess?
STAPH
Strep
E.coli
Anaerobes = clostridium
TB or bartonella henselae from cats
What is duct ectasia?
Thickening of the wall of the milk duct under the nipple that can become clogged and have fluid build up
Age related cause
Symptoms of duct ectasia?
Palpable lump behind the nipple
Thick, sticky discharge (white/green/black)
+-tender, solid
Duct ectasia RFs and management?
menopause, smoking, obesity, 50-50YO
US +-biopsy
Conservative, abx and excision
Fibroadenoma definition and epidemiology?
Benign neoplasm of the lobule fromed from stroma and glandular epithelium
20-30YO or those of reproductive age
Symptoms of fibroadenoma?
Palpable lump, small, regular, round, lobular
Normal nodes
Smooth rubbery, painless, mobile and takes time to form
RFs, IX and management for fibroadenoma?
Obesity, OCC<20, recent puberty
US or mammogram if >35, FNA or core biopsy if susp
Conservative or treatment
Breast mouse
What are fibrocystic changes?
Benign breast condition encompassing fibrous changes, cysts and adenosis that occurs bilaterally
Premenopausal 30-50 YO
Symptoms of fibrocystic changes?
Multiple small lumps, smooth, regular, bilateral, often symmetrical
Normal nippls but may fluctuate wit periods
+-tender, rubbery, fluctuant, mobile, slow growing with fluctuations
RFs, Ix and maagement of fibrocystic changes?
Obesirty, nulliparity, late menopause and increased oestrogen
Ix: Us or mammogram >35, FNA = straw coloured
Conservative management of FNA if drainage needed
UOQ
Fat necrosis symptoms?
+-skin retraction and thickening, irregular, red brused
+- retraction
Hard +-tender, trauma and fixed
what is intraductal papilloma?
Rare benign fibroepithelial tumour formed from the lactoferous duct epithelium
30-55
Peri-post menopause
Symptoms of intraductal papilloma?
No mass, full feeling, bloody or serous discharge, unilateral
+-tender and slow
RFs, Ix and management of intraductal papilloma?
Peri-post menopause
US or mammogram >35yo, FNA core biopsy
Conservative or excision of the affected duct
Breast cancer Hx and Rfs?
Malignant lesions in the breats with different features and behaviours.
Elderly, high oestrohen, obesity, 1st degree relative, radiation, endometrial cancer, inherited genes, early menses and late menopause
Breast cancer examination?
Examination, imaging from Mmmography or USS, histology from FNA
Contents of anterior triangle?
Common carotid, internal and external carotid, Ix, X, XII, thrid, parathyorid, pharynx, ansa cervicalis
Contents of posterior triangle?
Xi, external jugular vein, brachial pleux trunks, subclavian artery
Anterior triangle neck lumps?
Brachial cyst, carotid body tumour, carotid artery aneurysm, laryngocele
Posterior triangle neck lumps?
Cystic hygroma, cervical rib, pharyngeal pouch and subclaian aneurysm
What is a carotid body tumour?
Chemodectoma
Mobile side to side but not up down, slow growing, pulsatile and causes horners or dizziness
Features of cystic hygroma?
Turners association, in babies and transilluminates
Hodgkins lymphoma specifics?
Hurts with alcool, younger, cervical painless lymphadenopathy
B symptoms
Non-hodgkins lymphoma specifics?
Older, disseminatedlymphadenopathy and B symptoms
Cervical lymphadenitis specifics?
Swelling due to infection or inflammation or cancer
Pharyngeal pouch specifics?
Regurgiation, dysphagia, halitosis, older
Branchial cysts specifics?
Fluctuant, non tender, upper 1/3 anterior, can be intermittent with URTi,
young
What are neck lump Ix and Mx?
Bloods, USS +- FNA, MRI or CT if malignant
Removal or draingage or conservative
