Breast Flashcards by Ben Moore

Differential of <30?

Mastitis, galactocele, benign cystic change, fibroadenoma, normal lumpy breast

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Differentials of 30-45?

Benign cystic change, cyst, abscess and carcinoma, fibroadenoma

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Differentials of 45-60?

Duct ectasia, carcinoma, abscess, cyst

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Differentials >60?

Carcinomas

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Time differentials?

Abscess and cysts = rapid

Firboadenoma and carcinoma = slow

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What do seatbelt injuries cause?

Fat necrosis

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Pain differentials?

Benign cystic change, acute mastitis, abscess +/- cysts

Cancer ends to be painless

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Signs on breast?

peau d’orange, nipple inversion, bloody nipple, scaling, serous discharge, red erytherma, palpable lump

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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

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What hereditary conditions to know for breast cancer?

Breast cancer (BRCA1/2), ovarian cancer

Klinefelters, peutz-jeghers, corden, li-fraumeni

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How to assess brain Lump?

Straps need tightening
Size, shape, skin

Nipple, meNstruation, Nodes

Time, texture, tethering, temperature, trauma, tender

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What causes mastitis and abscess?

Clogged ducts with milk stasis, nipple injury, bacteria enter damaged breast (staph Aureus)

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If mastitis but no infection?

Duct ectasia

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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

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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

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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

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Causative organisms of Mastitis/abscess?

STAPH
Strep
E.coli

Anaerobes = clostridium
TB or bartonella henselae from cats

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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