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General Surgery > Breast > Flashcards

Breast Flashcards

1
Q

What is the most common bacteria in mastitis?

A

S. Aureus

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2
Q

How is lactational mastitis treated?

A

Continue milk drainage or feeding
If serious: cabergoline to stop breastfeeding (dopamine agonists)

Lactation mastitis in first 3 months of breast feeding

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3
Q

What are some causes of non-lactational mastitis?

A

Duct ectasia
Peri-ductal mastitis
Tobacco smoking

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4
Q

How can mastitis lead to duct fistula

A

Periareolar or peripheral mastitis

Peri-aeroplane mastitis in younger patients can lead to duct fistula

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5
Q

How are breast abscesses treated?

A

US-guided needle therapeutic aspiration

Co-amoxiclav/ flucloxacillin

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6
Q

What are breast cysts?

A

Epithelial-lined fluid-filled cavities

Form when lobules become distended

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7
Q

Which age group are prone to breast cysts?

A

Perimenopausal

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8
Q

Management of breast cysts

A

Aspiration if large and causing pain or discomfort

Usually self-resolve

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9
Q

What are some complications of breast cysts?

A

Breast cancer
Fibroadenois (fibrocystic change)
Can mask malignancy
Cyclical pain (give high dose gamolenic acid or danazol)

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10
Q

Treatment of breast cysts

A

Gamolenic acid: for fibrocystic change, relieves cyclical symptoms

Danazol: inhibits pituitary gonadotropin secretion, side effects are acne and hirsutism

Bromocriptine: inhibits pituitary prolactin release and can produce dizziness

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11
Q

What is the mechanism of action of danazol?

A

Inhibits pituitary gonadotropin secretion
SE: acne/hirsutism
Treatment for breast cysts, moderate to severe cyclical pain

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12
Q

What is the mechanism of action of Bromocriptine?

A

Inhbiits pituitary prolactin release and can produce dizziness
Used for breast cysts

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13
Q

What is mammary duct ectasia?

A

Dilation and shortening of the major lactiferous ducts

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14
Q

Clinical features of mammary duct ectasia

A

Green/yellow nipple discharge
Palpable mass
Nipple retraction
Peri-menopausal women

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15
Q

What will you see on a mammogram of mammary duct ectasia?

A

Calcification

Dilated ducts

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16
Q

Management of mammary duct ectasia

A

Duct excision

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17
Q

Causes of fat necrosis

A

Trauma, previous surgical or radiological intervention

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18
Q

Clinical features of fat necrosis

A

Asymptomatic lump
Fluid discharge
Skin dimplinG
Pain and nipple inversion

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19
Q

Management of fat necrosis

A

Self-limiting

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20
Q

Findings on investigations of fat necrosis

A

Hyperechoic mass on US, positive traumatic history

Area of calcification on mammography

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21
Q

What is a fibroadenoma

A

Proliferation of stromal and epithelial tissue of duct lobules
In women of reproductive age

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22
Q

Clinical features of fibroadenoma

A

Highly mobile
Well defined and rubbery
Multiple and bilateral
Smooth and discrete lumps

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23
Q

Management of fibroadenoma

A

Often left alone

Excision if >4cm or changing or suscpicious history

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24
Q

What are the different types of fibroadenoma?

A

Juvenile fibroadenoma
Giant fibroadenoma >5cm
Phyllodes tumour
Common fibroadenoma

25
Q

What are the features of an adenoma?

A

Nodular
Benign glandular
Older population

26
Q

What is a papilloma?

A

Benign epithelial mass growing exophytically
Sub areolar region
40s/50s

27
Q

What are some examples of benign breast disease?

A 
Phyllodes tumour
Breast haematoma
Galactocele
Lipoma
Papilloma
Adenoma
Fibroadenoma
28
Q

What are phyllodes tumours?

A 
Rare fibroepithelial tumours
Large, occur in older age groups
In both epithelial and stromal tissue
Grow easily
One third have malignancy potential
29
Q

Breast haematoma

A

Most common problem following breast trauma

Spontaneously in patients on anticoagulants

30
Q

What is a galactocele?

A

Cystic lesion filled with milk
Contains breast milk which may Be inpissated
Women who stop breast feeding suddenly

31
Q

Pathological causes of gynaecomastia

A 
Lack of testosterone
Increased oestrogen 
Medication
Idiopathic
Pubertal
32
Q

Conditions causing low testosterone

A

Klinefelter’s syndrome
Androgen insensitivity
Testicular atrophy
Renal disease

33
Q

Causes of increase oestrogen

A 
Liver disease
 Hyperthyroidism 
Obesity
Adrenal tumours 
Leydig cell tumours
34
Q

Medications causing gynaecomastia

A 
Digoxin 
Metronidazole 
Spironolactone 
Chemotherapy
Goserelin 
Antipsychotic 
Anabolic steroids
Hormonal treatment for prostate cancer
Ranitidine
CCB
35
Q

Clinical features of gynaecomastia

A

Rubbery or firm mass <2cm in diameter

Starts from underneath nipple and spreads outwards over breast region

36
Q

Management of gynaecomastia

A

Tamoxifen for pain

37
Q

What is Galactorrhea

A

Bilateral, multi-ductal milky discharge
Not associated with pregnancy or lactation
Milk production 6-12months after pregnancy and cessation of breast feeding

38
Q

What are some causes of hyperprolactinaemia

A
  • Idiopathic
  • Pituitary adenoma (prolactinoma)
  • Drug-induced: SSRIs, anti-psychotics, H2 antagonists
  • Neurological: varicella zoster/ spinal cord injury inhibits dopamine release
  • Hypothyroidism: elevated thyrotropin-releasing hormone can simulate prolactin released. Cushing’s disease, Acromegaly, Addison’s disease
  • Renal or liver failure
  • Damage to pituitary stalk, reduced dopamine inhibition to pituitary, from surgical resection, multiple sclerosis, sarcoidosis, or tuberculosis
39
Q

Management of galactorrhea

A

Dopamine agonists therapy for confirmed pituitary tumors. Cabergoline and Bromocriptine
Potential trans sphenoidal surgery
Bilateral total duct excision

40
Q

Causes of cyclical mastalgia

A

Both breasts
Hormonal changes
Actively menstruating
HRT

41
Q

Non cyclical causes of mastalgia

A

Medication
Hormonal contraceptives
Anti depressants (sertraline)
Anti psychotics (haloperidol)

42
Q

Clinical features of mastalgia

A

Lumps, skin changes, fevers, discharge
Association with menstrual cycle
Drug history, breast feeding, pregnancy

43
Q

Causes of nipple discharge

A 
Physiological 
Duct papilloma
Duct ectasia
Periductal mastitis
Carcinoma
Galactorrhea
44
Q

Management of mastalgia

A

First line: paracetamol, NSAIDs, evening primrose oil, supportive bras
Second line: danazol, anti-gonadotropin agent

45
Q

What are the two types of breast carcinoma in situ

A

Ductal (more common) and lobular (more likely to become invasive)

46
Q

Types of ductal carcinoma in situ

A

Comedo (microcalcifications)
cribiform (multi focal)
micropapillary (multifocal)

47
Q

Ductal carcinoma in situ features in mammography

A

Micro calcifications, either localised or wide spread

48
Q

Management of ductal carcinoma in situ

A

Complete wide excision
Widespread or multifocal DCIS
Normally requires complete mastectomy

49
Q

Management of lobular carcinoma in situ

A

Low grade LCIS
Monitoring
Bilateral prophylactic mastectomy if patient possesses BRCA 1/2 genes

50
Q

Types of invasive ductal carcinoma

A 
Tubular
Cribriform 
Papillary 
Mucosal (colloid)
Medullary carcinomas
51
Q

Invasive lobular carcinoma

A

More common in older women
Diffuse (stromal) pattern of spread makes detection more difficult
Can spread to GI and skin

52
Q

Sites of metastases

A

Lung (pleural effusion)
Liver (ascites)
RICP (brain metastases)

53
Q

Risk factors for breast cancer

A

Female sex and age
BRCA 1/2
FH
Previous benign disease, developed country, obesity, alcohol
Degree of exposure to unopposed oestrogen, early menarche, late menopause, nulliparous women, oral contraceptives/HRT, first pregnancy after 30years of age

54
Q

Clinical features of breast cancer

A 
Breast lump 
Asymmetry
Swelling
Abnormal nipple discharge
Nipple retraction
Skin changes
Mastalgia
Palpable lump in axilla
55
Q

What is Nottingham prognostic index?

A

Sizex0.2) + nodal status + grade (Bloom-Richardson)

56
Q

Investigations for breast cancer

A 
Triple assessment
Histology
Grade
Vascular invasion
Receptor status
57
Q

What is Paget’s disease of the nipple?

A
  • Roughening, reddening and slight ulceration of the nipple
  • Underlying neoplasm in most (in situ or invasive)
  • Involvement of epidermis microscopically by malignant ductal cells
58
Q

Clinical presentation of paget’s

A

Itching or redness in nipple and/or areola, with flaking and thickened skin on or around nipple
Area often painful and sensitive
Flattened nipple with or without yellowing or bloody discharge

59
Q

Management of paget’s

A

Surgical removal of nipple and areola

Radiotherapy if there’s an underlying malignancy

General Surgery (2 decks)

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