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A. MLA Map General Practice and Primary Healthcare > Breast abscess/ mastitis > Flashcards

Breast abscess/ mastitis Flashcards

1
Q

When a patient has suspected breast pathophysiology they will attend a specialist breast clinic. The basis of all breast investigations can be remembered using CRP. What does this relate to?

1 - clinical examination, relative history, path medical history
2 - clinical examination, radiology, pathology
3 - clinical examination, radiology, path medical history
4 - clinical examination, relative history, pathology

A

2 - clinical examination, radiology, pathology

  • referred to as the triple assessment if lump is present
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2
Q

When a patient has suspected breast pathophysiology they will attend a specialist breast clinic. During the clinical examination and history we ask about pain, and if it is cyclic or non cyclic. What does this mean?

1 - cyclic refers to pain that comes and goes in continuous pattern
2 - patient that cycles in line with circadian rhythm
3 - pain that is present during menstruation cycle

A

3 - pain that is present during menstruation cycle

  • so non-cyclic pain is anything not involving menstruation
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3
Q

We must ask questions relating to oestrogen exposure. One question is what age were you during menarche. What is this?

1 - when your periods stopped
2 - when you began contraception
3 - when periods stopped for >6 months
4 - when they had their 1st period

A

4 - when they had their 1st period

  • menopause is the opposite, so when did periods stop
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4
Q

If we locate a mass on the breasts, we must describe all of the following, EXCEPT?

1 - location
2 - size
3 - contour
4 - texture
5 - duration its been there

A

5 - duration its been there

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5
Q

Patients of a certain age will require a mammogram screening every 3 years at what age?

1 - >40
2 - >50
3 - >60
4 - >70

A

3 - >60

  • NHS states that it is between 51-71 years of age
  • stops at age 71
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6
Q

Why do patients <40 y/o not routinely get a mammogram in the UK?

1 - too expensive
2 - women don’t want it
3 - breast tissue is too dense

A

3 - breast tissue is too dense

  • sensitivity in <40 = 50%
  • sensitivity in >40 = 95%
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7
Q

What % of breast cancers are missed on routine population screening with mammograms?

1 - 0.5%
2 - 5%
3 - 15%
4 - 50%

A

2 - 5%

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8
Q

Mammograms are the mainstay for diagnosing breast abnormalities. However, which imaging modality is used to differentiate a breast cyst from a soft tissue mass?

1 - ultrasonography
2 - CT
3 - MRI
4 - Pet scan

A

1 - ultrasonography

  • also 1st line for image guided axillary guided biopsy
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9
Q

Although not commonly used, when can an MRI be useful for imaging breast tissue?

1 - older patients
2 - younger patients
3 - patients with breast implants
4 - patients with pace makers

A

3 - patients with breast implants

  • good at differentiating recurrent breast cancer from scar tissue
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10
Q

As part of the CRP (clinical examination/history, radiology, pathology) patients may receive a core biopsy. This is performed with 2 aids, what are they?

1 - image guided and a nurse assisting
2 - nurse assisting and vacuum biopsy
3 - image guided with vacuum

A

3 - image guided with vacuum

  • imaging is via ultrasound
  • vacuum removes and collects biopsy
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11
Q

A core biopsy allows full assessment of any located membranes can also be used to distinguish between carcinoma in-situ and invasive carcinoma. What does carcinoma in-situ mean?

1 - cancer has spread inside the breast
2 - cancer has spread to nearby organs
3 - localised in breast and not beyond the basement membrane

A

3 - localised in breast and not beyond the basement membrane

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12
Q

Once a core biopsy is taken, where will it be taken?

1 - cytology
2 - histology
3 - biochemistry
4 - bloods

A

1 - cytology

  • allows analysis of cells to identify if malignant
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13
Q

In addition to analysing if the biopsy is carcinoma in situ or invasive, we can also look at molecular markers. Which of the following is NOT a common marker looked for in breast biopsy?

1 - human epidermal growth factor receptor 2 (HER-2) receptors
2 - cancer antigen 19-9 (CA19-9) receptors
3 - estrogen receptors
4 - progesterone receptors

A

2 - Cancer antigen 19-9 (CA19-9) receptors

  • if these come back positive then this is good as we can treat with immunotherapy
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14
Q

What is a cyst?

1 - pus filled collection lined by any type of cell
2 - fluid filled area lined by granulation tissue
3 - fluid filled area lined by epithelial cells

A

3 - fluid filled area lined by epithelial cells

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15
Q

What % of women will experience breast pain at some point?

1 - 0.7%
2 - 7%
3 - 37%
4 - 70%

A

4 - 70%

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16
Q

Breast pain can be categorised into various types. Which of the following is most common?

1 - cyclical
2 - non-cyclical
3 - extra-mammary
4 - intra-mammary

A

3 - extra-mammary

  • essentially not breast related
  • outside of breast tissue
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17
Q

Cyclical breast pain resolves in what % of women?

1 - 0.2-0.3%
2 - 2-3%
3 - 20-30%
4 - 40-60%

A

3 - 20-30%

  • recurrence is high at 60%
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18
Q

Non-cyclical breast pain does not respond well to therapy, but what % resolves spontaneously?

1 - 0.5%
2 - 5%
3 - 50%
4 - 100%

A

3 - 50%

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19
Q

Does breast cancer normally present with pain?

A
  • no
  • only 3% present with breast pain
20
Q

Cyclical breast pain is normally associated with hormone fluctuations during menstrual cycle. When does this type of pain commonly occur?

1 - day 4
2 - day 14
3 - week following menstruation
4 - week prior to menstruation

A

4 - week prior to menstruation

21
Q

Which of the following is NOT true about cyclical breast pain?

1 - unilateral
2 - most severe in upper/outer quadrants
3 - associated with HRT and OCP
4 - week prior to menstruation

HRT = hormone replacement therapy
OCP = oral contraceptive pill

A

1 - unilateral

  • breast pain is normally bilateral
22
Q

Which of the following is NOT true about non-cyclical breast pain?

1 - constant or intermittent
2 - bilateral
3 - variable in its location
4 - related to a breast or chest wall lesion
5 - associated with musculoskeletal sources

A

2 - bilateral

  • normally unilateral
23
Q

What % of breast lumps in women between 20-50 y/o are benign?

1 - 0.9%
2 - 9%
3 - 49%
4 - >90%

A

4 - >90%

  • patients always think malignancy
  • if lump is present we do triple therapy (CRP)
24
Q

There are a myriad of different benign breast lumps. A fibroadenoma is a firm and mobile mass common in young women. What is a fibroadenoma?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - collection of pus lined by any types of cells
4 - fibrotic tissue around fluid filled sacs

A

1 - glandular and stromal tissue (fat)

25
Q

There are a myriad of different benign breast lumps. A fibrocystic change is a mildly tender nodular breast, common in premenopausal women. What is a fibrocystic change?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - collection of pus lined by any types of cells
4 - fibrotic tissue around fluid filled sacs

A

4 - fibrotic tissue around fluid filled sacs

26
Q

There are a myriad of different benign breast lumps. A cyst is a discrete, compressible solitary mass. What is a breast cyst?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - collection of pus lined by any types of cells
4 - fibrotic tissue around fluid filled sacs

A

2 - fluid filled sac lined by epithelial cells

27
Q

There are a myriad of different benign breast lumps. A breast abscess is a painful and tender lump that can occur with skin changes. What is a breast abscess?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - collection of pus lined by any types of cells
4 - fibrotic tissue around fluid filled sacs

A

3 - collection of pus lined by any types of cells

28
Q

There are a myriad of different benign breast lumps. A galactocele is common in breastfeeding women.
What is a galactocele?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - a collection of breast milk
4 - fibrotic tissue around fluid filled sacs

A

3 - a collection of breast milk

29
Q

There are a myriad of different benign breast lumps. Fat necrosis is common following trauma. What is fat necrosis?

1 - glandular and stromal tissue (fat)
2 - necrosis of fat tissue due to trauma
3 - a collection of breast milk
4 - fibrotic tissue around fluid filled sacs

A

2 - necrosis of fat tissue due to trauma

30
Q

What is breast mastitis?

1 - trauma to the breast tissue
2 - fluid filled sacs in breast tissue
3 - inflammation of breast tissue
4 - pain caused by menstruation

A

3 - inflammation of breast tissue

31
Q

Breast mastitis is inflammation of breast tissue, and can be grouped into lactating (breast feeding women) and non-lactating (non-breast feeding women). Which is most common?

A
  • lactating
  • accounts for 75% of mastitis
32
Q

Lactating mastitis is commonly causes by painful and cracked nipples, leading to bacteria from the baby to enter the ducts. This can also cause milk to become stagnant causing a blockage and/or infection. What are 2 other risk factors for lactating mastitis?

1 - smoking
2 - liver disease
3 - diabetes
4 - IBS

A

1 - smoking
3 - diabetes

33
Q

Non-lactating mastitis is basically where women who are not breastfeeding get a blocked duct that could lead to an infection. This can be caused by:

  • inflammatory cancer
  • infected foreign bodies (implants)
A
34
Q

In a patient who has mastitis they will need to be treated with all EXCEPT one of the following?

1 - antibiotics
2 - breast feeding advice
3 - breast core biopsy

A

3 - breast core biopsy

  • women may be encouraged to breast pump to let nipples heal
35
Q

What is the most common cause of mastitis in women?

1 - staphylococcus aureus
2 - escherichia coli
3 - streptococcus
4 - coryneform

A

1 - staphylococcus aureus

  • gram positive bacteria
36
Q

In a patient with mastitis due to a staphylococcus aureus infection, what antibiotic would we give them?

1 - flucloxacillin
2 - metronidazole
3 - gentamicin
4 - vancomyocin

A

2 - metronidazole
- able to work against gram positive and negative bacteria

  • if patient smokes then need to give them flucloxacillin as well
37
Q

Breast abscess can form in women and is most commonly caused by staphylococcus aureus following mastitis. Which of the following is NOT a risk factor for a breast abscess in lactating women?

1 - maternal age >30 y/o or gestational age >41 y/o?
2 - smoking
3 - 1st pregnancy
4 - diabetes
5 - RA or trauma
6 - liver disease

A

6 - liver disease

  • in non lactating women risk factors are obesity and smoking
38
Q

Breast abscess can present in a variety of ways. Which of the following is NOT a common presentation?

1 - localised pain
2 - redness and inflammation
3 - bilateral
4 - fever and malaise
5 - tender and palpable mass

A

3 - bilateral

  • normally only unilateral
39
Q

What imaging technique would we use to diagnose a breast abscess?

1 - X-ray
2 - mammogram
3 - CT
4 - ultrasonography

A

4 - ultrasonography

  • needle aspiration can also be performed
  • also used to percutaneously drain abscess if required
40
Q

In a patient with a breast abscess what is the most common advice given to mums to relieve the pain and abscess?

1 - continue breast feeding
2 - massage breast
3 - express milk with pumps

A

3 - express milk with pumps

41
Q

Which of the following is not a common complication of breast abscess?

1 - mammary duct fistula (communication between skin and duct)
2 - milk fistula
3 - antibioma (hard walled abscess)
4 - fat necrosis

A

4 - fat necrosis

42
Q

Although rare, what must be ruled out in women who non-lactating?

1 - inflammatory breast cancer
2 - fibrocystic changes
3 - fat necrosis
4 - galactocele

A

1 - inflammatory breast cancer

  • if doesn’t resolve with abscess treatment then need to do triple assessment
43
Q

Gynaecomastia is the hyperplasia of glandular tissue in males. Although common, does it always cause symptoms?

A
  • no, mainly asymptomatic
  • 60-90% in neonates
  • 50-60% adolescents
  • 70% in 50-69 y/o
44
Q

An imbalance between which 2 hormones is normally responsible for gynaecomastia?

1 - estrogen
2 - testosterone
3 - growth hormone
4 - androgen

A

1 - estrogen
4 - androgen

45
Q

The following are all causes of gynaecomastia, but which is the most common accounting for 58% of cases?

1 - Idiopathic
2 - Hypogonadism
3 - Hyperprolactinaemia
4 - Chronic liver disease
5 - Drug induced
6 - Testicular cancer

A

1 - Idiopathic

  • always do triple assessment (CRP) to identify cause

A. MLA Map General Practice and Primary Healthcare (28 decks)

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