Breast abscess/ mastitis Flashcards
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
2 - clinical examination, radiology, pathology
- referred to as the triple assessment if lump is present
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
3 - pain that is present during menstruation cycle
- so non-cyclic pain is anything not involving menstruation
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
4 - when they had their 1st period
- menopause is the opposite, so when did periods stop
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
5 - duration its been there
Patients of a certain age will require a mammogram screening every 3 years at what age?
1 - >40
2 - >50
3 - >60
4 - >70
3 - >60
- NHS states that it is between 51-71 years of age
- stops at age 71
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
3 - breast tissue is too dense
- sensitivity in <40 = 50%
- sensitivity in >40 = 95%
What % of breast cancers are missed on routine population screening with mammograms?
1 - 0.5%
2 - 5%
3 - 15%
4 - 50%
2 - 5%
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
1 - ultrasonography
- also 1st line for image guided axillary guided biopsy
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
3 - patients with breast implants
- good at differentiating recurrent breast cancer from scar tissue
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
3 - image guided with vacuum
- imaging is via ultrasound
- vacuum removes and collects biopsy
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
3 - localised in breast and not beyond the basement membrane
Once a core biopsy is taken, where will it be taken?
1 - cytology
2 - histology
3 - biochemistry
4 - bloods
1 - cytology
- allows analysis of cells to identify if malignant
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
2 - Cancer antigen 19-9 (CA19-9) receptors
- if these come back positive then this is good as we can treat with immunotherapy
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
3 - fluid filled area lined by epithelial cells
What % of women will experience breast pain at some point?
1 - 0.7%
2 - 7%
3 - 37%
4 - 70%
4 - 70%
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
3 - extra-mammary
- essentially not breast related
- outside of breast tissue
Cyclical breast pain resolves in what % of women?
1 - 0.2-0.3%
2 - 2-3%
3 - 20-30%
4 - 40-60%
3 - 20-30%
- recurrence is high at 60%
Non-cyclical breast pain does not respond well to therapy, but what % resolves spontaneously?
1 - 0.5%
2 - 5%
3 - 50%
4 - 100%
3 - 50%
Does breast cancer normally present with pain?
- no
- only 3% present with breast pain
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
4 - week prior to menstruation
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
1 - unilateral
- breast pain is normally bilateral
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
2 - bilateral
- normally unilateral
What % of breast lumps in women between 20-50 y/o are benign?
1 - 0.9%
2 - 9%
3 - 49%
4 - >90%
4 - >90%
- patients always think malignancy
- if lump is present we do triple therapy (CRP)
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
1 - glandular and stromal tissue (fat)
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
4 - fibrotic tissue around fluid filled sacs
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
2 - fluid filled sac lined by epithelial cells
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
3 - collection of pus lined by any types of cells
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
3 - a collection of breast milk
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
2 - necrosis of fat tissue due to trauma
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
3 - inflammation of breast tissue
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?
- lactating
- accounts for 75% of mastitis
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
1 - smoking
3 - diabetes
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)
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
3 - breast core biopsy
- women may be encouraged to breast pump to let nipples heal
What is the most common cause of mastitis in women?
1 - staphylococcus aureus
2 - escherichia coli
3 - streptococcus
4 - coryneform
1 - staphylococcus aureus
- gram positive bacteria
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
2 - metronidazole
- able to work against gram positive and negative bacteria
- if patient smokes then need to give them flucloxacillin as well
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
6 - liver disease
- in non lactating women risk factors are obesity and smoking
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
3 - bilateral
- normally only unilateral
What imaging technique would we use to diagnose a breast abscess?
1 - X-ray
2 - mammogram
3 - CT
4 - ultrasonography
4 - ultrasonography
- needle aspiration can also be performed
- also used to percutaneously drain abscess if required
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
3 - express milk with pumps
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
4 - fat necrosis
Although rare, what must be ruled out in women who non-lactating?
1 - inflammatory breast cancer
2 - fibrocystic changes
3 - fat necrosis
4 - galactocele
1 - inflammatory breast cancer
- if doesn’t resolve with abscess treatment then need to do triple assessment
Gynaecomastia is the hyperplasia of glandular tissue in males. Although common, does it always cause symptoms?
- no, mainly asymptomatic
- 60-90% in neonates
- 50-60% adolescents
- 70% in 50-69 y/o
An imbalance between which 2 hormones is normally responsible for gynaecomastia?
1 - estrogen
2 - testosterone
3 - growth hormone
4 - androgen
1 - estrogen
4 - androgen
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
1 - Idiopathic
- always do triple assessment (CRP) to identify cause
