Breast and peripheral vascular Flashcards
Types of breast cancer
Non-invasive: can’t spread, can’t kill e.g. Paget’s (DCIS of nipple)
Invasive: can spread but treatable e.g. ductal (most common), lobular (second most common)
Breast cancer screening programme
Mammogram
50-70 every 3 years
Trial in some parts of England to do ages 47-73
Breast cancer investigations
Triple assessment
- History and physical exam
- Radiological exam (USS<35, MG>35)
- Histological exam (FNA)
Grading of breast cancer
- Normal
- Benign
- Indeterminate
- Suspicious
- Malignant
Breast cancer management
Chemotherapy
Surgery
Radiotherapy after surgery
ER +ve - hormone therapy
HER2 +ve - biological therapy
When would you do excision vs mastectomy
Excision - solitary, small in large breast, DCIS <4cm
Mastectomy - multifocal, large in small breast, DCIS >4cm
Lactational mastitis management
Continue breastfeeding
Analgesia
Flucloxacillin
Non-lactional mastitis management
Broad-spectrum abx e.g. co-amoxiclav
Breat abscess management
USS guided aspiration
When should you use incision and drainage in breast abscess?
If pus is really thick, but need to explain risk of fistula formation
When do you excise a fibroadenoma?
> 3cm
ABPI interpretation
1.0-1.2 - normal
0.8-0.9 - mild claudication
0.5-0.79 - severe claudication
<0.5 - critical limb ischaemia
Investigation for intermitten claudication
- Duplex USS
- ABPI
Intermittent claudication management
Conservative - stop smoking, supervised exercise training, treat HTN/DM/obesity
Medical - clopidogrel, statin
Difference between critical limb ischaemia and acute-limb threatening ischaemia
Acute has sudden pain (<2 weeks) rather than gradual pain at rest
Acute may be pale, pulseless, paralysed, paraesthetic, or cold
Critical has gangrene and ulcers
