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NPLEX 2 RaeForReal > Breast/Axillae > Flashcards

Breast/Axillae Flashcards

1
Q

Types of non-invasive breast cancer

A
  1. Ductal carcinoma in situ
  2. Lobular carcinoma in situ
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2
Q

Types of invasive breast cancer

A
  1. Inflammatory carcinoma
  2. Invasive ductal carcinoma of the breast
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3
Q

Most common benign breast tumor, and where it is typically found

A

Fibroadenoma, upper outer quadrant

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4
Q

Cause of fibrocystic breast disease

A

Fibrous and cystic hyperplasia of breast tissue due to excess estrogen (usually B/L)

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5
Q

Name of ductal carcinoma that invades the nipple and presents unilaterally as dermatitis

A

Paget disease of breast

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6
Q

Infectious agent of mastitis

A

S aureus

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7
Q

Pathophysiology of gynecomastia

A
  • Endocrine: Primary hypogonadism, hyperthyroid, extreme hyperprolactinemia, arenal disease
  • Tumors: Pituitary, adrenal, testicular, breast
  • Chronic disease: Liver disease, malnutrition
  • Meds: Spironolactone, digoxin, chemo
  • Genetic: Klinefelter syndrome
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8
Q

Investigation of gynecomastia

A
  • TSH, PRL, LH, FSH, free T, estradiol, LTFs, B-HCG
  • Chest x-ray, CT chest/abdomen/pelvis
  • Testicular US to R/O mass
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9
Q

Mastitis etiology and symptoms

A

S aureus

Unilateral localized breast pain, tenderness, erythema, malodorous breast milk, worse pain with nursing.

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10
Q

Clinical features of imflammatory carcinoma of the breast

A

Erythema, non-pitting edema, +/- lump, warm/swollen/tender breast, obstruction of lymphatics causes orange peel consistency to skin (peau d’orange)

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11
Q

Cause of nipple retraction in invasive ductal carcinoma of the breast

A

Cancer invades cooper ligaments within ducts

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12
Q

Identify the dx:
Non-tender, firm, smooth, rubbery, mobile breast mass. Well circumscribed, rarely becomes malignant.

A

Fibroadenoma

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13
Q

(T or F) 80% of DCIS are non-palpable, and are detected by screening mamogram

A

True

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14
Q

Tx of DCIS

A
  • Lumpectomy and radiation
  • Mastectomy if high grade/large area of disease
  • Tamoxifen as adjuvant
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15
Q

Survival rate of DCIS

A

99% 5-year survival rate

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16
Q

This condition is usually found incidentally on breast biopsy for another indicaiton

A

Lobular carcinoma in situ

17
Q

(T or F) 50% of breast cancer is located in the upper outer quadrent

A

True

18
Q

(T or F) 90% of breast cancer arise in ductal epithelium

A

True

19
Q

Risk factors for breast cancer

A
  • 99% female
  • 80% over 40 YO
  • Nullparity, first pregnancy over 30, menarche before 12, menopause over 55
  • Fhx (greater risk if first degree and premenopausal)
  • Obesity, high-fat diet, sedentary lifestyle
  • BRCA 1 & 2 gene mutations
  • > 5 year HRT use, >10 year OC use

Lower risk with lactation, early menopause, early childbirth

20
Q

Case 1 / Question 1
What diagnostic test would confirm the suspected diagnosis?

62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast

A

Biopsy

21
Q

Case 1 / Question 2
The most likely diagnosis is?

62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast

A

Breast cancer

22
Q

Case 1 / Question 3
Which of the following treatments may be considered in non-metastatic hormone receptor-positive breast cancers:
1. Tamoxifen
2. Vinblastine
3. 5-fluorouracil
4. Finasteride?

62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast

A

1 - Tamoxifen (SERM commonly used in tx of hormone-receptor positive breast cancers)

23
Q

Case 1 / Question 4
The best tx recommendation to give this pt to prevent recurrence is:
1. 400mg diindolylmethane daily
2. 3000 mg vit C daily
3. Reduce alcohol intake
4. 2000 IU vit D daily

62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast

A

1 - 400mg diindolylmethane daily

24
Q

Case 1 / Question 5
She was given a drug to tx her condition and is now experiencing severe hot flashes. Which tx is effective for tx of hot flashes in men with prostate cancer, and has been demonstrated to be effective in women with breast cancer?
1. Vitex agnus-castus
2. Dioscorea villosa
3. Serenoa repens
4. Salvia officinalis

62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast

A

4 - Salvia officinalis

25
Q
A

NPLEX 2 RaeForReal (27 decks)

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