Breast conditions

Question 1

What are the two causes of Peurperal mastitis?

Answer 1

Non-infective: accumulation of milk causing an inflammatory response

Infectious: accumulated milk allows bacteria to grow. Normally staph aureus.

Question 2

What are the symptoms of mastitis?

Answer 2

One breast being tender, painful, red and hot. Normally .>1 week postpartum.

Question 3

Signs of mastitis?

Answer 3

Unilateral oedema
Erythema in a wedge shaped area, and tenderness
Fever
If abscess there will be a fluctuant tender lump

Question 4

Investigations for mastitis?

Answer 4

Diagnosis is usually clinical
If abscess is suspected ultrasound will show collection of pus
If infection is severe or recurrent then milk can be cultured

Question 5

Should breast feeding be continued in mastitis?

Answer 5

Yes

Question 6

First line treatment of mastitis?

Answer 6

Reassurance
continue breast feeding
Improve milk removal
Analgesia

Question 7

What is the management for breast abscesses?

Answer 7

Incision and drainage with cavity packed open with gauze
Parenteral antibiotics
Needle aspiration of abscess every other day until pus no longer accumulates

Question 8

What is the most common complication of mastitis?

Answer 8

Cessation of breast feeding

Question 9

How many women with peurperal mastitis will get a breast abscess?

Answer 9

3-7%

Question 10

How do benign breast masses normally present on examination?

Answer 10

three dimensional, mobile, smooth, has regular borders and is solid or cystic in consistency

Question 11

How do malignant breast masses normally present?

Answer 11

Firm in consistency, has irregular borders and is fixed to the underlying skin or soft tissue. There may also be skin changes or nipple retraction

Question 12

What is mammary duct ectasia?

Answer 12

Characterised by dilation of major ducts in the subareolar region. The ducts contain eosinophilic granular secretions and foamy histiocytes. The secretions may undergo calcification and this may be the presenting sign

Question 13

How does mammary duct ectasia present?

Answer 13

Microcalcification on a routine mammogram
Nipple discharge
Palpable subareolar mass
Non-cyclical mastalgia
Nipple inversion or retraction

Question 14

How is mammary duct ectasia diagnosis made?

Answer 14

Via a combination of ultrasound, Ductography and ductal lavage and cytology

Question 15

How is mammary duct ectasia managed?

Answer 15

Surgical excision of the ducts below the nipple

Question 16

What is pagets disease of breast?

Answer 16

An infiltrating carcinoma of the nipple epithelium

Question 17

Where do breast cancers arise from?

Answer 17

The epithelial lining of ducts and are called ductal.

From the epithelium of the terminal ducts of the lobules and are called lobular.

Question 18

What is the lifetime risk of females developing breast cancer?

Answer 18

1 in 8

Question 19

What is the lifetime risk of a women with the BRCA1 mutation?

Answer 19

80-85%

Question 20

Why are ultrasound scans used in younger women as opposed to mammography?

Answer 20

Younger women have denser breast tissue

Question 21

What causes Peau d’orange?

Answer 21

cutaneous lymphatic edema

Question 22

What treatment modalities are available for breast cancer?

Answer 22

surgery
chemotherapy
hormonal therapy
radiotherapy