breast conditions

Question 1

mastalgia

Answer 1

breast pain

Question 2

cyclic mastalgia s/s, location, duration

Answer 2

heavy, soreness, radiates to axilla/arm, variable duration, resolves spontaneously, bilateral and poorly localized

Question 3

noncyclic mastalgia s/s/, location, duration

Answer 3

sharp or burning, unilateral and localized

Question 4

extramammary

Answer 4

pain is felt in breast but it does originate in it, ex. chest wall pain, cracked ribs

Question 5

mastalgia work up in <30 if clinical breast exam normal,

Answer 5

no imagining needed, if they want it then order ultrasound

Question 6

mastalgia work up <30 with abnormal clinical breast exam work up, focal pain, mass, risk breast ca

Answer 6

order ultrasound

Question 7

mastalgia >30 clinical breast exam abnormal work up, focal mass, risk breast ca

Answer 7

order ultrasound and mammogram

Question 8

cyclic treatment mastalgia

Answer 8

better bra, evening primrose oil, flaxseed, diet, decrease caffeine, warm compress

Question 9

first line medication for mastalgia

Answer 9

NSAIDS, diclofenac patch then danzol

Question 10

danazol (synthetic progestin) is used for?

Answer 10

mastalgia after NSAIDS

Question 11

side effects of danazol (synthetic progestin)

Answer 11

facial hair, voice changes

Question 12

causes of cyclic mastalgia

Answer 12

fibrocystic changes, hormonal contraception, normal hormonal changes

Question 13

stages of fibrocystic changes

Answer 13

1. ) stromal proliferation or hyperplasia
2. ) adenosis (increased glands)
3. ) cyst formation

Question 14

what do fibrocystic changes feel like? location of breast?

Answer 14

rope-like or lumpy especially in upper quadrants

Question 15

Fibrocystic changes management

Answer 15

NSAIDS, OC, ultrasound for discrete masses, fine needle aspiration of cysts, surgery, possible biopsy, primerose oil

Question 16

galactocele

Answer 16

milk-filled cyst thats usually harmless

Question 17

intraductal papilloma

Answer 17

a benign, wart like growth in a milk duct

Question 18

Fibroadenoma

Answer 18

fibrous/glandular tissue within the breast

Question 19

Fibroadenoma s/s

Answer 19

round, mobile, fluctuant (rubbery), defined border

Question 20

do fibroadenomas change with menses?

Answer 20

no

Question 21

simple cysts fluid color, mobile?

Answer 21

clear fluid, mobile, ballotable, no echoes

Question 22

complicated cysts fluid color, mobile?

Answer 22

fluid filled, low level echoes

Question 23

when do you refer for simple cysts?

Answer 23

if there is severe pain, obstruction of tissue (so you cant see all tissue)

Question 24

complex cysts characteristics

Answer 24

wall is thicker, septination, cyst is solid, bloody fluid

Question 25

when do you refer for complicated cysts?

Answer 25

refer for aspiration

Question 26

when do you refer for complex cysts?

Answer 26

refer for aspiration and/or biopsy

Question 27

Intraductal papilloma

Answer 27

small,non cancerous tumor in milk duct (can harbor Ductal carcinoma insitu)

Question 28

when does intraductal papilloma usually occur in women

Answer 28

35-55

Question 29

Intraductal papilloma s/s, unilateral? bilateral?

Answer 29

breast enlargement, lump pain, nipple discharge (thick cream), unilateral

Question 30

Intraductal papilloma treatment

Answer 30

surgical removal of duct

Question 31

Intraductal papilloma diagnostics

Answer 31

ultrasound if discharge, mass may be palpable, aspiration or biopsy, ductogram

Question 32

Causes of noncyclic mastalgia

Answer 32

mastitis, large boobs, breast ca, HRT, ductal ectasia( dilatedmilk duct)

Question 33

mastitis labs

Answer 33

CBC, CRP

Question 34

Mastitis treatment

Answer 34

tylenol, ibuprofen, abx

Question 35

good standard abx for Mastitis

Answer 35

dicloxacillin 500 mg 4 times a day

Question 36

breast abscess

Answer 36

mastitis plus fluctuant mass

Question 37

breast abscess s/s

Answer 37

red, hot, painful, high fever, swelling

Question 38

steps in evaluating a palpable mass

Answer 38

1. ) serial exam : if exam doesn’t present with dominant mass and patient <35 without risk factors, can re-examine 3-10 days after onset of menses or f/unect clinical breast exam
2. )ultrasound: <35 with breast compliant (and not following conservatively), determine if mass is solid, complex etc
3. ) mammogram: if ultrasound shows complex or solid lesion or if exam is suspicious for breast ca and patient >35
4. ) needle aspiration:send to breast center, if fluid clear and cyst resolves, can re-evaluate in 4-6 weeks
5. ) Biopsy of mass: done by surgeon

Question 39

causes of bloody nipple discharge

Answer 39

malignancy vs papilloma….unilateral blood discharge= concerned

Question 40

causes of purulent nipple discharge

Answer 40

infection, usually related to lactation

Question 41

causes of milky discharge

Answer 41

hypothyroidism, prolactinomas, tricyclic antidepressants, dopamine agonists, OCPs

Question 42

causes of green, brown nipple discharge

Answer 42

duct ectasia (inflammation of lactiferous ducts

Question 43

duct ectasia and what color discharge does it cause

Answer 43

inflammation of lactiferous ducts, causes green, brown discharge of nipple

Question 44

pathologic nipple discharge work up

Answer 44

diagnostic mammogram, breast ultrasound, refer to breast surgeon even if WNL, NO CYTOLOGY (absence of cancer cells doesn’t r/o cancer)

Question 45

meds that cause nipple discahrge

Answer 45

HTN meds, GI meds, hormones, reglan, opiates, psychotropic agents, antipsychotics, MAOIs, SSRIs

Question 46

adenopathy

Answer 46

abnormal enlargement of a lymph node