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3rd year core conditions > Breast conditions > Flashcards

Breast conditions Flashcards

1
Q

Which is the most common pathogen causing breast abscess?

A. S epidermidis
B. S aureus
C. E Coli

A

B

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2
Q

Which of these are risk factors for breast abscess?
(can be more than one)

A. Lactation
B. Obesity
C. Hypertension
D. Smoking
E. Xs alcohol
F. Large breasts
A

A, B, D and F

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3
Q

Breast abscesses occur most commonly in which age range?

A. 35-50
B. 20-55
C. 15-45

A

C. Presumably because those are commonest child bearing age, and usually occurs in breast feeding mums

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4
Q

How often does breast abscess occur in women with mastitis?

A

3-11%

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5
Q

Which of these are NOT a type of mastitis

A. Lactating mastitis
B. Non-lactating mastitis
C. Cyclical mastitis
D. Neonatal mastitis

A

C.

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6
Q

What causes neonatal mastitis?

A

maternal hormones result in transiently enlarged breasts

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7
Q

What proportion of neonatal mastitis progress to breast abscess?

A. 20%
B. 30%
C. 45%
D. 50%

A

D.

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8
Q

What are the 2 main causes of breast abscess?

A

Lactational and duct ectasia. Both can lead to blocked ducts.

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9
Q

Define duct ectasia. How does this contribute to the formation of breast abscess?

A

Duct ectasia = milk duct beneath nipple widens, duct walls thicken and the duct fills with fluid – associated with peri-menopausal women
Blocks + inflames ducts = prone to infection

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10
Q

When do breast abscesses usually form after giving birth?

A. 2-5 weeks
B. 3-8 weeks
C. 7-13 weeks
D. 6-9 weeks

A

B.

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11
Q

Which of these are not first line ix for breast abscess?

A. FBC
B. Breast USS
C. Needle aspiration
D. Culture + sensitivity of aspirate

A

A.

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12
Q

Can lactational patients still breast feed?

A

Mostly yes

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13
Q

What are symptoms to look out for in baby if breast feeding and on abx?

A

Signs of systemic illness, diaper rash

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14
Q

What are some management options for a breast abscess?

A

Conservative: promote effective milk removal (avoid stasis)
Medical: pain relief + abx
Surgical: needle aspiration, surgical incision + drainage

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15
Q

Which of these age groups are fibrocystic breasts most common?

A. 25-29 years
B. 40-44 years
C. 45-49 years

A

C. Peak incidence is between 3rd-4th decade of life.

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16
Q

Which of these is NOT a risk factor for fibrocystic breasts?

A. oestrogen replacement therapy
B. Late-onset menopause
C. Later age at first childbirth
D. Late menarche
E. Nulliparity
A

D.

17
Q

Which of these are true of pain experienced in fibrocystic breasts?

A. often bilateral
B. not associated with hormonal changes
C. precedes menses by a few days and stops shortly after
D. sharp constant pain

A

A and C

18
Q

Which of these are not first line investigations for fibrocystic breasts?

A. mammography
B. breast USS
C. cyst aspiration
D. CA 125 blood test

A

C and D

19
Q

Does having fibrocystic breasts increase the risk of getting breast cancer?

A

fibrocystic changes don’t correlate with increased risk of breast cancer.

HOWEVER, it reflects a broad spectrum of conditions, some of which may increase the risk of breast cancer

20
Q

What are the 2 first line treatments for fibrocystic breasts?

A

1 ) supportive – reassuring the patient that the breast pain/lumpiness it is just the effects of hormonal cycling

2) analgesics – paracetamol/ibuprofen/aspirin

21
Q

What is the 2nd line treatment for fibrocystic breasts and when should it be considered?

A

Hormonal therapy – tamoxifen

If breast pain is:

1) severe
2) >6mths
3) interfering with daily activities

22
Q

Primary invasive breast cancer makes up what percentage of all new cancer cases in women?

A. 20%
B. 25%
C. 30%
D. 35%

A

B.

23
Q

Which of these are NOT risk factors for primary invasive breast cancer?

A. Younger age
B. Family history
C. Genetic predisposition
D. Decreased breast density 
E. Xs alcohol consupmtion
F. Smoking
A

A. and D. (it’s older age and increased density thats a risk factor)

24
Q

Which of these symptoms/signs are consistent with primary invasive breast cancer?

A. bilateral breast tenderness
B. axillary lymphadenopathy
C. smooth, well demarcated & mobile mass
D. tethering of the breast

A

B. and D.

25
Q

Explain peau d’orange

A

Lymphatic oedema of breast –> parts of skin in breast tethered by ligaments of cooper so can’t swell –> creates many dimples in skin resulting in orange peel like appearance

26
Q

Is tethering a sign of benign or malignant disease? Why?

A

Malignant. Tethering is a sign of infiltration and a fibrous response (myofibroblasts produce fibrous tissue that contracts), which is characteristic of malignancy

27
Q

What is the most suitable breast imaging modality for women under 40 years old? Why?

A

USS. Younger women have dense, fibrous tissue in their breasts so mammograms are less useful.

28
Q

Which of these are 1st line imaging modality for breast cancer?

A. Mammogram
B. USS
C. CT
D. MRI

A

A. and B.

29
Q

What are some characteristics of malignancy in a mammogram?

A

irregular, spiculated mass
clustered microcalcs
linear branching calcs

30
Q

What are some characteristics of malignancy in a breast USS

A

hypoechoic mass
internal calcs
enlarged axillary nodes

31
Q

Which of these treatments are NOT appropriate for a HER2+ and ER+ 13mm UUQ tumour in the right breast with no obvious nodal involvment or distant metastases?

A. trastuzamab
B. tamoxifen
C. wide local excision with sentinal node biopsy
D. mastectomy

A

D.

32
Q

Which of these are NOT a type of breast reconstructive techniques

A. TRAM flap
B. LD flap
C. DIEP flap
D. TRUSS flap
E. Implant reconstruction
F. Tissue expanders reconstruction
A

D. a truss is a device used to treat hernias

33
Q

What is the most common cause of bloody nipple discharge in women 20-40 years?

A. primary invasive breast cancer
B. duct ectasia
C. intraductal papilloma
D. fibroadenoma

A

C.

34
Q

What is an intraductal papilloma?

A

Benign tumour
Within ducts
From ductal epithelial cells

35
Q

Are intraductal papillomas a high-risk or low-risk precursor lesion?

A

High-risk

36
Q

Where do intraductal papillomas usually present?

A. upper outer quadrant
B. centrally posterior to nipple
C. peri-aerolar
D. peripherally

A

B. and D.

peripheral if multiple, centrally if only one.
breast cancers usually present in upper outer quadrant

37
Q

Which of these are the most appropriate modality for investigating intraductal papilloma

A. mammogram
B. USS
C. CT
D. MRI

A

B.

usually too small to be picked up on mammogram

38
Q

How are intraductal papillomas treated and what kind of follow up is required?

A

Complete excision and removal of the tumour - lumpectomy.

Annual screening mammograms at age of 40 - educate about self-examination for breast lesions

3rd year core conditions (3 decks)

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