breast diseases

Question 1

fibrocystic breast changes

Answer 1

• most common cause of benign breast disorders
• painful/sensitive breasts
• nodular
• pain related to menses

Question 2

risk factors for fibrocystic breast changes

Answer 2

• nulliparity
• late menopause
• estrogen replacement therapy
• common in women 30-50

Question 3

clinical presentation of fibrocystic breast changes

Answer 3

• painful bilat breasts
• nodular, smooth, well defined
• freely moving
• fluctuates with menstrual cycle

Question 4

work up for fibrocystic breast changes

Answer 4

• H&P
• if normal exam reeval in 2-4 weeks
• US to distinguish from cystic vs solid mass
• mammogram if < 40 and suspicious of mass

Question 5

tx of fibrocystic breast changes

Answer 5

• reassurance
• wear supportive bra
• analgesia
• any dominant mass must be referred to breast surgeon*

Question 6

fibroadenoma of the breast

Answer 6

• benign glandular tissue
• ages 10-30
• hormonally influenced
• if mass detected > 30 must r/o cancer

Question 7

si/sx of fibroadenoma

Answer 7

• increases with pregnancy
• regresses with menopause
• painless, round, hard/ rubbery
• movable
• discrete, well defined
• may be single or multiple tumors

Question 8

dx of fibroadenoma

Answer 8

• H&P
• US
• mammogram if age appropriate
• core biopsy*
• excision* if dx uncertain or large/uncomfrotable

Question 9

tx of fibroadenoma

Answer 9

• reassurance
• monitor with serial breast exam, short term f/u
• can excise if symptomatic or if pt prefers removal

Question 10

acute mastitis

Answer 10

• breast infx
• common in breast feeding mothers, first 2 months
• d/t s. aureus

Question 11

si/sx of mastitis

Answer 11

• unilateral inflammation, erythema
• mastalgia
• sore nipple
• engorged breast
• fever/ chills

Question 12

treatment of mastitis

Answer 12

• regular breast emptying
• dicloxacillin* or cephalexin
• get rid of milk

Question 13

complication of mastitis

Answer 13

• abscess

Question 14

breast abscess

Answer 14

• localized collection of pus in breast
• usu dev from mastitis or cellulitis
• can be first presentation of breast infx
• does not have to be in breast feeding moms

Question 15

risk factors for breast abscess in non-lactating females

Answer 15

• AA
• obese
• smoker- assoc with recurrence

Question 16

si/sx of breast abscess

Answer 16

• localized painful inflammation of breast
• fever, malaise
• fluctuant, tender, palpable mass
• variable course

Question 17

tx of breast abscess

Answer 17

• 10-14 days
• dicloxacillin*
• cephalexin
• bactrim if MRSA

Question 18

gynecomastia

Answer 18

• benign proliferation of glandular tissue of male breast
• due to increased estrogen
• unilateral or bilateral

Question 19

physiologic causes of gynecomastia

Answer 19

• infancy
• puberty
• older age

Question 20

pathologic causes of gynecomastia

Answer 20

• drugs
• androgen deficiency
• testicular tumor
• hyperthyroidism
• CKD
• cirrhosis
• malnutrition

Question 21

drugs assoc with gynecomastia

Answer 21

• spironolactone
• cimetidine
• anabolic steroids

Question 22

pseudogynecomastia

Answer 22

• fat deposition without glandular proliferation

- often seen in obese men

Question 23

clinical findings for gynecomastia

Answer 23

• palpable mass, usu at least 0.5 cm

- most common under the nipple

Question 24

treatment for gynecomastia

Answer 24

• differentiate from pseudogynecomastia and carcinoma
• dont miss testicular cancer
• d/c offending drugs
• f/u exam
• treat any underlying conditions

Question 25

risk factors for breast cancer

Answer 25

• advanced age, female, white
• early menarche, late menopause
• BRCA1/ BRCA2 mutation
• first degree relative with breast ca
• later age of 1st pregnancy, no breast feeding, nulliparity
• alcohol, smoking
• postmenopausal obesity

Question 26

protective factors from breast cancer

Answer 26

• breastfeeding

- physical activity

Question 27

early si/sx of breast cancer

Answer 27

• immobile, fixed, ill defined margins
• hard
• painless
• mammogram- linear calcifications

Question 28

late si/sx of breast cancer

Answer 28

• fixed mass to skin or chest wall
• skin or nipple retraction
• asymmetric enlargement or shrinkage
• edema, erythema, pain
• spont unilateral bloody d/c
• jaundice, bone pain, wt loss
• peau d’orange

Question 29

lymphadenopathy with breast cancer

Answer 29

• matted, hard, firm, immovable
• fixed to skin or deeper tissues
• > 1 cm
• assess axillary, supra/ infraclavicular nodes
• spreads through lymphatics

Question 30

work up for breast cancer

Answer 30

• mammogram/ US
• biopsy
• TNM staging
• LN eval
• biomarkers- ER, PR, HER-22
• alk phos, LFTs, CBC
• CT and PET scan

Question 31

where does breast cancer metastasize to

Answer 31

• bone
• lung
• liver
• brain

Question 32

dx of breast cancer

Answer 32

• percutaneous biopsy- FNA or core needle aspiration

Question 33

inflammatory breast cancer

Answer 33

• rapidly progressing, tender, firm enlargement of breast
• thickening of underlying skin
• presents similarly as mastitis, r/o if infx doesnt respond to abx

Question 34

SERM tx for breast cancer

Answer 34

• used in premenopausal women
• given 5-10 years then switch to AI
• tamoxifen

Question 35

SERM ADRs

Answer 35

• DVT
• uterine ca
• vasomotor sx

Question 36

aromatase inhibitors for breast cancer

Answer 36

• superior to SERMs
• given for 5 years
• c/i in premenopausal women
• anatrozole, letrozole

Question 37

aromatase inhibitor ADRs

Answer 37

• bone loss
• myalgias
• arthralgias

Question 38

mammography

Answer 38

• primary imaging modality for early det of breast ca
• only imaging that decreases mortality
• spiculated
• dense breast can obscure ca
• not used if < 40 y/o