Breast Disorders

Question 1

what are the 3 most common breast complaints?

Answer 1

pain (mastalgia), mass, discharge

Question 2

can any of those complaints be from something benign?

Answer 2

yes and usually are!

Question 3

is breast pain indicative of breast cancer?

Answer 3

RARELY

Question 4

what usually causes breast pain?

Answer 4

hormonal changes

Question 5

is breast pain more common in pre-menopausal or post-menopausal women?

Answer 5

pre

Question 6

what is cyclic breast pain?

Answer 6

breast soreness and heaviness felt 1 week before menses

Question 7

where is cyclic breast pain most severely felt?

Answer 7

upper outer quad

Question 8

in what age group does non-cyclic breast pain occur?

Answer 8

40-50 MC

Question 9

what does non-cyclic breast pain feel like?

Answer 9

sharp or burning, unilateral

Question 10

is non-cyclic breast pain dangerous?

Answer 10

more alarming than the others, but can just be from something benign like having large breasts

Question 11

how do you treat breast pain?

Answer 11

it’s self-limited. bras, analgesics, evening primrose oil

Question 12

which mastalgia drug can cause androgenic s/e?

Answer 12

danazol

Question 13

can you perform surgery for breast pain?

Answer 13

never

Question 14

what are the 3 types of nipple discharge?

Answer 14

1. normal/lactation
2. galactorrhea
3. pathologic

Question 15

what gets secreted from the nipple during lactation?

Answer 15

milk and colostrum

Question 16

a woman presents to you in family care. She stopped breast feeding 4 months ago, but is still getting a lot of discharge from her nipples and she is worried. What should you do?

Answer 16

Tell her that it is normal to have nipple discharge for up to 6 months after breastfeeding

Question 17

what is galactorrhea

Answer 17

bilateral milky discharge involving multiple ducts caused by an increase in prolactin

Question 18

what is secreted in pathologic nipple discharge?

Answer 18

something other than milk

Question 19

what is the MC cause of pathologic nipple discharge?

Answer 19

papilloma

Question 20

which of the following is pathologic? nipple discharge with compression or spontaneous discharge

Answer 20

spontaneous

Question 21

which of the following is pathologic? nipple discharge that is bilateral or unilateral

Answer 21

unilateral

Question 22

which of the following is pathologic? nipple discharge coming from multiple ducts or one duct?

Answer 22

one duct

Question 23

which of the following is pathologic? nipple discharge in a woman over 40y or in her reproductive years?

Answer 23

reproductive years

Question 24

is bloody discharge pathologic?

Answer 24

yes

Question 25

is clear, yellow, white, and/or dark green discharge pathologic?

Answer 25

none

Question 26

if nipple discharge is associated with a mass, is it pathologic?

Answer 26

yes

Question 27

After a hx and breast exam, what 4 lab values should you get in a patient with nipple discharge

Answer 27

hCG, prolactin, TSH, renal

Question 28

when do you refer someone with nipple discharge to surgery?

Answer 28

if it is spontaneous + unilateral

Question 29

when a woman is concerned about a breast mass, what history questions should you ask?

Answer 29

change in breast, change in skin, nipple inversion or discharge, breast pain and its relationship to cycle, onset and evolution, location, family hx, PMH of breast cancer

Question 30

what are the 5 types of benign breast masses?

Answer 30

1. fibroadenoma 2. cyst 3. fibrocystic changes 4. galactocele 5. fat necrosis

Question 31

which type of benign breast mass is associated with cyclic breast pain during pre-menopausal years, and is diffuse, tender, and not well defined?

Answer 31

fibrocystic changes

Question 32

which type of benign breast mass is a solid, firm, mobile spot that can be "rolled to an edge," occurs in young women, and is associated with hormones?

Answer 32

fibroadenoma

Question 33

which type of benign breast mass is related to milk retention in breastfeeding women?

Answer 33

galactocele

Question 34

which type of benign breast mass is a fluid-filled, compressible, ballotable spot that may be painful, and occurs at pre- and peri-menopause?

Answer 34

cysts

Question 35

which type of benign breast mass occurs post-trauma, surgery, radiation, or breast augmentation and is hard to distinguish?

Answer 35

fat necrosis

Question 36

what is the "triple test" needed for diagnosis?

Answer 36

PE mammography needle bx

Question 37

what are the 2 types of needle bx?

Answer 37

fine needle aspiration core needly bx

Question 38

how do you manage benign breast masses?

Answer 38

follow-up in 2-4mos for breast exam

Question 39

when do you consider a surgical referral for a benign breast mass?

Answer 39

if aspirate is bloody if there is not a complete collapse if it recurs a lot

Question 40

what 4 other things can cause breast masses?

Answer 40

abcess mastitis cancer inflammatory breast cancer

Question 41

what are the sx of lactational mastitis?

Answer 41

local, painful breast inflammation fever, malaise abcess if left untreated

Question 42

what will you see on PE with lactational mastitis?

Answer 42

hard, red, tender, swollen area

Question 43

what organism causes lactational mastitis?

Answer 43

S aureus

Question 44

how do you treat lactational mastitis?

Answer 44

dicloxacillin or clinda (MRSA)

Question 45

what is gynecomastia

Answer 45

benign proliferation of glandular breast tissue in males

Question 46

what do you feel on PE with gynecomastia?

Answer 46

palpable mass most likely under the nipple

Question 47

what causes physiologic gynecomastia?

Answer 47

hormone imbalance (high estrogen, low androgen)

Question 48

who gets physiologic gynecomastia?

Answer 48

1. neonates 2. puberty 3. older males

Question 49

how do you treat physiologic gynecomastia?

Answer 49

you don't, it's self-limited

Question 50

what causes pathologic gynecomastia?

Answer 50

drugs cirrhosis hypogonadism CKD tumors

Question 51

when do you give a mammogram for gynecomastia?

Answer 51

unilateral, non-tender, and fixed

Question 52

is male breast cancer common?

Answer 52

no super rare