Breast Disorders

Question 1

If you see nipple ulceration that looks like eczema, with some burning and itching, what should you think of?

Answer 1

Paget’s disease

Question 2

How do we diagnose Paget’s disease?

Answer 2

skin biopsy

Question 3

A red inflamed breast, with an “orange peel” texture – what is it? Prognosis?

Answer 3

Inflammatory breast cancer, worse prognosis than most breast cancers

Question 4

How do you diagnose inflammatory breast cancer?

Answer 4

Mammography

Question 5

A male presenting with increased breast size or a palpable mass is known as? Tx?

Answer 5

Gynecomastia

- Self-limited, or due to hormonal imbalance

Question 6

If a breastfeeding woman has a painful inflamed left breast with fever and malaise, dx? Cause? Tx?

Answer 6

Mastitis

          - Caused by staph aureus
          - Tx with dicloxacillin or clinda

Question 7

What is pain in the breast prior to menopause or menses?

Answer 7

Mastalgia

Question 8

If a woman has breast pain and heaviness 1 week prior to the onset of menses, dx? Tx? What if they’re over 30?

Answer 8

Cyclic breast pain

          - No Tx usually hormonal
          - U/S add mammogram if over the age of 30

Question 9

If a 20 y/o woman comes in with concern for breast lump, and you note 1-3cm, freely moveable, firm/rubbery mass – how do you proceed? Dx?

Answer 9

could do an U/S first
Most likely a FNA or core biopsy
Dx: Fibroadenoma

Question 10

If you see a 40y/o woman with a firm, bollotable, mobile mass – how do you proceed? Dx?

Answer 10

Age 40 can do a mammogram à then, with U/S + FNA

Dx: breast cyst

Question 11

A pt has a breast cyst and during FNA blood is extracted – how do you proceed? What if there was no blood?

Answer 11

If bloody = surgical referral
Not bloody = close F/U in 2-4 months for recurrence or does not result in complete collapse à surgical referral

Question 12

If a 30y/o patient has a painful, erythematous breast what should you do?`

Answer 12

Mastitis or breast abscess

Treat with Doxy or Clinda (for staph aureus)

Question 13

What if your pt with an erythematous, painful breast is 58y/o?

Answer 13

Not normal to have mastitis or breast abcess in a post-menopausal woman
è GET A MAMMOGRAM
For Inflammatory breast cancer

Question 14

If a female has nipple discharge during reproductive years, is it something to be concerned about?

Answer 14

Usually no

Question 15

If a female is over the age of 40 with spontaneous nipple discharge of any color, should you be concerned? What will you do?

Answer 15

Yes, it may be pathologic such as papilloma
U/S + mammo
Labs: HCG, prolactin, TSH, and renal function

Question 16

When does ACOG suggest we start/do mammograms?

Answer 16

age 40 & yearly

Question 17

When foes US preventative task force suggest we start.do mammography?

Answer 17

Age 50 & biannually

Question 18

What does a breast U/S tell us?

Answer 18

for a mass it defines if it is cystic or solid