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1. Foundations III > Breast disorders > Flashcards

Breast disorders Flashcards

1
Q

What are the 2 types of breast tissue?

A
  • epithelial elements
  • stromal elements
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2
Q

When is the best time to perform a breast exam?

A

7-9 days after onset of menses

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3
Q

What kind of abnormalities are you looking for on the visual breast exam?

A
  • asymmetry
  • skin changes
  • nipple asymmetry
  • nipple inversion or retraction
  • nipple discharge or crusting
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4
Q

What is the initial study performed for a new palpable breast mass?

A

Mammogram

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5
Q

What is the Mammogram looking at?

A
  • shape
  • margin
  • orientation
  • echogenicity
  • homogeneity
  • attenuation
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6
Q

In the 0-6 scale, what is a suspicious mass (f/u= coordination w/ surgeon)?

A

4= Suspicious

5= highly suggestive of malignancy

6= known biopsy-proven malignancy

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7
Q

if a pt has a BI-RADS score of 3, when do they f/u?

A

probably benign- short f/u in 6 mo

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8
Q

What is the initial test done for young, low-risk women w/ suspected fibroadenoma?

A

US

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9
Q

Describe the classic pt w/ a fibroadenoma and how does it present?

A

-young -more frequent in black women -usually solitary mass -round 1-5 cm -rubbery -discrete -movable -non-tender

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10
Q

How do you dx and tx a fibroadenoma?

A

Dx= core needle biopsy Tx= -excision -conservative tx w/ monitoring

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11
Q

What is a Phyllodes tumor and how is it treated?

A

Large fibroadenoma that grows rapidly -benign, borderline, or malignancy -Excision required!

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12
Q

MC breast lesion

A

fibrocystic changes

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13
Q

What age group, what hormone a/w, and what risk factor a/w Fibrocystic changes?

A

-age 30-50 -estrogen dependent -increased risk w/ alcohol use

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14
Q

Clinical presentation of fibrocystic changes

A

-painful -multiple -usu. b/l -rapid change in size and appearance -nodular breast tissue -mobile -tender

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15
Q

Dx for fibrocystic changes?

A

-mammogram and/or US -fine needle aspiration (for single cyst) -core needle biopsy if “cord-like”, nodular

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16
Q

Tx options for fibrocystic changes

A

-breast support -evening primrose oil? -low fat diet? -avoid caffeine? -vitamin E? (will subside w/ menopause)

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17
Q

Top 3 risk factors for breast CA?

A
  • BRCA1/BRCA2 genes
  • personal and/or fam hx ovarian, peritoneal, or breast CA
  • radiotherapy to chest b/t age 10-30
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18
Q

Other RFs for breast CA?

A

-age -white race -postmenopausal obesity -tall stature -high estrogen -dense breast tissue -higher bone density -DES exposure in utero HRT/contracetives -early menarche or late menopause -nulliparity -first pregnancy > age 35 -alcohol -smoking

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19
Q

What are protective factors against breast CA? (5)

A

-breastfeeding -higher parity -physical activity -oophorectomy < 35 yo -aspirin use

20
Q

What is the name of the risk calculator used for breast CA in average risk women?

A

Gail model

21
Q

What are the USPSTF guidelines for mammogram screening?

A
  • age 40-49, individualize
  • every 2 yrs, age 50-74
22
Q

What are the ACOG guidelines for mammogram screening?

A

-age 40-49, shared decision making -recommend age 50-74 -every 1-2 yrs - >75, shared decision making

23
Q

What are the general guidelines for mammograms in high risk women?

A
  • annual screening starting at age 25 (or 5-10 yrs before dx of affected relative)
  • supplemental screening breast MRI
  • scheduled 6 months apart
24
Q

What are some things that would make you think that a pt would be good for genetic testing?

A

-any relative w/ BRCA 1 or 2 -breast CA before age 50 -b/l breast CA -breast and ovarian CA in same woman or family -multiple breast CAs in fam -male breast CA -Ashkenazi Jewish ethnicity

25
Q

What is Ductal carcinoma in situ

A

neoplastic lesions confined to breast ducts and lobules

26
Q

What is Infiltrating ductal carcinoma?

A

MC! -arises from epithelial lining of the large or intermediate-sized ducts

27
Q

What is Infiltrating lobular carcinoma?

A

arises from the epithelium of the terminal ducts of the lobules

28
Q

What are some presentations of breast CA?

A

*Majority due to abnormal mammogram* -breast or axillary mass -+/- skin changes -w/ mets (back/leg pain, abd pain, sob)

29
Q

What is the popcorn phrase in mammogram finding that would indicate breast CA?

A

*Spiculated soft tissue mass*

30
Q

What are surgical options for breast CA tx?

A

-lumpectomy + radiation therapy (“breast conservation therapy”) -mastectomy -modified radical mastectomy -breast reconstruction

31
Q

What is medical therapy tx for breast CA?

A

chemotherapy + estrogen antagonists

32
Q

what is the f/u for breast CA?

A

-every 3-6 months x 2 yrs, then annually most recurrences are w/in 5 yrs

33
Q

What is Inflammatory breast CA, MC in who, characterization?

A

-aggressive breast CA -higher in younger age black women **diffuse dermatologic erythema and edema= peau d’orange**

34
Q

Possible clinical findings in Inflammatory breast CA

A

-rapid presentation -+/- mass -breast pain tender, firm, enlarged breast -itching of breast -lymph node involvement -1/3 have distant mets

35
Q

What is the diagnostic test and finding of Inflammatory breast CA?

A

Full-thickness skin punch biopsy =dermal lymphatic invasion by tumor cells

36
Q

What is tx for inflammatory breast CA?

A

chemo followed by mastectomy w/ axillary node dissection and post-mastectomy radiation (NO breast conservation therapy)

37
Q

What is characteristic skin findings of Paget disease of the breast?

A

scaly, raw, vesicular or ulcerated lesion that begins on the nipple and spreads to the areola

38
Q

Clinical presentation of Paget disease?

A

-Pain, burning, and/or pruritis (May be present prior to skin findings!) -occasional bloody discharge -usually unilateral

39
Q

Dx of Paget disease of the breast?

A

-full thickness wedge or punch biopsy of the nipple -bilateral mammogram

40
Q

What are worrisome findings a/w nipple discharge? (4)

A

-spontaneous -bloody -unilateral, uniductal -a/w a mass

41
Q

Who gets Mastitis most often?

A

primiparous nursing patient

42
Q

Clinical presentation of mastitis

A

-fever -swelling -painful, erythematous lobule in outer breast quadrant -+/- other systemic symptoms -+/- axillary lymphadenopathy

43
Q

Tx for mastitis

A

-continue breastfeeding -local heat -breast support -ABX= Dicloxacillin, Cephalexin, (or clindamycin)

44
Q

Clinical presentation of breast abscess

A

-localized, painful inflammation -fluctuant, tender, palpable mass -fever, malaise

45
Q

What are some causes of gynecomastia?

A

-drugs- exogenous estrogen, others -Hypogonadism (Klinefelter, Cryptorchidism) -Tumors

46
Q

What is the normal tx of gynecomastia?

A

-regresses spontaneously in >70% of pts after 1 yr -rare regression if persists over 1 yr or after age 17

1. Foundations III (20 decks)

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