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Foundations III > Breast disorders > Flashcards

Breast disorders Flashcards

1
Q

Breast tissue: epithelial

A
  1. Lobules

2. Ducts

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2
Q

Breast tissue: stromal

A
  1. Fat

2. Connective tissue

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3
Q

What is polythelia?

A

congenital suprenumerarary nipples (occur along milk lines)

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4
Q

When is the breast exam (including neck, chest wall, breasts and axillae) ideally performed?

A

7-9 days after the onset of menses

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5
Q

What is the initial study for new palpable breast mass?

A

diagnostic mammogram

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6
Q

What are the levels of findings for mammograms (0-6)?

A

0: incomplete
1: Negative
2: Benign
3: Probably benign (short interval follow up)
4: Suspicious
4A; low suspicion for malignancy
4B: moderate suspcion for malignancy
4C: High suspicion for malignancy
5**:Highly suggestive of malignancy
6: Known biopsy-proven malignancy

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7
Q

What is the initial test for young. low risk women who have a breast lump?

A

Ultrasound

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8
Q

What is a downside with MRI imaging of the breast?

A

high false positive rate (finds things that may not be cancer)

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9
Q

In what type of patient might a MRI with contrast be useful to image the breast?

A

high risk women

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10
Q

What is a benefit of core needle biopsy versus fine needle aspiration

A

Core biopsy can perform hormone receptor analysis from tissue

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11
Q

What type of patient is most likely to get fibroadenoma?

A

young women, more often black

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12
Q

What are the defining features of fibroadenoma of the breast?

A
  • smooth
  • nontender**
  • mobile
  • grows gradually over time
  • DOES NOT wax and wane with menstruation**
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13
Q

What are the defining features of fibrocystic changes of the breast?

A
  • tender**
  • bilateral
  • multiple, mobile, well demarcated
  • change in size with menstrual hormonal changes** (estrogen dependent)
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14
Q

What is the name of the large fibroadenoma that grows very rapidly, and needs to be excised?

A

Phyllodes Tumor

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15
Q

What is the most common type of benign breast lesion?

A

Fibrocystic change

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16
Q

If you suspect fibrocystic change of the breast, what study would you use to diagnose this?

A

ultrasound, fine needle aspiration

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17
Q

Fibrocystic changes: Treatment

A
  • Bra (breast support)
  • Evening primrose oil
  • Low fat diet
  • Will subside with menopause
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18
Q

Breast cancer: epidemiology

A
  • MC female reproductive cancer

- 2nd most common cause of cancer death in women (1st is lung cancer)

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19
Q

Breast cancer: Risk factors

A
  1. Age >65
  2. Caucasion
  3. Tall
  4. Obesity
  5. High estrogen levels*
  6. Dense breast tissue
  7. Higher bone density
  8. DES exposure in utero
  9. BRCA1/BRCA2
  10. Early menarche (<12) or late menopause
  11. Nullparity
  12. First pregnancy >35
  13. Personal or family history of ovarian, peritoneal or breast cancer
  14. Alcohol
  15. Smoking
  16. Radiotherapy to chest between ages 10-30
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20
Q

What are the USPSTF guidelines for breast cancer screening?

A

If 50-74: mammogram every 2 years

If 40-49: individualize

21
Q

In high risk women, what is the screening recommendation for breast cancer?

A

25 and older: mammogram every year (or 5-10 years before age of dx in relative)

-refer to high risk center

22
Q

American college of obsetrics and gynecology breast cancer screening recommendation

A

40-74: mammogram every year

75+: individualize

23
Q

risk of breast cancer with BRCA1?

A

65% by age 70

24
Q

Risk of breast cancer with BRCA2?

A

45% by age 70

25
Q

What type of cancers is BRCA associated with?

A

Ovarian

Breast

26
Q

Who needs to have genetic testing for BRCA?

A
  1. any relative with BRCA1 or 2 mutation
  2. 2 relatives with breast cancer before 50. One is 1st degree relative
  3. 3 relatives with breast cancer before 50
  4. 1 relative with ovarian cancer
  5. Multiple relatives with melanoma
27
Q

What is the most common type of breast cancer?

A

Infiltrating ductal carcinoma

associated with lymphatic METS especially axillary

28
Q

Breast cancer clinical manifestations

A
  • painless, hard, non-mobile lump
  • MC in upper outer quadrant
  • Unilateral blood discharge**
29
Q

Paget’s disease (breast)

A
  • May first present as pain, burning and itching (before rash appears)
  • chronic eczematous itchy, scaling rash on the nipple and areola**
30
Q

Inflammatory breast cancer: PE

A
  • red, swollen, warm, itchy breast
  • Rapid growth
  • nipple retraction, peau d’orange**
  • 1/3 have distant METs
  • poor prognosis

–>must do chemo + mastectomy w/ axillary node dissection + radiation

31
Q

What are the key findings you would expect on mammogram of breast cancer?

A

microcalcifications and spiculated masses**

32
Q

If a women is younger than 40 what is the initial imaging modality?

A

ultrasound (due to high density of the breast)

33
Q

If a breast cancer patient would like to conserve breast tissue, what is a good option?

A

lumpectomy followed by radiation therapy

34
Q

What treatment should you initiate if the patient has ER positive tumor?

A

Tamoxifen (anti-estrogen)

35
Q

What treatment should you initiate if the patient has breast cancer and is postmenopausal?

A

Letrozole, Anastrozole (aromatase inhibitors)

-Prevent estrogen production

36
Q

How long is Tamoxifen used to lower risk in high risk patients (either post menopausal or over 35yrs)?

A

5 years (preventative course)

37
Q

What drug can be used for HER-2 cancers?

A

Trastuzumab

severe ADE: heart failure, respiratory problems

38
Q

After a patient’s breast cancer is treated, how do you follow up?

A
  1. Visit every 3-6 months for 2 years. Then, annually
  2. Annual mamogram and CBE indefinitely

Most recurrences are within 5 years

39
Q

What can a full-thickness skin punch biopsy for Inflammatory Breast Cancer show you?

A

dermal lymphatic invasion

40
Q

If you think a patient has Paget Disease of the Breast, how would you diagnose this?

A
  1. Full thickness wedge or punch biopsy of nipple

2. Bilateral mammogram

41
Q

BI-RADS score of 1,2

A

normal or benign: routine follow-up

42
Q

BI-RADS score of 3

A

Probably benign: 6 month follow up mammogram

43
Q

BI-RADS score of 4 or 5

A

Needs to see surgeon (these need biopsy!**)

44
Q

Worrisome nipple discharge

A
  • spontaneous
  • bloody
  • unilateral, uniductal
45
Q

When are you most likely to see mastitis?

A

1st pregancy nursing (primiparous)

46
Q

Mastitis: Tx

A

Continue breast feeding/pumping

Dicloxacillin
Cephalexin
Cephalosporin

(if fungal, Fluconazole)

47
Q

Breast abcess: Tx

A

Incision and drainage

Stop breast feeding

48
Q

Risk factors for breast abscess

A
  1. > 30
  2. First pregnancy
  3. Gestational age >41 weeks
  4. Tobacco use
49
Q

Where is the most likely location for gynecomastia?

A

symmetrical, around areolar-nipple complex

-Tender for about 6 mo then gradually resolves

Foundations III (34 decks)

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