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OB/GYN > Breast Disorders in Women's Health > Flashcards

Breast Disorders in Women's Health Flashcards

1
Q

Breast Disorders

A 
Breast fibrocystic change
Breast fibroadenomas
Mastitis
Breast abscess
Intra-ductal papilloma
nipple discharge
Breast tenderness
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2
Q

Breast Disorders

A 
Breast fibrocystic change
Breast fibroadenomas
Mastitis
Breast abscess
Intra-ductal papilloma
nipple discharge
Breast tenderness
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3
Q

Breasts Histologically Composed of

A

Lobules/glands
Milk ducts
Connective tissue
Fat

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4
Q

Connective Tissue Disorders

A

Fibrocystic changes

Fibroadenomas

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5
Q

Issues with Duct System

A

May become dilated
Contain papillary neoplasms
Undergo malignant transformations

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6
Q

Blood Supply to the Breasts

A 
Internal mammary artery
Lateral thoracic artery
Thoracodorsal artery
Thoracocramial artery
Intercostal perforating arteries
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7
Q

Lymphatic System of the Breast

A

Superficial and deep nodal chains through head & neck
Axilla
Deep to pectoralis muscles
Caudal to diaphragm

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8
Q

Breast Cancer

A

Most common malignancy in women

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9
Q

Risk Factors for Breast Cancer

A 
Age
Family history
Race
Genetics
Early menarche
Late menopause
Increased exposure to estrogen
Use of estrogen therapy
Nulligravid state
First pregnancy after 35
Fibrocystic conditions when accompanied by proliferative changes
CA in one breast
Endometrial CA
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10
Q

Breast Cancer & Age

A

Increases with age
Plateau in women 50-55
Most significant risk factor after gender

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11
Q

Breast Cancer & Family History

A 
1st degree relative i
2+ relatives with breast or ovarian CA
Breast CA younger than 50
Relatives with both breast CA & ovarian CA
1+ relative with 2 cancers
Male relatives with breast cancer
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12
Q

Breast Cancer & Race

A

Caucasian more likely

Individuals of Ashkenazi Jewish descent

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13
Q

Breast Cancer & Genetics

A

BRCA1 & BRCA2

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14
Q

Breast Cancer & Early Menarche

A
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15
Q

Breast Cancer & Late Menopause

A

> 50 years old

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16
Q

Breast Cancer & Increase Exposure to Estrogen

A

Obesity

Persisten anovulation

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17
Q

Breast Cancer & Use of Estrogen Therapy

A

BSO before 35 with HRT

Postmenopausal treatment with HRT

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18
Q

Other Risk Factors for Breast Cancer

A

Not breastfeeding
Hx of epithelial hyperplasia with atypic
Exposure to ionizing radiation or other carcinogens
Certain dietary factors: fat, ETOH

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19
Q

BRCA 1 & BRCA2 Mutations

A

Disrupt protein productions
Change in one of the protein blocks to make BRCA proteins
Unable to help fix damaged DNA
Results in build up of mutations
Causes cells to divide in uncontrolled way

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20
Q

Harmful BRCA1 Mutations and Increased Risk of Other Cancers in Women

A

Cervical
Uterine
pancreatic
Colon

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21
Q

Male BRCA1 & BRCA2 & Increased Risk of Other Cancers

A

Breast
Pancreatic
Testicular
Early-onset prostate

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22
Q

Male BRCA1 & BRCA2 & Increased Risk of Other Cancers

A

Breast
Pancreatic
Testicular
Early-onset prostate

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23
Q

Breasts Histologically Composed of

A

Lobules/glands
Milk ducts
Connective tissue
Fat

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24
Q

Connective Tissue Disorders

A

Fibrocystic changes

Fibroadenomas

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25
Q

Issues with Duct System

A

May become dilated
Contain papillary neoplasms
Undergo malignant transformations

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26
Q

Blood Supply to the Breasts

A 
Internal mammary artery
Lateral thoracic artery
Thoracodorsal artery
Thoracocramial artery
Intercostal perforating arteries
How well did you know this?
1
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2
3
4
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27
Q

Lymphatic System of the Breast

A

Superficial and deep nodal chains through head & neck
Axilla
Deep to pectoralis muscles
Caudal to diaphragm

How well did you know this?
1
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2
3
4
5
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28
Q

Breast Cancer

A

Most common malignancy in women

How well did you know this?
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2
3
4
5
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29
Q

Risk Factors for Breast Cancer

A 
Age
Family history
Race
Genetics
Early menarche
Late menopause
Increased exposure to estrogen
Use of estrogen therapy
Nulligravid state
First pregnancy after 35
Fibrocystic conditions when accompanied by proliferative changes
CA in one breast
Endometrial CA
How well did you know this?
1
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2
3
4
5
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30
Q

Breast Cancer & Age

A

Increases with age
Plateau in women 50-55
Most significant risk factor after gender

How well did you know this?
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31
Q

Breast Cancer & Family History

A 
1st degree relative i
2+ relatives with breast or ovarian CA
Breast CA younger than 50
Relatives with both breast CA & ovarian CA
1+ relative with 2 cancers
Male relatives with breast cancer
How well did you know this?
1
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2
3
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32
Q

Breast Cancer & Race

A

Caucasian more likely

Individuals of Ashkenazi Jewish descent

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33
Q

Breast Cancer & Genetics

A

BRCA1 & BRCA2

34
Q

Important Previous Pregnancy History of a Patient when Presenting with a Breast Lump

A

Age at first pregnancy
Term pregnancies
Abortions
Breastfeed

35
Q

Breast Cancer & Late Menopause

A

> 50 years old

36
Q

Breast Cancer & Increase Exposure to Estrogen

A

Obesity

Persisten anovulation

37
Q

Breast Cancer & Use of Estrogen Therapy

A

BSO before 35 with HRT

Postmenopausal treatment with HRT

38
Q

Other Risk Factors for Breast Cancer

A

Not breastfeeding
Hx of epithelial hyperplasia with atypic
Exposure to ionizing radiation or other carcinogens
Certain dietary factors: fat, ETOH

39
Q

BRCA 1 & BRCA2 Mutations

A

Disrupt protein productions
Change in one of the protein blocks to make BRCA proteins
Unable to help fix damaged DNA
Results in build up of mutations
Causes cells to divide in uncontrolled way

40
Q

Harmful BRCA1 Mutations and Increased Risk of Other Cancers in Women

A

Cervical
Uterine
pancreatic
Colon

41
Q

Harmful BRCA2 Mutations & Increase Risk of Other Cancers in Women

A

Pancreatic
Stomach
Gallbladder & Bile duct
Melanoma

42
Q

Male BRCA1 & BRCA2 & Increased Risk of Other Cancers

A

Breast
Pancreatic
Testicular
Early-onset prostate

43
Q

Presentation of Breast Cancer

A 
Mass
Solitary nodule
Non-tender
Firm to hard
Ill define margins
Not mobile
Skin nipple retractions
Axillary lymphadenopathy
44
Q

ACS Breast Care Guidelines

A

40-44: have choice to start mammograms
45-54: yearly mammograms
55+: yearly or every other year mammograms

45
Q

Define Fibrocystic Change

A

Exaggerated physiologic response to a changing hormonal environment

46
Q

Fibrocystic Change

A

Most frequent lesion of breast
Common in women 30-50
Rare in postmenopausal women NOT taking HRT
Painful mass exacerbates or increases in size during premenstrual phase
Exacerbated by ETOH

47
Q

Presentation of Fibrocystic Change

A 
Multiple, bilateral masses
Rapid fluctuation in size
Painful & tender
Occurs or increases during premenstrual phase
Size increases during premenstrual phase
48
Q

Diagnostics & Treatment of Fibrocystic Changes

A

Re-examine at intervals
Reassure patient that discomfort is not a sign of CA
Symptoms improve with cyclical decrease in hormonal stimulation
OCPs offer no benefit
Use support bras
Vitamin E supplements
Avoid chocolate, alcohol, & caffeinated beverages
Teach & encourage monthly BSE
May need to be biopsied

49
Q

Fibroadenoma

A

Benign neoplasm made from overgrowth of glandular & fibrous breast tissue
Occur alone, in groups, or as complex
Most frequently in young women (20 years after puberty)
Earlier age in black women
Multiple tumors in 10-15% of patients
Women over 30 need to distinguish from fibrocystic change or CA

50
Q

Presentation of Fibroadenoma

A 
Round or ovoid
Non-tender
Smooth margins
Rubbery
Discrete
Relatively movable
1-5 cm in diameter
51
Q

Diagnostics & Treatment of Fibroadenoma

A 
US can distinguish cystic
FNB can confirm cytology
Teach & encourage BSE
Treatment varies on diagnosis
If small, treatment usually not necessary but follow-up with US
If large, tumor can be removed
Removed in women over 40
52
Q

Important History of a Patient when Presenting with a Breast Lump

A 
Age of patient
Disease history
Family history
Medication history
Onset of menarche
Where they are in cycle
Onset of menopause
Social habits
Ingestion habits
Previous Pregnancies
Mammogram history
Frequency of SBE
Last exam by provider
53
Q

Important Social Habits of a Patient when Presenting with a Breast Lump

A

ETOH

Smoking

54
Q

Important Ingestion Habits of a Patient when Presenting with a Breast Lump

A

Caffeine

high fat

55
Q

Important Previous Pregnancy History of a Patient when Presenting with a Breast Lump

A

Age at first pregnancy
Term pregnancies
Abortions
Breastfeed

56
Q

Imaging of Breast Conditions

A

Ultrasound

Mammography

57
Q

Ultrasound and Breast Conditions

A

Preferred if palpable mass, patient

58
Q

Mammography & Breast Conditions

A

Palpable mass, >30-35 years old, & not pregnant

Follow up US if need determination between cystic & solid

59
Q

When to Refer for a Breast Condition

A

Further investigation

Biopsy

60
Q

Types of Breast Biopsies

A

FNA
Core needle aspiration
Excisional

61
Q

FNA Biopsy

A

Small gauge needle (21-25)

Need adequate specimen

62
Q

Core Needle Aspiration Biopsy

A

Large gauge needle (14-18)

Need adequate specimen

63
Q

Excisional Biopsy

A

Mass & surrounding tissue excised for histological exam
Definitive diagnosis of breast CA
therapeutic without additional surgery

64
Q

Mastitis

A 
Breast tenderness
Warm to touch
Malaise
Swelling of breast
Pain/burning continuously or while breastfeeding
Skin redness
Fever 101+
65
Q

Mastitis Presentation

A

Unilateral
Begins 3 months post delivery
Start as sore or fissure nipple
Lump possible if beginning to form an abscess

66
Q

Mastitis Treatment

A 
Antibiotics against PCN-resistant staph
Regular emptying of breast by nursing 
Warm compresses
Failure to response within 3 days should prompt consideration of MRSA
Possibly admitted for IV therapy
Delay in treatment = abscess
67
Q

Prevention of Mastitis

A 
Breastfeed equally from both breasts
Empty breasts completely
Use good breastfeeding techniques
Avoid dehydration
Practice careful hygiene: hands, breasts, baby
68
Q

Define Breast Abscess

A

Redness, tenderness, induration on breast during nursing or otherwise

69
Q

Define Intraductal Papilloma

A

Tiny wart-like growth in breast tissue that sometimes punctures a duct

70
Q

Intraductal Papilloma

A

Most often in women 35-55

Most common cause of spontaneous nipple discharge from single duct

71
Q

Types & Related Condition of Intraductal Papilloma

A

Solitary intraductal papillomas
Multiple papillomas
papillomatosis

72
Q

Solitary Intraductal Papillomas

A

One lump
Near nipple
Causes discharge

73
Q

Multiple Papillomas

A

Groups of lumps
Further from nipple
Doesn’t cause discharge
Can’t be felt

74
Q

Papillomatosis

A

Small groups of cells inside the ducts
Type of hyperplasia
More scattered than multiple papillomas

75
Q

Tests for Intraductal Papilloma

A

Breast biopsy
Examination of discharge
X-ray with contrast dye

76
Q

Treatment of Intraductal Papilloma

A

Duct is surgically removed

Cells checked for CA

77
Q

Causes of Nipple Discharge

A 
Papilloma
Premenopausal women: spontaneous
Prolactinoma
OC agents
Abscess
Medications
Hypothyroidism
78
Q

Suspicious Nipple Discharge

A 
1 breast
1 duct
Associated with lump
Leaks out on it's own
Most days of month
Water or bloody
A lot
79
Q

Not Suspicious Nipple Discharge

A 
Both breasts
Several ducts
Squeezing brings it on
Occasional
Different colors
A little
80
Q

Breast Tenderness

A 
Unilateral or bilateral
Usually not related to trauma
Usually related to fibrocystic changes
May be associated with breast CA
May be related to dietary habits: caffeine, chocolate, salt
81
Q

Evaluation of Breast Tenderness

A

Breast exam checking for areas of tenderness, mass, trauma, nipple discharge
US/mammogram

82
Q

Treatment of Breast Tenderness

A

NSAIDs
Eliminate caffeine, chocolate, salt
Monthly SBE
Return to recheck if symptoms don’t resolve within 1-2 months

OB/GYN (12 decks)

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