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Women's Health Exam 1 (A,S,L) > Breast Disorders (Lauren 🌭) > Flashcards

Breast Disorders (Lauren 🌭) Flashcards

1
Q

What is the difference between a “Screening” Mammogram and a “Diagnostic” Mammogram?

A

Screening mammogram- has 2 views. Used when you have no specific concern, your patient is just the right age for a mammogram

Diagnostic mammogram- more than 2 views. Used when you have a specific concern

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2
Q

What are the 2 views used in a screening mammogram

A

Craniocaudal CCO (top to bottom)

Mediolateral Oblique MLO (side to side)

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3
Q

What are some additional mammogram views that are used when you have a specific concern?

A

Spot compression- pushing excess tissue away from the nodule

Cleavage view- exactly what it sounds like. Helps you see the medial tissues better

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4
Q

Can you get a mammogram if you got dem fake tittttttayyyyssss

A

Yes, the technician just has to push the implants back towards the chest wall

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5
Q

Malpractice cases of delayed breast cancer diagnoses usually involve women who:

A

Are under age 50 who receive false negative results, or didn’t receive diagnostic mammograms they should have

Who do they sue: PAs and DOCTORS not the radiologists!!!

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6
Q

Do you want me to put stuff that said FYI on the slide, yet she went over anyways?

A

Sure why not

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7
Q

FYI:

What “score” will the radiology report of a mammogram have?

A

BI-RADS score:

0: radiologist needs more views to determine the score

1-2: 👍

3-6: not what you want

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8
Q

In general, why do we use mammograms for older women and not for younger women?

A

Younger women have denser breasts with less fat and more breast tissue, and mammograms can’t see through them very well

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9
Q

When do we use ultrasound to evaluate breasts?

A

Young women***

Dense breast tissue

To differentiate between a SOLID and CYSTIC mass

Guiding core-needle biopsies

Inconclusive mammogram results

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10
Q

When would we use MRI to look at some breasts

A

Detecting breast cancer in high-risk women

Staging breast cancer

Hmmmm….something seems to be missing here…

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11
Q

What do we NOT use MRI for when were looking at boobs

A

NOT recommended for evaluation of a breast mass****

Can’t tell if something is benign or malignant

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12
Q

What is the difference between Fine-needle Aspiration and Core-Needle Biopsy?

A

FNA: smaller needle for mass you probably think is benign

Core Needle Biopsy: used to obtain samples from larger, solid breast masses

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13
Q

Would you use FNA or Core needle biopsy to determine if a palpable lump is a simple cyst?

A

Fine needle aspiration.

Stick it in there and if clear fluid comes out, youre good its just a cyst

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14
Q

What are some important questions to ask if a woman presents to you with concerns about a breast lump

A

Nipple discharge?

Size changes?

Associated with Menstrual Cycle?**

Risk factors in increase likelihood of malignancy

Location, duration, how it was discovered

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15
Q

What is mastalgia?

A

Breast pain (can be cyclic or non cyclic)

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16
Q

What is cyclic breast pain?

A

FIBROCYSTIC changes that happen in BOTH breasts during the luteal phase of your menstrual cycle

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17
Q

What may cause non-cyclic breast pain?

A

Medications (hormonal BC, HRT SSRIs, spironolactone)

Large, pendulous breasts can cause ligamentous pain

(Can be in just one breast, or focal, unlike cyclical pain)

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18
Q

If you don’t palpate a mass, but your patient is complaining of focal pain in her breast, what is your next step?

A

Younger than 30: ultrasound

30 or older: ultrasound AND mammogram

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19
Q

Who gets mastitis?

A

Breastfeeding women

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20
Q

How does mastitis present?

A

Hard, red, tender, swollen area in one breast

Fever

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21
Q

Which organism most commonly causes mastitis?

A

Staph aureus

***

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22
Q

What is a VERY important thing that should be on your DDx when you think a patient has mastitis?

A

Inflammatory Breast Cancer***

DO NOT MISS THIS

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23
Q

What is the treatment for mastitis?

A

Dicloxicillin or cephalexin

Continue Breastfeeding!!! (Want to get milk out of there. It is safe for the baby)

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24
Q

What are some characteristics of breast masses that usually indicate it is benign?

A

Well defined margins

No skin changes

Smooth

Soft or firm

Mobile

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25
Q

What are some characteristics of breast masses that are more likely to be malignant?

A

Poorly defined margins

Skin changes 🍊

Hard

Immobile

Fixed (to chest wall or outer surface of breast)

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26
Q

What is this:

FLUID FILLED round or ovoid breast mass that is influenced by hormone fluctuations

A

Breast cyst

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27
Q

What is the peak age of women who get breast cysts?

A

35-50

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28
Q

Are breast cysts always solitary?

A

No you can get clusters of cysts that may palpate as an ill-defined mass

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29
Q

How do you manage breast cysts?

A

Simple cysts: no intervention needed. FNA if symptomatic

Complicated cysts with <1% chance of malignancy: FNA or do imaging every 6 months

Complex cysts with a 1-23% chance of malignancy: biopsy/excision

(There was no information about what made a cyst simple/complicated)

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30
Q

What is this:

Benign SOLID tumor containing glandular and fibrous tissue

A

Fibroadenoma

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31
Q

What age is the peak incidence of fibroadenoma?

A

15-35***

Younger than cyst

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32
Q

Are fibroadenomas painful?

A

No

Cysts, however, might be painful

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33
Q

Do fibroadenomas fluctuate in size every month?

A

No

can increase in size during pregnancy and if you use estrogen

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34
Q

How do you treat fibroadenoma?

A

Core needle biopsy (it’s a SOLID tumor)

OR if benign features on ultrasound, 3-6 month repeat

If it increases in size***: mandatory excision

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35
Q

If a fibroadenoma is rapidly growing, what should you consider in your differential?

A

Phyllodes tumor

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36
Q

What is a phyllodes tumor?

A

A rare, rapidly growing tumor that is usually benign

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37
Q

Breast Cyst of Fibroadenoma:

Well-defined mobile mass

A

Both

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38
Q

Breast Cyst of Fibroadenoma:

May fluctuate in size

A

Breast cyst

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39
Q

Breast Cyst of Fibroadenoma:

Peak incidence at 35-50

A

Breast cyst

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40
Q

Breast Cyst of Fibroadenoma:

Peak incidence at 15-35

A

Fibroadenoma

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41
Q

Breast Cyst of Fibroadenoma:

may be tender

A

Breast cyst

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42
Q

Breast Cyst of Fibroadenoma:

Firm or ballotable

A

Breast cyst

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43
Q

Breast Cyst of Fibroadenoma:

Firm

A

Firboadenoma

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44
Q

Breast Cyst of Fibroadenoma:

Fluid filled

A

Cyst

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45
Q

Breast Cyst of Fibroadenoma:

Solid

A

Fibroadenoma

46
Q

If your patient presents with a breast mass and your examination suggests that it is a ~suspicious~ mass, what is your next step?

A

Mammogram AND ultrasound

No matter how old they are!!

47
Q

What characteristics of nipple discharge are usually associated with a Pathological (bad) cause?

A

Spontaneous***

Unilateral**

Single duct**

Bloody** (always concerning)

Associated with a mass

48
Q

What are possible causes of Pathologic (bad) nipple discharge?

A

Intraductal papilloma!!!!!

Duct ectasia (painful)

Cancer

Infection

49
Q

What characteristics are associated with physiologic (normal) nipple discharge?

A

Bilateral

Multiple ducts

Associated with stimulation

50
Q

What is the most common cause of pathologic (bad) nipple discharge?

A

Intraductal papilloma****

A benign, warty tumor that develops from the duct wall and grows into the lumen, but MAY turn into DCIS

51
Q

FYI:

What kinds of medications did Ms. Shamblen specifically say can cause nipple discharge

A

Antipsychotics

52
Q

Nipple discharge that is bloody is (concerning/NBD)

A

Always concerning- refer to surgeon

53
Q

Nipple discharge that is unilateral from a single duct is (concerning/NBD)

A

Always concerning. Refer to surgeon

54
Q

In the US, 1 in ___ women will develop invasive breast cancer over the course of her lifetime

A

8

55
Q

What are the 2 strongest risk factors for breast cancer?

A

Being female

Age (65+)

56
Q

What two tumor suppressor genes are associated with hereditary breast and ovarian cancer when mutated?>

A

BRCA1

BRCA2

57
Q

What are your options if you do a 23andme test and you find out you have a BRCA mutation?

A

Increased surveillance

Chemoprevention (tamoxifen in women over 35)

Mastectomy

58
Q

If you do a 23andme test and you find out you do not have a BRCA mutation, are you good to go

A

No it does NOT mean that you will NOT get breast cancer

59
Q

Which is worse for women: BRCA1 or BRCA2?

A

BRCA 1

60
Q

Which is worse for men: BRCA1 or BRCA2

A

BRCA2

Men have breasts too!!!

61
Q

What do we recommend now instead of monthly self breast exams?

A

“Breast awareness”

62
Q

What is a Clinical Breast Exam?

A

PA or Doctor does a breast exam

63
Q

What time of the month is the best time for your PA to do a Clinical Breast Exam?

A

Follicular phase of menstrual cycle

64
Q

What does the USPSTF think about clinicians teaching women how to perform a self breast exam?

A

Not recommended

65
Q

What does the USPSTF think about the benefits of doing a clinical breast exam beyond screening mammograms in women over 40?

A

Current evidence is insufficient to assess the benefits of doing a CBE

(I’m not totally sure what this means and this probably wont be on our test)

66
Q

True or false:

All major groups agree about doing a clinical breast exam

A

False

67
Q

True or false:

All major groups agree on “Breast Awareness”

A

True

68
Q

What are the recommendations for doing screening mammograms in women who are at average risk?

A

Consider it at 40-49

Screen all women at 50+

Stop screening at age 75

Screen every 1-2 years

(This slide also said FYI but it seems kind of important i don’t know what to do!!)

69
Q

Who is recommended to get an annual MRI screening for breast cancer?

A

BRCA mutation

First degree relative has BRCA

Lifetime risk >20-25% or greater

(THIS SAID FYI REALLY BIG BUT SHE ALSO PUT A STAR ON THIS UPTODATE CHART 🤯)

70
Q

What are the clinical presentations of breast cancer?

A

Palpable mass (MOST COMMON)*

Nonpalpable suspicious lesion on mammogram

Skin changes

Nipple discharge

Metastatic spread

71
Q

What does “in situ” mean?

A

It means the lesions have not penetrated the basement membrane (noninvasive)

72
Q

What are the two types of noninvasive (in situ) breast carcinomas?

A

Lobular LCIS

Ductal (DCIS)

73
Q

DCIS or LCIS:

Treated as a malignancy because it has potential to develop into invasive cancer

A

DCIS

****

74
Q

DCIS or LCIS:

Does NOT become an invasive cancer if left untreated

A

LCIS

75
Q

What does DCIS look like on mammography?

A

clustered pleomorphic calcifications*

76
Q

80% of DCIS are (palpable/nonpalpable)

A

Non-palpable

77
Q

What are the specific findings on mammogram and ultrasound for LCIS?

A

There aren’t any

****

78
Q

True or false:

LCIS is an indicator for increased risk of invasive breast cancer

A

True

However it will not turn into one

79
Q

What is the treatment for DCIS?

A

Breast conserving surgery with radiation or mastectomy

+/- sentinel node biopsy

Hormone therapy if estrogen and progesterone positive- Tamoxifen, Arimidex

80
Q

What is the treatment for LCIS?

A

No treatment recommended (not a true cancer)

Lifelong close surveillance

If you really wanted to, you could do chemoprevention with Tamoxifen or Arimidex

If you really wanted to, you could do a bilateral prophylactic mastectomy

81
Q

What is the MOST COMMON breast malignancy?

A

Infiltrating Ductal Carcinoma
****
****
⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️

82
Q

What is the most common presentation of Infiltrating Ductal Carcionoma and Infiltrating Lobular Carcinoma?

A

Palpable mass

Or

Mammography abnormality

83
Q

Which is more likely to be bilateral:

Infiltrating Ductal Carcinoma or Infiltrating Lobular Carcinoma

A

Lobular

84
Q

True or false:

Infiltrating Lobular Carcinoma is usually hormone (estrogen) positive

A

True

85
Q

What ultrasound findings would make you very concerned that a breast lesion is Invasive

A

Taller than it is wide*****

86
Q

Is a “Stellate Lesion” on mammogram good or bad

A

Pretty sure its bad

87
Q

What is this:

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

A

Paget Disease of the Breast

*****

88
Q

What might happen before Paget Disease becomes clinically apparent?

A

Pain, burning, or itching may present

89
Q

Is Paget Disease common?

A

No, very rare

90
Q

What does Paget Disease have to do with breast cancer?

A

88% of women with Paget Disease have an underlying breast cancer

91
Q

What is the rarest but most aggressive form of breast cacner

A

Inflammatory Breast Cancer

*****

92
Q

What are the clinical features of Inflammatory BReast Cancer?

A

Pain

Rapidly progressing, tender, firm, enlarged breast

Skin is warm, thickened, peau d’orange appearance, and erythematous***

Almost all have lymph node involvement at presentation

1/3 have distant metastasis at presentation

93
Q

Which type of breast cancer is specifically associated with a peau d’orange appearance

A

Inflammatory Breast Cancer

94
Q

What are the two paths that breast cancers can take to metastasize?

A

Lymphatic spread

Hematogenous spread- lung, liver, bone, ovaries, and brain

95
Q

Which lymph nodes does breast cancer usually spread to first

A

Axillary lymph nodes

96
Q

What other lymph nodes may breast cancer spread to other than axillary?

A

Internal mammary nodes

Supra clavicular nodes is a late finding

97
Q

What is the treatment for breast cancer?

A

Surgery (lumpectomy vs mastectomy)

Radiation

Chemotherapy

Endocrine therapy

98
Q

What is a lumpectomy?

A

“Breast Conserving Surgery”
Just the part with the cancer is removed

+/- selective sampling of axillary nodes

99
Q

True or False:

Multiple clinical trials have shown that breast conserving surgery (lumpectomy) with radiation is the appropriate treatment for Stage I or II breast cancer

A

True

100
Q

What is the difference between simple, modified radical, and radical mastectomy?

A

Simple (aka Total)- entire breast including nipple and areola

Modified Radical- entire breast including nipple and areola plus axillary lymph nodes

Radical- entire breast, lymph nodes, and pectoralis muscle

101
Q

Are radical mastectomies performed often?

A

Rarely performed now

102
Q

What are the two forms of radiation for breast cacner?

A

External beam- lasts 5-7 weeks

Brachytherapy- seeds/wires placed on tumor for shorter time

103
Q

All patients with (+) lymph nodes get what kind of tratemnet?

A

Chemotherapy

104
Q

What is the difference between neoadjuvant and adjuvant chemotherapy?

A

Neoadjuvant- given before surgery to shrink the tumor; might allow for breast conservation surgery

Adjuvant- after surgery, kills cancer cells left behind

105
Q

Do we do endocrine/hormone therapy for all breast cancers?

A

No, only cancers that are Estrogen Receptor (+) or Progesterone Receptor (+)

106
Q

What are the options for Endocrine/Hormone therapy for ER(+) and PR(+) cancers?

A

SERM- tamoxifen x 5 yrs

Aromatase inhibitors- Arimidex (Anastrozole)

107
Q

Can a patient do Endocrine/Hormone therapy instead of chemo+radiation?

A

No, they are a supplement to chemo and radiation

108
Q

What’s the big deal with this HER2/neu overexpression thing?

A

Its a protein that promotes growth that 20% of breast cancers have increased amounts of and we can target it

109
Q

What is Herceptin?

A

A drug that targets the HER2/neu protein. Can be used in addition to chemo

110
Q

What imaging would you use to differentiate between a solid and cystic mass in the breast

A

Ultrasound

Women's Health Exam 1 (A,S,L) (3 decks)

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