Breast Disorders- Paulson

Question 1

A patient comes in with a small brown freckle along the milk line that is cosmetically weird looking and the patient wants to know what it is. What should you tell the patient?

Answer 1

It is a supernumerary nipple and this is completely normal

Question 2

An enlargement of the breasts that occurs in males is called what?

Answer 2

Gyneocomastia

*Spironolactone or risperodone can cause this

Question 3

A patient presents with increased swelling, pain and enlarged breasts commonly with OCPs and cyclic with her menstrual cycle. What will you tell her this is?

Answer 3

Mastodynia (breast pain/tenderness)

Question 4

What is the tx for Mastodynia (breast pain/tenderness)?

Answer 4

Reasurrance

• Vit B6 can help
• Supportive bra
• NSAID

Question 5

What is the primary organism that causes mastitis?

Answer 5

S. aureus

Question 6

A lactating women presents with red hot and swollen LUQ breast with flu like symptoms. What should you tell her the condition is called?

Answer 6

Mastitis

Question 7

What is the tx for mastitis?

Answer 7

Dicloxacillin

Question 8

A patient presents with a 1 day hx of painful, swollen breast with an induration filled with pus. WHat is this and what is the tx?

Answer 8

Breast abscess

-I&D and Dicloxacillin

Question 9

Can a patient with mastitis continue to breast feed?

Answer 9

Yes

Question 10

If a patient with a suspected breast abscess does not get better, what should you do?

Answer 10

If patient does not respond to treatment, suspect inflammatory breast cancer especially if associated with axillary lymphadenopathy

Question 11

You feel a firm nodule on a patients breast. You suspect fat necrosis of the breast. How do you determine if CA or non-CA?

Answer 11

Biopsy

Question 12

Is breast cancer usually painful?

Answer 12

No

Question 13

A patient states that every time around her menstrual cycle she has increased firm oval shaped nodules that develop in her breasts. What is the dx and tx?

Answer 13

Fibrocystic breast changes and a supportive bra

-Avoid caffeine, low salt diet, Vit E

Question 14

A patient has a round firm, smooth and rubbery mass in her breast. What is this and what are the next steps?

Answer 14

Core needle biopsy or 3-6 month follow up with repeat ultrasound and breast exam

Question 15

T/F: Nipple discharge is totally normal if a patient is not lactating?

Answer 15

false - always need to be suspicious of nipple d/c if a patient is not lactating

Question 16

What should you do next for a patient with nipple discharge?

Answer 16

order a u/s or mammogram

Question 17

Wht are some risk factors for breast cancer?

Answer 17

Nullparity, early menarche, late menarche, late menopause, long term estrogen exposure, child bearing >30 yrs and first degree relatives

Question 18

_______ puts people at a higher exposure for breast CA

Answer 18

estrogen

Question 19

A patient states that she thinks she has eczema over her nipple x 1 month. She has tried some creams without improvement. What should we work the patient up for?

Answer 19

This is pagets disease of the breast but it is breast cancer until proven otherwise. the patient will need a full-thickness bx

Question 20

Lobular carcinoma is a _______ find

Answer 20

Lucky

Lobular=lucky because there is an increased risk of developing breast cancer

Question 21

What is the most common quadrant for breast cancer?

Answer 21

Upper outer quadrant

Question 22

P’eau d’orange and retraction of the nipple are serious signs of what?

Answer 22

Invasive carcinoma

Question 23

What are the current guidelines for mammography?

Answer 23

Every year starting at age 40 as long as a woman is in good health and can switch to every other year at age 55
-Age 50 to 64 every other yr

Question 24

For high risk women, what imaging is recommended in addition to mammogram every year starting at age 30?

Answer 24

For women at high-risk, recommend MRI in addition to mammogram every year starting at age 30 (ACS)

Question 25

What is the best way to detect breast cancer?

Answer 25

Combo of PE, mammography, u/s, fine needle or core needle and/or excisional bx

Question 26

Can men get breast cancer?

Answer 26

Yes, typically develops as a painless lump beneath the areola and generally a poorer prognosis than in women

Question 27

Are there any health benefits for babies that drink breast milk?

Answer 27

Ye great health benefits and this is where the baby gets all the antibodies from

Question 28

what is the let down relfex?

Answer 28

By sucking at the breast, your baby triggers tiny nerves in the nipple.These nerves cause hormones to be released into your bloodstream. Prolactin stimulates the mammary glands to produce milk. Oxytocin helps milk to be ejected