Breast Disorders & Preeclampsia/Eclampsia, HELLP

Question 1

BRCA 1 Associated Cancers

Answer 1

Breast

Cervical

Uterine

Pancreatic

Colon

Question 2

BRCA 2 Associated Cancers

Answer 2

Breast

Pancreatic

Stomach

Gallbladder

Bile duct

Melanoma

Question 3

BRCA Associated Cancers in Men

Answer 3

Breast

Pancreatic

Testicular

Early-onset prostate

Question 4

Fibrocystic Change

Answer 4

Exaggerated physiologic response to changing hormonal environment

Most common breast lesion, rare in postmenopausal

Painful masses which increase during premenstrual cycle phase w/ multiple bilateral masses w/ rapid size fluctuations

Tx: ASA/NSAID, warm compress, support bra, Vitamin E; bx if needed

Avoid chocolate, ETOH, Caffeine

Question 5

Fibroadenoma

Answer 5

Usually solitary if complex - increased risk of breast cancer

Common in younger women - if >30 yo need to distinguish from fibrocystic change or breast cancer

Round/ovoid, nontender, rubbery w/ smooth margins 1-5 cm

Dx: US to visualize - shows up well, FNB for cytology

Tx: excise if >3 cm, painful or growing - remove if >40 yo

Question 6

Phyllodes Tumor

Answer 6

Rapidly growing - fibroadenoma like tumor w/ rapid growth and early mets to the lungs

Develop in the 40s

Have to differentiate from fibroadenoma

Question 7

Fine Needle Aspiration (FNA)

Core Needle Aspiration (CNA)

Excisional Biopsy

Answer 7

Fine Needle Aspiration (FNA): 21-25 gauge needle - very sensitive and specific

Core Needle Aspiration (CNA): 14-18 gauge

Excisional Biopsy: take out w/ margins - only definitive diagnosis of breast cancer

Question 8

Mastitis

Answer 8

Breast tender, warm to touch, swollen, malaise w/ skin redness (wedge-shaped)

101 degree fever, usually Staph infection that starts as a fissured/sore nipple

Tx: Dicloxacillin, Keflex for 5-7 days; warm compress, nurse and pump empty breast to avoid abscess

Question 9

Intraductal Papilloma

Answer 9

Wart-like growth in breast that may puncture duct and cause benign nipple discharge

Solitary intraductal: 1 lump, near nipple, get discharge

Multiple papilloma: group of lumps far away from nipple, no discharge or palpation

Papillomatosis: very small cell groups w/in duct -> hyperplasia, more scattered than multiple papillomas

Tx: Surgical removal and bx for cancer

Question 10

Causes of Nipple Discharge

Answer 10

Papilloma

Premenopausal

Prolactinoma - often pituitary tumor

OCP

Abscess

Medication

Hypothyroidism

Question 11

Preeclampsia

Answer 11

New onset HTN and proteinuria or end-organ dysfunction

Occurs after 20 weeks gestation up to 6 weeks postpartum

Sx most commonly in 3rd trimester

7X more thromboxane (vasoconstrictor and increases platelet aggregation) than prostacyclin (vasodilator, decreased aggregation)

Question 12

Preeclampsia Indications for Delivery

Answer 12

>36 weeks

Epigastric pain, thrombocytopenia, visual disturbances = deliver immediately

Question 13

Severe Preeclampsia

Answer 13

BP >160

Proteinuria >500 mg or 4+

Oliguria

Thrombocytopenia

Increased risk for HELLP, may have systemic association

Question 14

HELLP

Answer 14

Hemolysis, elevated liver enzymes, low platelets

Sx: malaise, epigastric pain, N, RUQ tenderness

Complications: placental abruption, renal failure, hepatic hematoma/rupture, ascites

Question 15

Preeclampsia Underlying Problem

Answer 15

Endothelial dysfunction cause unknown

Question 16

HELLP Labs

Answer 16

Hemolysis: Increased bilirubin & LDH, abnormal peripheral smear - bury cells or schistocytes

LFTS: SGOT >70, LDH >600

Low platelets: <100,000

Question 17

Eclampsia

Answer 17

Severe preeclampsia w/ progression to seizures

Tx: Magnesium sulfate to control seizures

-q4-6 hours monitor blood levels

Question 18

Magnesium Toxicity

Answer 18

Decreased/loss of DTRs

Decreased Respiratory Rate

Reverse w/ calcium gluconate