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Phase 2B > Breast Examination > Flashcards

Breast Examination Flashcards

1
Q

What is the average age of women who develop breast cancer

A

62

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2
Q

Globally, which countries are worst affected by breast cancer? Why?

A

Western world

Western lifestyle is linked to breast cancer

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3
Q

Why is incidence of breast cancer rising?

A 
Western lifestyle
Alcohol
Post menopausal obesity
Not exercising 
Late start to child bearing 
Reduced breast feeding 
OCP and HRT 
Increased longevity
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4
Q

Name three reasons why breast cancer mortality is falling

A

Screening
Improvements in systemic therapies
Chemotherapy
Surgery

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5
Q

What are the 4 types of breast cancer presentation?

A

30% are asymptomatic
60% are early symptomatic (e.g symptomatic lump, distortion)
Rest present either with locally advanced breast cancer or metastatic breast cancer

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6
Q

Name 4 different non-malignant breast problems?

A 
Benign hormonal nodularity 
Cysts
sepsis
itchy nipples/discharge
breast pain
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7
Q

What is the most common cause of non-malignant breast lumps? What is this triggered by?

A

Benign breast change/fibrocystic breast change

Triggered by hormonal changes in pre-menopausal women

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8
Q

What are the characteristics of a benign breast change nodule?

A

tender/painful
may be cyclical
rubbery nodularity
common in all ages of pre-menopausal women (usually at the younger age of the range)

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9
Q

What is the management of benign breast change?

A

reassure

may be worth waiting until after the woman’s next period before referring as can usually settle between cycles

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10
Q

What are the characteristics of a breast fibroadenoma?

A 
smooth
mobile
non-tender
usually seen in teens-mid 30s 
1-3cm
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11
Q

What is giant juvenile fibroma of the breast?

A

A rare variant of fibroadenoma found usually in patients less than 20 years old
They present with rapid enlargement of single or multiple, discrete painless large nodules of the breast

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12
Q

Management of a fibroadenoma of the breast?

A

leave it unless it is increasing in size, has an atypical histology or is tender

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13
Q

how does a cyst on the breast present usually

A

tender lumps often in women with menopausal symptoms
tend to be about 1-2cm large
usually multiple cysts

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14
Q

characteristics of a breast cyst?

A

may feel cystic but if tense may be hard and irregular and difficult to tell from cancer

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15
Q

What is the management for a breast cyst?

A

Mammogram
Aspirate
Will cease at menopause unless on HRT

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16
Q

What age of women does acute peripheral or lactational sepsis occur?

A

less than 40 years old

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17
Q

what organism causes acute peripheral or lactational sepsis?

A

staph aureus

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18
Q

name 2 causes of acute peripheral or lactational sepsis ?

A

pregnancy
lactational blocked duct
diabetes

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19
Q

what is the treatment for acute peripheral or lactational sepsis ?

A

serial aspiration

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20
Q

why should you avoid surgical drainage in acute peripheral or lactational sepsis ?

A

may cause a lactational fistula

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21
Q

what antibiotics would you use to treat acute peripheral or lactational sepsis ?

A

flucloxacillin

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22
Q

What age of women does acute periareolar sepsis occur?

A

less than 50

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23
Q

name 2 organisms that can cause acute periareolar sepsis?

A

staph aureus
strep
baceroides
enterococci

24
Q

name 2 causes of acute periareolar sepsis?

A

duct ectasia
periductal mastitis
smoking

25
Q

what is the treatment for acute periareolar sepsis?

A

serial aspiration
surgical drainage
total duct excision
fistulectomy

26
Q

what antibiotics would you use to treat acute periareolar sepsis and why?

A

co-amoxiclav

they are broad spectrum

27
Q

what type of discharge is non-spontaneous, bilateral, yellow or creamy?

A

physiological

28
Q

what type of discharge is milky, multiduct, large volume, rarely bloody?

A

hormonal

29
Q

what type of discharge is greenish brown, multiduct?

A

duct ectasia

30
Q

what type of discharge is clear or bloody, uniduct?

A

papilloma or ductal carcinoma in situ

31
Q

what is the management for physiological discharge?

A

reassure

32
Q

what is the management for hormonal discharge?

A

pregnancy test
serum hormone profile
if bloody need to monitor

33
Q

what is the management for duct ectasia?

A

reassure or total duct excision if volume is excessive

34
Q

what is the management for papilloma or ductal carcinoma in situ?

A

imaging and proceed to microdochectomy

35
Q

what is duct ectasia?

A

when the milk duct beneath the nipple widens and the duct walls thicken and the duct fills with fluid

36
Q

what is periductal mastitis

A

ducts under the nipple become inflamed and infected

37
Q

what past medical history may be relevant in a breast lump history/

A

pregnant or breastfeeding
age at first pregnancy
age at menarche/menopause
OCP or HRT

38
Q

what skin changes are you looking out for during a breast inspection?

A

scaling
erythema
puckering
peau d’orange

39
Q

what are the features of Paget’s disease of the breast?

A

scaling of the nipple and/or areola
erythema
pruritius

40
Q

why does puckering of the breast tissue occur?

A

usually associated with invasion of the suspensory ligaments of the breast by an underlying malignancy that results in ligamentous contraction which draws the skin inwards.

41
Q

what is peau d’orange

A

dimpling of the skin that occurs due to cutaneous lymphatic oedema
dimples represent tethering of the swollen skin to hair follicles and sweat glands.

42
Q

what type of breast cancer is peau d’orange typically associated with?

A

inflammatory breast cancer

43
Q

what drugs are important to identify in a patient with a breast lump?

A 
clopidogrel
warfarin
apixaban
OCT
HRT
44
Q

what are red flag presenting symptoms for breast cancer?

A
  • painless lump/thickening
  • nipple discharge
  • nipple inversion
  • distortion
  • Paget’s disease
  • Axillary nodes
45
Q

what are red flag presenting signs for breast cancer?

A

painless lump that is hard, irregular and fixed
skin tethering
indrawn nipple

46
Q

characteristics of a breast cancer lump?

A

painless
hard
irregular
fixed

47
Q

if you find a lump what should you assess about it?

A
  1. size
  2. shape
  3. mobility/fixity relative to the skin, ribs and underlying tissue
  4. site in breast
  5. symmetry
  6. consistency
  7. smooth/irregular surface
  8. fluctuance
  9. skin tethering
48
Q

why is palpation of the axillary tail important

A

the axillary tail is a projection of breast tissue that extends into the axilla. majority of breast cancers develop in the upper outer quadrant of breast and extend into the axilla.

49
Q

what are the investigations following a breast exam?

A

mammography
ultrasound
core biopsy

50
Q

what is the main treatment for breast cancer

A

surgery
can be a full mastectomy or a lumpectomy with radiotherapy afterwards (same survival rates)
will also tend to have surgery to remove some or all of the axillary glands

51
Q

what are the different operations used to remove axillary glands?

A

majority of women have the sentinel lymph node biopsy

if clinically positive in the axillary nodes or high risk will have full axillary clearance

52
Q

what is sentinel lymph node biopsy?

A

a radioactive isotope is injected pre operatively into the tumour. This highlights the glands draining from the cancer so we can target and remove these.

53
Q

what can full axillary clearance cause?

A

lymphodema

54
Q

name 5 adjuvant therapies we use as well as surgery?

A 
endocrine therapy 
bisphosphonates 
chemotherapy 
target biologicals e.g trastuzumab
radiotherapy
55
Q

name three methods of breast reconstruction

A 
lipomodelling 
breast implants
reconstruction with expander implant 
using the lat dorsi for reconstruction for women with bigger droopier breasts
DIEP Flap (tummy tuck procedure) 
Superior gluteal artery perforator flap

then add new nipples

Phase 2B (1 decks)

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