Breast Infection / other

Question 1

What is Phyloddes tumour

Answer 1

Tumour of breast
Large and fast growing
Can be benign or malignant potential
FIbroepithlial

Question 2

What is benign part

Answer 2

Epithelial

Question 3

What is malignant

Answer 3

Stroma / connective tissue

Question 4

What type of malignancy

Answer 4

Mixed adenocarcinoma

Glandular and fibrous tissue

Question 5

How does it present

Answer 5

Pre-menopause (40-50)
Smooth firm lump
Circumscribed

Question 6

Histologically

Answer 6

Leaf like + cyst

Question 7

How do you investigation

Answer 7

Triple assess
Biopsy as FNA misses
Do multiple pass as don’t want to miss

Question 8

How do you Rx

Answer 8

Surgery
Often mastectomy but can do WLE
RT after if malignancy

Question 9

What can it be confused with

Answer 9

Fibroadenoma but usually larger and older patient

Question 10

What is duct ectasia

Answer 10

Dilatation and shortening of breast ducts in menopause
Leads to
Stagnant secretion
Ruptured material = dilatation / inflammation / fibrosis

Question 11

How does duct ectasisa present

Answer 11

Nipple discharge 
Lump behind nipple if inflamed 
Nipple retraction / inversion 
Mastalgia 
Red/ swollen / warm

Question 12

What is discharge

Answer 12

Green / yellow /red
Never blood but can be blood stained
Multiple duct
Bilateral

Question 13

RF

Answer 13

Menopause

Smoking

Question 14

How do you Dx

Answer 14

Triple assess

Question 15

How do you Rx

Answer 15

Stop smoking

Duct excision if persistent

Question 16

What are types of mastitis

Answer 16

Neonatal
Lactating
Non lactating
Skin associated

Question 17

What are common organism

Answer 17

S.Aureus

Question 18

What are other organisms in non-lactating

Answer 18

Enterococci

Anerobic strep

Question 19

What causes lactating mastitis

Answer 19

Milk stasis

If too painful = express

Question 20

What can develop with all breast infection

Answer 20

Abscess if left unRx
Red
Hot
Tender swelling
Pus dischage

Question 21

How does lactating mastitis present

Answer 21

Pain
Swelling
Tender
Erythema
Hx cracked nipple

Question 22

What is non-lactating mastitis known as

Answer 22

Periductal

Question 23

RF for peri-ductal mastitis

Answer 23

Smoking
Immunocompromised
DM
Obesity
Pregnant / lactating
Neonate

Question 24

What organism in neonate

Answer 24

E.coli

Question 25

How do you Dx

Answer 25

Examine Swab of discharge / breast milk USS guided aspiration if abscess

Question 26

How do you treat lactating

Answer 26

Continue breast feeding / express Warm compress Analgesia

Question 27

When do you give Ax

Answer 27

No improvement 12-24 hours | Culture +Ve

Question 28

What Ax

Answer 28

Fluclox 1st lie | Erythromycin

Question 29

How do you treat abscess

Answer 29

Aspiration USS Repeat till no pus Ax Surgical incision + drainage if necrotic

Question 30

What do you do if inflammatory lesion + solid on USS or not settling with one course Ax

Answer 30

BREAST REFERRAL Triple assessment Inflammatory carcinoma

Question 31

How does inflammatory carcinoma present

Answer 31

Red breast Not cured after Ax or no signs of infection - CRP / fever Peu d'orange

Question 32

Why is it important fast referral

Answer 32

Dermal lymphatic spread Bilateral Advanced nodes Block LN drainage

Question 33

How do you Rx

Answer 33

Chemo neoadjuvant = 1st line Mastectomy + RT Whole breast change

Question 34

What causes periductl

Answer 34

S.aureus

Question 35

How does it present

Answer 35

``` Hot red breast Tender Discharge Lump behind nipple Nipple pulled in Abscess ```

Question 36

Differentiate from duct ectasia

Answer 36

Younger

Question 37

How do you Dx

Answer 37

Triple asses USS FNA

Question 38

How do you Dx

Answer 38

Ax | Open incision and drain

Question 39

Complication

Answer 39

Mammary duct fistula

Question 40

What is gynaecomastia

Answer 40

Growth of Brest tissue in males | Benign and reversible

Question 41

What causes gynaecomastia

Answer 41

``` Decreased androgen - testosterone or increased oestrogen Puberty Old age Fat ```

Question 42

What are other non physiological causes

Answer 42

``` Anabolic steroid Cannabis Spinolactone Digoxin Furosemide Liver cirrhosis Alcohol Prolactinoma Primary hypogonadism - testicular issue Testicular tumour Hyperthyroid Chronic renal and pulmonary disease ```

Question 43

How do you Dx

Answer 43

Blood Hormonal + biochemical MG or USS differentiate / cancer

Question 44

What do you do for breast lump in male

Answer 44

3x assessment | Biopsy

Question 45

What is 1st line gynaecomastia

Answer 45

Tamoxifen

Question 46

Other Rx

Answer 46

Danazole (AI) | Surgery

Question 47

What is galactorrhea

Answer 47

Producing milk from breast Physiology in response to prolactin from AP Dopamine will block prolactin

Question 48

What causes galactorrhea

Answer 48

``` Lactation Pregnant and post breast feeding - can begin in 2nd trimester Idiopathic hyperprolactin Prolactinoma Drugs Endocrine Other ```

Question 49

What is a prolactinoma and what are the symptoms

Answer 49

Tumour of the pituitary gland - Galactorrhoea - Amenorrhoea - Infertiltiy - Gynaecomastia - Sexual dysfunction - Bitemporal hemianopia

Question 50

What types of prolactinoma can you get

Answer 50

Micro <1cm | Macro >1cm

Question 51

What can they be associated with

Answer 51

MEN1

Question 52

How do you treat

Answer 52

Dopamine agonist | Surgery if fails

Question 53

What drugs can cause hyperprolactin

Answer 53

``` Contraception SSRI Dopamine antagonist - Anti-psychotic / anti-emetic Methyldopa BB Digoxin Spirnolactone ```

Question 54

What endocrine causes

Answer 54

Hypothyroid Acromegaly CUshing's PCOS

Question 55

What are other causes

Answer 55

Liver failure | CKD