Breast Lump

Question 1

Causes of breast pain in postpartum women

Answer 1

Engorgement
Blocked Duct
Mastitis (Bacterial, Fungal)
Cystic Breasts
Breast Abscess

Question 2

Management of mastitis

Answer 2

Abx (cephalexin)
Compresses
Encourage Breastfeeding
Wear Support
Analgesics

Question 3

Inflammatory carcinoma sx

Answer 3

warm, tender, indurated skin

Question 4

Paget’s disease sx

Answer 4

scaling and eczematous skin around nipple

Question 5

Sx cystic breast lump

Answer 5

Fluctuates w/ cycle
Well demarcated, firm, mobile
Can be tender
>40y/o, uncommon after menopause

Question 6

Dx of cystic breast lump

Answer 6

Mammogram
FNA

Question 7

Rx of cystic breast lump

Answer 7

NSAIDs
Watch + wait

Question 8

Sx fibroadenoma

Answer 8

Rubbery, non tender, mobile
Usually upper outer quadrant, symmetrical
Associated w/ cycle + painful

Question 9

Ix for fibroadenoma

Answer 9

Mammogram
US
FNA

Question 10

Rx for fibroadenoma

Answer 10

Excise

Question 11

Intraductal papilloma sx

Answer 11

Bloody nipple DC
Solitary intraductal polyp

Question 12

Ix + Rx for intraductal papilloma

Answer 12

Mammogram
US

Excision

Question 13

RF for breast cancer

Answer 13

BRCA gene
Age >50 y/o
Prior hx of breast cancer
1st degree relative with breast cancer
Unopposed estrogen
Nulliparity
First pregnancy >30 y/o
Menarche <12 y/o
Menopause >55 y/o
Not breastfeeding
>5 yrs HRT
Radiation exposure

Question 14

Protective factors for breast cancer

Answer 14

Maintain healthy weight
Physical activity
Low alcohol use
Early pregnancy
Breastfeeding
Avoid smoking

Question 15

Breast cancer screening guidelines

Answer 15

HIGH RISK 30-69 = annual mammograms
BRCA
1st degree relative BRCA
Chest radiation <30 y/o + >8 yrs ago
>25% lifetime risk using IBIS or BOADICEA tool
50-74 screen q2-3 yrs based on pt preference

Question 16

When is genetic screening recommended for breast cancer?

Answer 16

Breast cancer <50 y/o
Ovarian cancer
Bilateral breast cancer
Breast + ovarian cancer in same woman
Multiple breast cancer same side of family
Male breast cancer
Ashkenazi Jewish

Question 17

Breast cancer screening for trans people

Answer 17

Trans women on >5 yr hormone therapy - screen as per guidelines
Trans men w/o top surgery - screen as per guidelines
Trans men w/ top surgery - no screening needed

Question 18

Prevention of breast cancer in high risk pts

Answer 18

HIGH RISK pts: mastectomy + TAHBSO

Question 19

Ix for breast lumps (<30 vs >30)

Answer 19

<30 = US
>30 = US + mammogram

Question 20

Treatment by stages of breast cancer

Answer 20

Stage 0 = breast conserving surgery +/- RT, mastectomy
Stage 1 = breast conserving surgery, axillary node dissection, RT, mastectomy +/- chemo
Stage 2 = breast conserving surgery, axillary node dissection, RT, mastectomy, chemo + tamoxifen if ER positive
Stage 3 + 4 = mastectomy, axillary node dissection, RT, chemo, hormones

Question 21

complications of breast cancer

Answer 21

1) Metastases = bone > lungs > liver > brain
2) Hypercalcemia
3) Osteoporosis
4) Menopausal sx

Question 22

Sx + Rx of hypercalcemia

Answer 22

Sx: N/V, constipation, abdo pain, dehydration, confusion
Tx: IVF NS, IV bisphosphonate (zolendronate), consider corticosteroids, calcitonin

Question 23

Name + SE of estrogen antagonists

Answer 23

Tamoxifen
hot flashes, vaginal dryness, fatty liver, VTE, endometrial cancer

Question 24

SE of progestins

Answer 24

wt gain, nausea, fluid retention

Question 25

SE of aromatase inhibitors

Answer 25

somnolence, rash, arthralgia, HTN, raised lipids, vaginal dryness

Question 26

Rx of mets

Answer 26

Treat w/ opioids, NSAIDs, steroids, bisphosphonates, RT

Question 27

SE of RT

Answer 27

Weakness, paresthesia, pulmonary/ cardiac fibrosis

Question 28

SE of chemo

Answer 28

Premature ovarian failure, dilated cardiomyopathy, MI, arrhythmia, cognitive dysfunction

Question 29

SE of surgery

Answer 29

Lymphedema, phantom pain