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Year 3 > Breast lump (oxford clin cases) > Flashcards

Breast lump (oxford clin cases) Flashcards

1
Q

What are the 4 common diagnoses when someone presents with a breast lump

A

Fibroadenoma
Abcess
Benign cystic change
Carcinoma

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2
Q

What is a breast lump likely to be if someone is under 30 years old?

A

Benign cystic change

Galactocele/other breast feeding issue if they are breast feeding

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3
Q

What is a breast lump likely to be in someone over 60?

A

Carcinoma

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4
Q

In what age group is a fibroadenoma the most common diagnosis for breast lump?

A

Under 30s

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5
Q

In what age group is carcinoma the most common diagnosis for breast lump?

A

Over 60s

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6
Q

What diagnoses will you only see in breastfeeding women for breast lump?

A

Galactocele or mastitis

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7
Q

What are the 2 biggest risk factors for developing breast cancer?

A

Being female

Increasing age

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8
Q

What are some risk factors for developing breast cancer?

A 
Female sex
Increasing age
Family history
Pmx of breast, endometrial, bowel, ovarian cancer 
Prolonged oestrogen exposure
Previous radiation to the chest
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9
Q

When would you be concerned about breast cancer in the family history?

A

When there are 3 blood relatives who have had it
When there are 2 blood relatives under 60
When theres 1 blood relative under 40
When any blood relative has had it bilaterally
When any male blood relative has had it

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10
Q

What are some reasons someone may have had prolonged oestrogen exposure?

A 
Early menstruation
Late menopause 
HRT (especially if oestrogen and progesterone) 
First child after 30 
Not breastfeeding 
Use of OCP
Obesity
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11
Q

If a breast lump has being growing slowly what diagnoses is more likely?

A

Carcinoma

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12
Q

If a breast lump has being grown very fast what diagnoses is more likely?

A

Cyst

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13
Q

If a breast lump changes with the menstrual cycle or cyclically in general what diagnosis is more likely and what is less likely?

A

Benign cyst is more likely

It is unlikely to be a carcinoma

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14
Q

How fast will a benign breast cyst grow?

A

Very fast, can appear almost overnight

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15
Q

What complications does breast trauma increase the risk of?

A

Infection

Fat necrosis

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16
Q

If a breast lump is painful what is the diagnosis more or less likely to be?

A

More likely to be mastitis or cyst

Less likely to be carcinoma

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17
Q

What does erythematous or warm skin on a breast lump indicate?

A

Infection eg mastitis or abcess

18
Q

What does peau d’orange indicate when theres a breast lump?

A

Carcinoma until proven otherwise

19
Q

What is peau d’orange?

A

Puckering of the skin that overlays the breast or overlays a lump

20
Q

What does recent distortion of the nipple suggest?

A

Carcinoma

21
Q

What is milky discharge from a nipple likely to be?

A

Galactocele

22
Q

What is green/brown/yellow discharge from a nipple likely to be?

A

Mastitis/infection

23
Q

What is bloody discharge from a nipple likely to be?

A

Carcinoma

24
Q

What symptoms besides from breast lump will a carcinoma present with?

A

Usually none- systemic symptoms like fever, weight loss, night sweats are unlikely
There may be some symptoms of mets eg back pain due to spinal mets

25
Q

What symptoms might accompany a breast lump?

A

Usually none, they often present by themselves

26
Q

What are some questions you might ask about the lump in a history when someone present with breast lump?

A

When did the lump appear?
Has the lump grown in size? If so how fast is it growing
Do they notice it changing with their menstrual cycle?
Is it painful?
Is there any discharge from the nipple? If yes what colour is it
Are they having any other symptoms?
Have they noticed any changes to the skin of the breast?
Have they noticed any changes to the nipple?

27
Q

What should you look for when you inspect the breast?

A

Contours- any disruptions in the natural curvature?
Asymmetry- this is natural but look for new asymmetry
Discharge
Changes to the nipples- inversion is natural but check if its new or if their nipples have always been inverted
Dimpling or peau d’orange

28
Q

Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a solitary cyst on the breast

A 
Surface= smooth
Border= well defined
Consistency= firm to lax
Mobility= no
Fixity= no 
Lymphadenopathy= no
29
Q

Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a fibroadenoma on the breast

A 
Surface= smooth
Border= well defined
Consistency= rubbery
Mobility= yes
Fixity= no
Lymphadenopathy= no
30
Q

Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a carcinoma on the breast

A 
Surface= irregular
Border= not well defines
Consistency= hard
Mobility= no
Fixity= maybe
Lymphadenopathy= maybe
31
Q

What type of breast lump will have mobility?

A

Fibroadenoma

32
Q

What will a cyst on the breast feel like- explain why

A

They will be either firm or lax, depending on the pressure of fluid inside them

33
Q

Describe the surface, borders, consistency, mobility, fixity and lymphadenopathy of a benign cystic change on the breast

A 
Surface= irregular
Border= not well defined
Consistency= mixed
Mobility= no
Fixity= no
Lymphadenopathy= no
34
Q

What is a fibroadenoma?

A

Aberrations of normal breast tissues containing stromal or epithelial cells

35
Q

How are fibroadenomas managed?

A

Usually they resolve by themselves
If they are increasing in size, are painful/uncomfortable or the patient really wants them gone they can be removed via excisional biopsy

36
Q

How are lumps investigated in the breast clinic?

A

Triple assessment

37
Q

What does triple assessment at a breast clinic involve?

A

Clinical examination
Radiography
FNA

38
Q

What radiography is done for those under 35? Why?

A

Ultrasound because their breast tissue is too dense to view via mammography

39
Q

What radiography is done for those over 35? Why?

A

Mammography because their breast tissue is not too dense and will be visible

40
Q

On a mammogram what will indicate a cancer?

A

Regions of increased density, spiculations (look like shards of glass), irregular margins

41
Q

What is the difference between fine needle aspiration and core biopsy when investigating a breast lump?

A

FNA= only tells you info on the types of cells and whether they are dysplastic or not
Core biopsy= gives you info on the local architecture of the tissue too

Year 3 (104 decks)

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