Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3a Finals > Breast Medicine > Flashcards

Breast Medicine Flashcards

1
Q

What is mastitis?

who does it occur in?

what can it be caused by?

A

occurs in lactating women, can still occur in non-lactating.

inflammation of breast tissue.

caused by bacterial infection, blocked milk ducts or combination of both.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

features of mastitis

A

breast pain and tenderness

swelling and redness of the breast

warmth and hardness of affectd area

flu-like symptoms : fever, chills and fatigue

skin changes: dimpling or puckering

nipple discharge, blood or pus-like

lymphadenopathy - in axilla

abscess formation - severe cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How would you manage mastitis?

A

1st line: continue breastfeeding

analgesia, warm compress

tx if systemically unwell, if nipple fissure, if sx dont get better after 12-24 hrs of effective milk removal or if culture indicates infection

1st line abx: oral flucloxacillin - 10-14 days. - mc organism causing it staph aureus.

abx for nonlactational mastitis : broad spectrum - co-amox, erythromycin/clarithro (macrolides) + metronidazole (covers anaerobes)

breastfeeding/expressing continue during abx tx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what’ll happen if mastitis is untreated?

A

breast abscess

incision and drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a breast abscess?

mc causative organisms

peak incidence

A

complication of infectious mastitis
collection of pus within an area of breast.

mc in breastfeeding women with mastitis.

mc: staph aureus
mrsa.
coagulase-negative Staphylococcus, diphtheroids and Pseudomonas aeruginosa.

peak : 30-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

common risk factor for brain abscess

A

smoking.

damage to nipple - provides bacteria entry.

underlying breast disease - cancer - affect drainage of breast, predisposing to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mc causative bacteria for mastitis/abscess

A

stap aureus - mc
streptococcal
enterococcal
anaerobic - bacteroides species and anaerobic streptococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

penicillins are effective in which bacterias

A

gram positive, staph, stepto enterococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

anaerobic bacteria tx

A

coamoxiclav
metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

non lactational abscess are common amongst who?

A

obese women
smokers
diabetes

nipple piercings: group b streptococcus and mycobacterium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pathophysiology of breast abscess

A

Milk stasis in lactating women due to either breastfeeding technique or blocked duct causes mastitis.

then mastitis gets infected by bacterial contamination from skin.

abscess forms- capsule of granulomatous tissue around developing infection to contain it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what might a non lactional breast abscess be caused by?

A

duct ectasia

thickening and widening of mild duct - 45-55. cause mastitis and subsequent infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

features of abscess

A

tenderness and pain
swelling - poss fluctuant
erythema and warmth

nipple discharge: poss purulent/serous discharge

nipple retraction: rare

skin changes: in longstanding case: skin might look thinned, or if severe sinus or fistula develop

lymphadenopathy: enlarged/tender axillary lymph nodes

systemic:
fever chills
malaise fatigue
tachycardia if sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ix for abscess

A

bloods - fbc u+e, crp, blood cultures if clinically unwell/septic

pregnancy tesT: if not breast-feeding women

imging:
breast ultrasound to characterise abscess.
mammogram - rule out underlying breast lesion.

microbiology:
- culture of needle aspirate of abscess to inform abx choice.
- milk culture might be helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Differentials of abscess

A

tb mastitis - rare presentation of tb - do mantoux test.

cellulitis

fat necrosis - firm round tender lump no erythema - biopsy

fibroadenoma - benign breast tumour. - do ultrasound. no systemic

invasive breast cancer - mammogram and ultrasound with biopsy

fibrocystic breast: multi-focal lumps with monthly pain around menses, improve with menstration. ultrasound.

galactocele - milk cyst on lactating women. no localised pain or systemic infection sign.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how would you manage breast abscess?

A

surgery
1st line - needle aspiration of abscess under 5cm - local anaesthetic - ultrasound guidance. - can be repeated daily over 5-7 days.

larger abscess: surgical incision and drainage with washout, or percutaneous drainage with indwelling catheter.

adjuvant medical mx:
- abx - if mrsa ruled out and systemically well then use fluclox or dicloxacilli
if penicillin allergic or if mrsa : doxycycline or clindamycin
systemically unwell pts: iv abx vancomycin

breast emptying in lactational abscess
- continue to express breast milk gives sx relief from breast engorgment.
- if suckling is painful especially during acute period, encourage mum to express manually or using pump to avoid breast engorgment

17
Q

What is duct ectasia?

who it happens in

peak incidence

A

benign breast condition characterisd by dilation and thickening of subareolar ducts.

perimenopausal and postmenopausal women

can occur i younger women rarely men

50-60

18
Q

aetiology of duct ectasia

A

involution: age releated change in breast tissue causing ductal dilation and thickening

inflammation: chronic inflammation of ducts might contribute to duct ectasia.

smoking: cigarettes.

19
Q

features of duct ectasia

A

nipple discharge: can be serous, serosanguineous, or green-black in colour - thick and stikcky

nipple inversion or retraction: occurs due to fibrosis of periductal tissue.

subareolar mass: palpable, non tender mass might be present in subareolar region.

mastalgia: pain/discomfort in breast in some pts

20
Q

ix for duct ectasia?

A

imaging:
mammography - initial imaging - identify dilated ducts.
ultrasound: nature of any lumps found. differentiate between solid and cystic lesiosn.

nipple discharge exam: if present send for cytological analysis.

ductography/galactography: inject contrast medium into nipple duct followed by mammography. detailed image. esp useful when discharge.

biopsy: rule out malignancy. - fine needle aspiration, core needle biopsyor vacuum-assisted biopsy

21
Q

how would you manage duct ectasia?

A

observe: if minimal sx.

med: oral abx. nsaids for pain/inflammation

surgery: if recurrent infection, severe nipple discharge, or persistent pain, consider surgery. : duct excision, microdochectomy, subareolar resection

22
Q

What is a fibroadenoma?

peak incidence

A

benign breast tumour.

mc breast mass - seen in woman of reproductive age

doesnt progress to breast cancer - may shrink over time

peak: 20-30

23
Q

Aetiology of fibroadenoma

genetic gene

mc during:

mc in?

A

mc - young women of reproductive age - men incidence rare.

mc during:
menses
pregnancy
while using combined oral contraceptives.

unknown aetiology - potentially related to sensitivity of breast tissue to oestrogen.

genetic: MED12 gene

24
Q

pathophysiology of fibroadenoma

A

benign - dont mutate into malignancy
they represent a proliferation of breast tissue but not exhibit any pleomorphism.

arise from terminal duct lobular unit.
compromised of both stromal tissue and epithelial connective tissue cells. - biphasic.

histology: sheets of epithelial cells in honeycomb or antler-like pattern.

stromal and epithelial cells arranged in 2 patterns:
- pericanalicular: stromal cells proliferate surrounding epithelial structures

  • intracanaliccular: stromal cells proliferate invaginating glandular tissue
25
Q

Features of fibroadenoma

where most are found

A

poss no sx

if sx:
- painless non tonder
-mobile/non tethered
-smooth
-well circumscribed
-solitary
-2-3cm in diameter (unless giant fibroadenoma (has 1% breast masses,can measure upto 5cm)

upper outer quadrant of breast. no overlying skin changes.

26
Q

how would you investigate for fibroadenoma?

A

imaging:
- ultrasound - younger women under 35 and in men, as it has greater sensitivity in denser breast tissue.

  • mammograms - women 35 and over
  • MRI not routinely.

histology: core biopsy - or fine needle aspiration cytology.

  • clinical exam, imaging, pathology.

risk assessment : examination score P1(normal) - P5 (malignant) and imaging scores M1 -M5 or U1-U5 - depends on modality and pathology scores from B1-B5

27
Q

referral criteria for fibroadenoma

A

2 week wait suspected cancer referral
for pt 30 and over with unexplained breast lump with or without pain.

non urgent if under 30 with unexplained with or without pain

28
Q

how would you manage fibroadenoma?

A

asx - no tx or follow up.

removal:
- surgical lumpectomy or excisional biopsy to remove mass.
- vacuum-assisted biopsy
- cryoablation - low temp to destroy breast tissue.

-high intensity focused ultrasound for ablation of fibroadenoma tissue.

29
Q

indications for surgical removal of fibroadenoma

A

large size - greater than 500g or larger than 5cm

continued growth of mass

patient request.

30
Q

differentials of fibroadenoma

A

mastitis - both unilateral but mastitis red warm pain systemic sx

breast cancer - both unilateral but cancer has skin changes nipple affected, discharge pain.

phyllodes tumour: both smooth firm well circumscribed. but phylloes older 40-50 and faster growing

cyst: both distinct mobile round/oval mass with menses related onset but cyst is older 35-50 and poss nipple discharge and pain.tenderness.

fibrocystic change both smooth lumpy changes, most prominent in reproductive yrs. difference is multiple bilateral lumps

31
Q

What is Pagets Disease of the nipple?

where does it effect?

what might it be associated with?

mc

A

rare breast cancer

malignant cells in nipple-areolar complex.

affects epidermis of nipple and areola - lead to erythema, scaling and ulceration.

poss associated with underlying in situ or invasive ductal carcinoma.

mc - infants

32
Q

Pathophysiology of pagets disease of nipple

A

unclear
2 theories

epidermotropic thory: malignant cells underlying ductal carcinoma migrate through lactiferous ducts and invade epidermis of nipple and areola.

intraepidermal origin: pagets cell arise independently within nipple epidermis and later infiltrate underlying breast tissue.

33
Q

features of pagets disease of nipple

A

unilateral - texture of nipple and areola.

sx:
erythema scaling thickening of skin

itching buring pain in nipple and areola

nipple discharge poss bloody or serous

nipple ivnersion or retraction

ulceration or erosions in advanced case.

canbe misdiagnosed as other benign skin conditions: eczema dermatitis.

34
Q

ix for pagets disease of nipple

A

imaging:
- mammography
-ultrasound
-mri

skin biopsy:
- punch/shave biopsy of nipple/areola - histopathology
- paget cells : large round pale staining cells with abundant cytoplasm and large nucli confirms

35
Q

mx for pagets disease of nipple

A

depends if underlying invasive/in situ breast cancer present.

diagnosis: skin biopsy of nipple lesion. mammogram + uss of breast and axillary lymph nodes. MRI to see extent of disease.

surgery: 2 options

  • breast conserving surgery: wide local excision. - excise nipple-areolar complex and margin of healthy tissue. preffered if no underlying breast carcinoma or if carcinoma is limited to area beneath the nipple-areolar complex. - bcs followed by radiation.

mastectomy : removal entire breast tissue underlying. in breast parenchyma.
if axillary lymph nodes spread. sentinel lymph node biopsy or axillary node dissection.
options breast reconstruction discussed before surgery.

radiation: after bcs to reduce local recurrence not after mastectomy until multiple positive lymph nodes.

systemic therapy: hormone or chemo, depends on her2 status an present of lymph node or distant mets. if er-positive tumour give adjuvanthormone therpay.
her2 positive - targeted therapy with trastuzumab

Phase 3a Finals (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions