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breast > Breast Pain > Flashcards

Breast Pain Flashcards

1
Q

When a patient presents with breast pain, other than SOCRATES, what is important to determine about the pain?

A

Is this a cyclical pain? Does it seem to occur once a month?

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2
Q

When is breast pain most common during the menstrual cycle?

A

Breast pain is usually worst during the luteal phase of the cycle (just before the next period begins)

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3
Q

When a patient presents with breast pain, what should also be a main focus of the consultation?

A

We should be concerned about why the patient is presenting with the pain. Is it because she thinks she has breast cancer? Or is the pain an inconvenience in her life?

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4
Q

What are Montgomery’s Tubercles?

A

Small sebaceous glands in the areola surrounding the nipple. They are a normal finding, they may become more pronounced during pregnancy.

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5
Q

What is cyclical breast pain?

A

This is breast pain that occurs with the menstrual cycle and is mediated by changing hormone levels. It is often described as a dullness. This tends to arrest after menopause.

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6
Q

What is non-cyclical breast pain?

A

Pain unrelated to the menstrual cycle in the breasts. This is an extramammary cause for pain such as costochondritis. Causes are often unclear.

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7
Q

What percentage of breast cancer cases present with breast pain?

A

3%

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8
Q

When a woman aged 40 and over presents with breast pain, what is the most appropriate investigation to arrange?

A

Bilateral screening mammogram

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9
Q

What colour is fibroglandular tissue on mammogram?

A

White

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10
Q

What colour is fatty tissue on mammogram?

A

Dark grey

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11
Q

What should the management steps include in a patient who presents with cyclical breast pain?

A
  1. Reassure the patient there is nothing sinister going on
  2. Advise the use of a well-fitting and supportive bra
  3. Use of topical NSAIDs when the pain is bad
  4. Change of COCP which may improve the symptoms
  5. Diet and lifestyle changes can sometimes be helpful
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12
Q

What is lactational mastitis?

A

An inflammatory condition of the interlobular connective tissue

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13
Q

What are the 2 types of lactational mastitis?

A
  1. Infective

2. Non-infective

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14
Q

What percentage of breastfeeding women are affected by lactational mastitis?

A

10%

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15
Q

What is the main cause of lactational mastitis?

A

Milk stasis - overproduction or insufficient removal of milk

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16
Q

What is the main concern when someone with lactational mastitis develops a lump with systemic symptoms?

A

This could then be a breast abscess

17
Q

What percentage of women with mastitis develop a breast abscess?

A

3%

18
Q

What 4 factors may predispose someone to developing mastitis?

A
  1. Nulliparity
  2. The use of dummy/bottle as well as breast - this may mean the baby will latch for less time to the breast
  3. A tight bra
  4. Baby not latching to the breast well
19
Q

If a breast abscess is suspected, what is the first investigation you would arrange?

A

USS of the breast

20
Q

What are the benefits of performing a breast abscess drainage under USS?

A
  1. Can be performed under local anaesthetic
  2. Less scarring for the patient
  3. Can be done in a local breast clinic
  4. Quicker recovery
  5. No need to separate mother and baby
21
Q

Which antibiotic would you use for treating an infective lactational mastitis in a woman who is to continue to breastfeed?

A

A penicillin as they are effective against Beta-lactamase producing organisms and only trace amounts are found in breast milk

22
Q

What is the most common organism to cause infective lactational mastitis?

A

Staphylococcus aureus

23
Q

Why is there little milk production in the breasts during pregnancy?

A

The high progesterone:oestrogen ratio favours growth of the ductal and lobular system

24
Q

What is the name of the first ‘milk’ produced by the breasts after the baby is born?

A

Colostrum

25
Q

Which hormone influences the ductal system to produce milk after childbirth?

A

Prolactin

26
Q

Which hormone sustains lactation during each breastfeeding episode?

A

Oxytocin

27
Q

What are the physical changes that may occur to the breasts during pregnancy and during breastfeeding?

A
  1. Breasts will look larger and firmer
  2. Alveolar and nipple pigmentation may increase (they will look darker)
  3. Montgomery’s tubercles may be more prominent
28
Q

What might be advisable to tell a breastfeeding mum before having a mammogram?

A

To breastfeed or express milk before the mammogram

29
Q

Which patients are at risk of non-lactational mastitis breast abscesses?

A
  • Smokers
  • Diabetics
  • Immunocompromised patients
30
Q

What is a very important condition to rule out in patients who present with mastitis like symptoms?

A

Inflammatory breast cancer

breast (7 decks)

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