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Clin med sem 2 > Breasts > Flashcards

Breasts Flashcards

1
Q

Supernumerary Nipple- pathophysiology

A

An extra nipple

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2
Q

Supernumerary Nipple- S/S & PE

A

Found along milk line
Not dangerous
Darken w/ pregnancy
Inc in size/location - hormones during pregnancy

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3
Q

Gynecomastia- pathophysiology

A

Enlargement/swelling of breast

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4
Q

Gynecomastia- epidemiology

A

Meds - resparadone, spiralactone

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5
Q

Gynecomastia- S/S & PE

A

Unilateral or bilateral
Indicator of hormone imbalance - inc estrogen
Males - during puberty or in elderly - dec testosterone

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6
Q

Mastodynia (Mastalgia)- pathophysiology

A

Common

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7
Q

Mastodynia (Mastalgia)- S/S & PE

A

Cyclical - hormonal changes
Inc w/ OCPs or HRT
During luteal phase

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8
Q

Mastodynia (Mastalgia)- treatment

A

Reassurance

Vit B6

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9
Q

Mastitis- pathophysiology

A

Breast infection

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10
Q

Mastitis- cause

A

Staph aureus

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11
Q

Mastitis- epidemiology

A

Lactating women

  • poor latch
  • incomplete emptying of breast
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12
Q

Mastitis- S/S & PE

A 
Abscess
Unilateral tenderness, heat
Fever/chills
Body aches 
Classic - one quadrant breast/lobule affected
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13
Q

Mastitis- labs & imaging

A

Culture - milk

- not usually done

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14
Q

Mastitis- treatment

A

Abx

  • Dicloxacillin - 500mg PO Q6hr x 10 days
  • Cephalosporin 10-14 days

Continue breastfeeding

Surgery - abscess

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15
Q

Breast Abscess- epidemiology

A

Lactation

Subareolar abscess in nonlactating - nipple piercing

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16
Q

Breast Abscess- S/S & PE

A

Painful
Swollen
Red, tender
Induration - filled w/ pus

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17
Q

Breast Abscess- treatment

A

I&D
Abx

Don’t respond to treatment - suspect inflammatory breast cancer
- esp if axillary lymphadenopathy

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18
Q

Fat Necrosis of Breast- pathophysiology

A

Benign

Damaged/dead breast tissue

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19
Q

Fat Necrosis of Breast- cause

A

Hx - trauma or surgery

Post - breast biopsy, surgery, radiation

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20
Q

Fat Necrosis of Breast- S/S & PE

A

Firm nodule

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21
Q

Fat Necrosis of Breast- diagnosis

A

Biopsy - to confirm

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22
Q

Fat Necrosis of Breast- labs & imaging

A

Imaging - can look like carcinoma

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23
Q

Fat Necrosis of Breast- treatment

A

Excision not needed

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24
Q

Fat Necrosis of Breast- prognosis

A

No inc risk of breast cancer

25
Q

Fibrocystic- pathophysiology

A

Benign - most common

26
Q

Fibrocystic- cause

A

Hormonal changes – inc in size w/ estrogen or progesterone

27
Q

Fibrocystic- epidemiology

A

30-50

28
Q

Fibrocystic- S/S & PE

A

Bilateral - multiple
Mobile
Cyclic pain
Breast tenderness

Multiple lesions - not carcinoma
- get biopsy w/ any concern

29
Q

Fibrocystic- treatment

A 
Supportive Bra
Avoid caffeine
Low salt diet
Vt E
Evening primrose oil
30
Q

Fibrocystic- prognosis

A

Will stop w/ menopause

31
Q

Fibroadenma- pathophysiology

A

Benign - glandular breast tissue

32
Q

Fibroadenma- epidemiology

A

Young W

AA

33
Q

Fibroadenma- S/S & PE

A 
Round or ovoid
Firm, smooth, rubbery
Discrete
Mobile
Non tender
34
Q

Fibroadenma- diagnosis

A

Core needle biopsy OR

3-6m f/u - w/ repeat U/S and breast exam

35
Q

Fibroadenma

A

None if diagnosis by biopsy

Surgery - if pt wants
Cryoablation

36
Q

Nipple Discharge- S/S & PE

A

Nl Lactation

Galactorrhea

  • Milky white discharge - bilateral
  • frequent result of hyperprolactinemia - meds or tumor

Pathologic Nipple Discharge

  • Causes - duct ectasia, intraductal papilloma, carcinoma
  • unilateral - single duct
  • Serous, bloody, serosanguineous
  • Purulent w/ breast abscess
37
Q

Nipple Discharge- diagnosis

A

Pathologic

  • U/S or Mammogram
  • cytogological of discharge - not helpful -> neg doesn’t rule out cancer
38
Q

Nipple Discharge- treatment

A

Pathologic:
Refer
Surgery - involved duct
- tx and diagnosis

39
Q

Breast Cancer- pathophysiology

A

Estrogen excess

  • length of reproductive life
  • Parity
  • age at first birth
40
Q

Breast Cancer- cause

A

BRCA1 and BRCA2

41
Q

Breast Cancer- epidemiology

A 
inc w/ age
61
Risk:
- Nullparity
- Early menarche
- Late menopause
- long term estrogen or radiation exposure
- Delayed childbearing >30
- 1st deg relatives
- hx of endometrial
42
Q

Breast Cancer- S/S & PE

A

Non-invasive
Ductal carcinoma in-situ
- no palpable mass
Lobular carcinoma in-situ

Invasive
Invasive ductal carcinoma - 80-85%
- underlying palpable mass 
Invasive lobular carcinoma
Special types
43
Q

Breast Cancer- diagnosis

A

Early - mammographic changes and no mass

PE, mammography, US, fine need biop, core biopsy, excisional biopsy

Tumor marking - estrogen and progesterone receptor

  • HER2/NEU
  • histologic

Additional testing - MRI, CT, chest xray, bone scan, PET scan

44
Q

Breast Cancer- labs & imaging

A

Breast Self-Awareness

  • be familiar w/ breasts
  • report any changes to PCP

Clinical Breast Exam
- No real benefit if getting mammograms

Mammography - best screening

  • ACS - yearly at 40, every 2 yr at 55yo
  • USPSTF - yearly at 50-75
  • start before 50 is pt decision - higher rates of false pos and unneeded biopsies -> more estrogen

MRI

  • high risk - MRI + mammogram yearly at 30yo
  • BRCA, 1st deg relat w/ BRCA, prior radiation to chest
45
Q

Breast Cancer- treatment

A 
Stage
Early - lumpectomy w/ sentinel node biopsy 
Mastectomy
Radiation
Chemo or hormonal therapy
Tamoxifen - estrogen + receptor
Palliative
46
Q

Breast Cancer- prognosis

A

Factors

  • Tumor size, grade
  • Lymph node involvement
  • age

F/U Care

  • long term f/u - most will recure w/in 2-5 yr
  • first 2yr - examine every 6m w/ mammogram -> then annually
47
Q

Pagaet Disease of Breast- pathophysiology

A

Rare - 1% of BC

48
Q

Pagaet Disease of Breast- S/S & PE

A

Eczematous/ulcerated lesion on nipple
Pruritic
Burning
Painful

49
Q

Pagaet Disease of Breast- diagnosis

A

Full thickness biopsy

50
Q

Pagaet Disease of Breast- treatment

A

Refer

mastectomy

51
Q

Lobular Carcinoma- pathophysiology

A

Incidental finding

Inc risk of developing into breast Cancer

52
Q

Lobular Carcinoma- treatment

A

Refer
Excise lesion
Chemo

53
Q

Invasive Carcinoma- S/S & PE

A 
Fixed firm nodule
non tender - but can have pin
Dimping
Nipple discharge
Breast size change
Skin thinkening - peau d'orange
Eczematous chnge
Axillary node enlargemtn
Palpable supraclavicular/infraclvicular nodes
Arm edema

Upper, outer quadrant - most common area

54
Q

Breast Cancer in Men- pathophysiology

A

Rare

55
Q

Breast Cancer in Men- cause

A

BRCA2

56
Q

Breast Cancer in Men- epidemiology

A

> 50yo

Inc w/ prostate ca

57
Q

Breast Cancer in Men- S/S & PE

A

Painless lump beneath areola
Nipple discharge
retraction
ulceration

58
Q

Breast Cancer in Men- prognosis

A

Poor - worse than women

Clin med sem 2 (30 decks)

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