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Clinical medicine > Breasts > Flashcards

Breasts Flashcards

1
Q

What are the three methods of CBE?

A

circular, wedge, vertical strip

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2
Q

The benign conditions

A

fibrocystic breasts, fibroadenoma, nipple discharge, fat necrosis, breast abcesses

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3
Q

What is the most frequent lesion of the breast?

A

fibrocyst

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4
Q

What age range is a fibrocystic breast common?

A

30-50

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5
Q

What two substances are related to fibrocysts?

A

estrogen and alcohol

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6
Q

Describe the physical findings of a simple breast cyst

A

fluid filled round or oval, derived from the terminal duct lobular unit, presents as a single or multiple mass, may fluctuate in size, number and mag of sx (pain depending on cycle)

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7
Q

What will fibrocystic breasts increase your risk for?

A

Breast cancer

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8
Q

Symptoms of fibrocystic breast?

A

painful, often multiple, usually bilateral masses, rapid fluctuation of size, pain increases during premenstrual phase, serous discharge

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9
Q

What does bloody nipple discharge indicate?

A

cancer

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10
Q

What is diagnostic test for fibrocystic breast?

A

U/S not mammogram, FNA if indicated

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11
Q

Treatment of fibrocystic breast

A

watch for alarming signs, avoid trauma, wear supportive bra, Danazol (100-200 mg po BID for pain), oil of evening primrose, tamoxifen, low fat diet

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12
Q

What is the most common in women ~20 years after puberty?

A

fibroadenoma, but earlier in african americans

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13
Q

How much does your risk of cancer increase with fibroadenomas?

A

1.5-2 times

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14
Q

Characteristics of fibroadenoma?

A

round or ovoid, rubbery, discrete, movable, nontender mass, 1-5 cm

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15
Q

What is the treatment of fibroadenoma?

A

FNA to r/o other etiologies, cryoablation

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16
Q

What is phyllodes tumor?

A

a type of fibroadenoma, can be bening or malignant, should remove, sometimes mastectomy

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17
Q

Why is it important to take care of phyllodes tumors ASAP?

A

can metastasize to the lung

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18
Q

The most common causes of nipple discharge?

A

duct ectasia, intraductal papilloma, carcinoma

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19
Q

Types of discharge?

A

serous, bloody, green or brown

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20
Q

What can of fluid will occur with intraductal papilloma?

A

serous

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21
Q

What type of discharge is associated with premenopause?

A

green or brown

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22
Q

What is associated with milky discharge?

A

hyperprolactinemia, pregnancy

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23
Q

What is associated with purulent discharge?

A

subareolar abcess

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24
Q

What should be done when pt has nipple discharge?

A

watch and reexamine every 3-4 months if benign, check TSH/prolactin levels, d/c any OCP or antipsychotics, remove tumor or abcess

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25
Q

How should discharge be examined?

A

ductoscopy

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26
Q

What is a rare lesion of the breast that is accompanied by skin or nipple retraction?

A

fat necrosis

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27
Q

What is indistinguishable from carcinoma on imaging?

A

fat necrosis

28
Q

What is the most likely cause of fat necrosis?

A

trauma

29
Q

When is it common to see fat necrosis?

A

pt after segmental resection, radiation therapy, flap reconstruction after mastectomy

30
Q

When do breast abscesses develop?

A

when mastitis or cellulitis does not respond to abx, during nursing

31
Q

What is the most common organism in breast abscesses?

A

staph aureus

32
Q

What should be done if abscess found in non-lactating breast?

A

this is very rare so inflammatory carcinoma must be explored, will recur after I&D so excise laciferous duct

33
Q

How to treat abscess?

A

needle aspiration and drainage, surgical drainage, if pus thick use 17-19 gauge needle to dilute, reexamine every 2-3 days, can use U/S to visualize cavity, abx

34
Q

What kind of abx do you use for abscesses?

A

10-14 days, dicloxacillin 500 mg QID or cephalexin 500 mg QID, if beta lactam hypersensitive- clindamycin 300-450 TID, if MRSA- Bactrim 1-2 tabs BID/ clindamycin 300-450 TID, if severe- Vanco 15-20 mg/kg BID-TID

35
Q

What is the average age of Breast cancer

A

61

36
Q

how many women develop breast cancer?

A

1 in 8

37
Q

What are risk factors of developing breast cancer?

A

early menarche, late menopause, ashkenazi jew, delayed child bearing, positive fam hx, genetic, personal hx

38
Q

What are the early findings of breast cancer?

A

single, nontender, firm mass, ill defined margins

39
Q

What are the later findings of breast cancer?

A

skin or nipple retraction, axillary lymphadenopathy, breast enlargement, erythema, edema, pain, fixation of mass to skin or chest wall

40
Q

what is ductal carcinoma in situ?

A

heterogeneous group of neoplastic lesions confined to the breast ducts and lobules that differ in histologic appearance and biological potential

41
Q

What is the goal of therapy in ductal carcinoma in situ?

A

prevent occurence of invasive br ca

42
Q

What appears as microcalcifications on mammogram?

A

ductal carcinoma in situ

43
Q

what is a microinvasive carcinoma?

A

stromal invasion by tumor cells invading basement membrane, measures more than 1mm, present w/ DCIS

44
Q

What is the prognosis of microinvasive cancer?

A

good, 97-100% survival rate

45
Q

What is atypical ductal hyperplasia?

A

proliferation of uniform epithelial cells with monomorphic round nuclei filling part, but not all of involved duct, include both ductal and lobular hyperplasia

46
Q

What is the risk of subsequent breast cancer?

A

3.7-5.3 relative risk

47
Q

what is lobular carcinoma in situ?

A

noninvasive lesion that arises from the lobules and terminal ducts of breasts, usually incidental finding

48
Q

How does LCIS differ from DCIS?

A

regards to radiologic features, morphology, biologic behavior and anatomic distribution in the breast

49
Q

What is BRCA 1?

A

on chromosome 17, ca develops in 85%, pts recommended to have double mastectomy

50
Q

What is BRCA 2?

A

chomosome 13, CA develops in 1%, more likely to develop cancer in other breast if has developed in one already, so bilateral mastectomy is recommended

51
Q

When should mammograms be performed?

A

after 50 yo up to 74 then evaluate life expectancy, every two years

52
Q

What are the two general categories of br ca?

A

soft tissue masses, and clustered microcalcifications

53
Q

How frequent are microcalcifications?

A

they are seen in about 60% of Ca detected by mammogram, associated with 1/3 of invasive carcinomas

54
Q

What labs should you do for br ca?

A

ESR, ALP, Ca, CEA and CA 15-3 or CA 27-29

55
Q

What imaging should be done for br ca?

A

mammogram, U/S, CT, bone scan

56
Q

Biopsy info

A

all suspicous lesions- 60% are benign, FNA cytology- aspirated with minimal risks and less expensive, core biopsy, open biopsy

57
Q

Other testing for Br Ca?

A

estrogen receptor, progesterone receptor, HER-2/neu overexpression, if ER and PR are positive- better prognosis

58
Q

What are s/sx of paget’s disease of the breast?

A

itching, burning of nipple, superficial erosion or ulceration that is eczema-like on nipple and areola w/ copious clear yellowish exudate

59
Q

Why is paget’s disease usually not diagnosed right away?

A

it is confused with dermatitis or bacterial infection

60
Q

How is paget’s disease diagnosed?

A

detailed hx, nipple scrape cytology or full thickness wedge or punch biopsy of the nipple, bilateral mammography

61
Q

What’s the hallmark of paget’s

A

malignany, intraepithelial adenocarcinoma cells occurring singly or in small groups within the epidermis of the nipple

62
Q

How is paget’s disease treated?

A

stage according to underlying mass, simple mastectomy, folllow guidlines for br ca, prognosis dependent on if palpable mass was present and if there was LN involvement

63
Q

What is the most common breast cancer in males?

A

invasive ductal carcinomas, hormone receptor-positive

64
Q

How does male breast cancer present?

A

painless, firm mass that is usually subareolar with nipple involvement ranging between 40-50%, less than 1% is bilateral

65
Q

What type of biopsy should be preformed for male breast cancer?

A

core needle biopsy, not FNA because it won’t provide enough sample

66
Q

What is affective for 5 year survival in male cancer?

A

tamoxifen

Clinical medicine (19 decks)

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