C. Breast Disorders

Question 1

What is important to ask about when patients have breast implants & why?

Answer 1

Silicone vs. Saline

Saline are newer/safer. Silicone can leak & cause scaring or disfigurement

Question 2

What should be at the top of a dif diagnosis when a red crusty/scaly nipple is found?

Answer 2

Pagets

Question 3

What lymph nodes should be examined during a breast exam?

Answer 3

Axillary

Supraclavicular

Question 4

What is Peau d’ orange effect? What is it suggestive of?

Answer 4

Invasice cancer effects ligaments –> Dimpling of skin

Question 5

Fixed mass. Benign or malignant?

Answer 5

Malignant (invaded into tissue so cant move)

Question 6

Mobile mass. Benign or malignant?

Answer 6

Benign

Question 7

Irregular mass. Benign or malignant?

Answer 7

Malignant

Question 8

Tender mass. Benign or malignant?

Answer 8

Benign cyst

Question 9

Non-tender mass. Benign or malignant?

Answer 9

Malignant

Question 10

+ Regional lympn node adenopathy/lymphadenopathy. Benign or malignant?

Answer 10

Malignant

Question 11

What are the different imaging studies & when are they used?

[On test]

Answer 11

Ultrasound for younder patients (does better with denser breasts & patients are low risk)

Mammogram screening test of choice

MRI = only for high risk patients

Question 12

What are the guidelines for mammogram screening?

Answer 12

Every couple years starting at 40

Every year starting at 50

Start earlier in high risk patients (5 years before 1st degree relative got it)

Question 13

How does breast density change with age?

Answer 13

Younger have denser

As age, glandular tissue is replaced with fat

Question 14

How does a cyst appear on imaging?

Answer 14

Well circumscribed, fluid filled (black) mass

Question 15

What makes a definitive diagnosis in breast cancer?

[On test]

Answer 15

Stereotactic or excisional biopsy

Question 16

What are the different types of breast biopsy?

Answer 16

Stereotactic = mammgram guided if there is scattered small calcifications

Excisional biopsy is can palpate mass

Question 17

What should be at the top of the diff diagnosis if find purulent/yellow disharge from the nipple?

[On test]

Answer 17

Mastitis

Question 18

What are risk factors for mastitis?

[On test]

Answer 18

Breast feeding (Puerperal)
Trauma (Non-Puerperal)
Piercings (Non-Puerperal) even in men

Question 19

What organisms cause mastitis?

[On test]

Answer 19

Staph Aureus (70%)
Strep Viridans (30%)

Question 20

Treatment of Mastitis?

[On test]

Answer 20

Sodium Dicloxacillin (cousin of pen)
Cephalexin (Cephalosporin, give if have mild pen allergy)
Trimethoprim-sulfamethaxole (If severe allergy)
Clindamycin (If allergic to sulfa drugs & pen)

Question 21

What is suspected when there is a bloody nipple discharge?

[On test]

Answer 21

Intraductal papilloma

Malignancy

Question 22

What test should be performed for Mastitis?

Answer 22

Culture for MRSA (if +, changes treatment)

Question 23

What test should be performed for bloody nipple discharge?

[On test]

Answer 23

Ductogram mainly (small catheter inject die)
Mammogram
Biopsy

Question 24

What test should be performed for milky discharge?

[On exam]

Answer 24

TSH

Prolactin (If high –> MRI pituitary)

Question 25

What is the treatment for Galactorrhea?

Answer 25

Dopamine agonist

Question 26

Causes of Galactorrhea?

[On test]

Answer 26

Idiopathic
Drugs (anti-psychotic)
Hypothyroidsim (TRH can increase prolactin)
Pituitary mass --> increase in prolactin
Chest wall irritation

Question 27

What things do you need to look for in a breast mass?

[On test]

Answer 27

discharge
firm/cystic
skin changes
overlying skin changes
tenderness

Question 28

Tests for Galactorrhea?

[On test]

Answer 28

Serum prolactin & TRH