C. Breast Disorders Flashcards
What is important to ask about when patients have breast implants & why?
Silicone vs. Saline
Saline are newer/safer. Silicone can leak & cause scaring or disfigurement
What should be at the top of a dif diagnosis when a red crusty/scaly nipple is found?
Pagets
What lymph nodes should be examined during a breast exam?
Axillary
Supraclavicular
What is Peau d’ orange effect? What is it suggestive of?
Invasice cancer effects ligaments –> Dimpling of skin
Fixed mass. Benign or malignant?
Malignant (invaded into tissue so cant move)
Mobile mass. Benign or malignant?
Benign
Irregular mass. Benign or malignant?
Malignant
Tender mass. Benign or malignant?
Benign cyst
Non-tender mass. Benign or malignant?
Malignant
+ Regional lympn node adenopathy/lymphadenopathy. Benign or malignant?
Malignant
What are the different imaging studies & when are they used?
[On test]
Ultrasound for younder patients (does better with denser breasts & patients are low risk)
Mammogram screening test of choice
MRI = only for high risk patients
What are the guidelines for mammogram screening?
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)
How does breast density change with age?
Younger have denser
As age, glandular tissue is replaced with fat
How does a cyst appear on imaging?
Well circumscribed, fluid filled (black) mass
What makes a definitive diagnosis in breast cancer?
[On test]
Stereotactic or excisional biopsy
What are the different types of breast biopsy?
Stereotactic = mammgram guided if there is scattered small calcifications
Excisional biopsy is can palpate mass
What should be at the top of the diff diagnosis if find purulent/yellow disharge from the nipple?
[On test]
Mastitis
What are risk factors for mastitis?
[On test]
Breast feeding (Puerperal)
Trauma (Non-Puerperal)
Piercings (Non-Puerperal) even in men
What organisms cause mastitis?
[On test]
Staph Aureus (70%) Strep Viridans (30%)
Treatment of Mastitis?
[On test]
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)
What is suspected when there is a bloody nipple discharge?
[On test]
Intraductal papilloma
Malignancy
What test should be performed for Mastitis?
Culture for MRSA (if +, changes treatment)
What test should be performed for bloody nipple discharge?
[On test]
Ductogram mainly (small catheter inject die)
Mammogram
Biopsy
What test should be performed for milky discharge?
[On exam]
TSH
Prolactin (If high –> MRI pituitary)
What is the treatment for Galactorrhea?
Dopamine agonist
Causes of Galactorrhea?
[On test]
Idiopathic Drugs (anti-psychotic) Hypothyroidsim (TRH can increase prolactin) Pituitary mass --> increase in prolactin Chest wall irritation
What things do you need to look for in a breast mass?
[On test]
discharge firm/cystic skin changes overlying skin changes tenderness
Tests for Galactorrhea?
[On test]
Serum prolactin & TRH