Clinical Flashcards
CFs of fat necrosis
- Firm lump eventually shrinks in size until resolution
- Difficult to differentiate from other causes of breast lump
- ~40% will describe Hx of trauma
Rx of mastalgia
- Reassurance -> no Ca
- Supportive bra
- Reduce dietary fat + caffeine
- Severe mastalgia affecting ADLs =-> estrogen suppression
Approach to nipple d/c
- Spontaneous vs. squeezing @ nipple
- Single vs. multiple duct d/c (check x1 duct d/c for Hb)
- Bloody d/c requires triple assessment (5-10% = Ca)
XR features of Ca on mammography
- Microcalcifications within / without lesions
- Areas of increased density or irregularity
Most common presenting breast Sx
- Breast lump / lumpiness 36%
- Painful breast lump 33%
- Mastalgia 17.5%
- Nipple d/c 5%
Nipple retraction 3%
Most important part of clinical assessment
- Pt’s age -> increasing age -> increased breast Ca incidence
- In younger pt’s the pathology is much more likely to be benign
- Duration of Sx
- Ca = slow
Screening of high risk females
- <50yo then mammography + MRI
Triple assessment
- Clinical exam
- Imaging (US +/- mammogram)
- Bx - core vs. FNA
Benign breast conditions <25yo
Stromal = juvenile hypertrophy
Lobular = fibroadenoma
Benign breast conditions 25-40
Cyclical activity = cyclical mastalgia, cyclical nodularity (diffuse/local)
Benign breast conditions 30-55
Involution
Lobular = palpable cysts
Ductal = ductal ectasia
Stromal = sclerosing lesions
CFs of ductal ectasia
- Nipple d/c = chessy
- Nipple retraction = slit-like (in contract to breast Ca where the whole nipple is pulled in)
CFs of ductal papilloma
- Nipple d/c = serous or blood-stained
Principles of breast infection
- Give appropriate Abs early to reduce incidence of abscess formation
- If an abscess is suspected -> confirm presence of pus prior to aspiration
- Excl. breast Ca using imaging + consider core Bx in any inflamm. lesions NOT improving w/ ABx
ABx Rx of breast infection
- Lactating = flucloxacillin
- Non-lactating = augment DF
