Condition

Question 1

Definition for breast abscess

Answer 1

usually a complication of infectious mastitis which can either be puerperal mastitis (due to breast feeding) or subareolar abscess (an aseptic inflammation associated with squamous metaplasia of the lactiferous ducts)

Question 2

how common is breast abscess

Answer 2

quite rare - 0.4-0.5% of breastfeeding mother’s develop an abscess

Question 3

who is affected the most by breast abscess

Answer 3

mainly breastfeeding mothers who develop puerperal mastitis

Question 4

RF for breast abscess

Answer 4

maternal age >30 (age of delivery)

past history of mastitis

gestational age> 41 weeks

improper nursing leading to incomplete emptying of the breast

Question 5

symptoms for breast abscess

Answer 5

tender, hard breast mass

fluctuant

overlying erythema

Question 6

further investigation for breast abscess

Answer 6

USS - see if collection of pus

Question 7

management of breast abscess

Answer 7

improve breast feeding technique

manual extraction of milk

antibiotics - flucloxacilin or erythromycin

surgical - if overlying skins is thin or necrotic

needle aspiration every other day if severe

Question 8

complication for breast abscess

Answer 8

sepsis

Question 9

what is fibrocystic disease of the breast

Answer 9

noncancerous breast lumps

Question 10

how common is fibrocystic disease

Answer 10

30-60% of women

5% of childbearing age

Question 11

causes of fibrocystic disease of the breast

Answer 11

not fully understood but might link to hormone levels

Question 12

symptoms of fibrocystic disease of breast

Answer 12

lumpy, cobblestone texture in the breast

smooth with defined edges

breast aching/tenderness

breast swelling

itchy breast/nipple

symptom might follow periodic trend closely related to menstrual cycle

Question 13

further investigation for fibrocystic disease of breast

Answer 13

diagnosis mainly clinical once breast cancer excluded

USS/MRI including mammography might be used for a diagnosis

Question 14

treatment or management for fibrocystic disease of breast

Answer 14

no treatment normally but if needed then progesterone ointments and supplements

Question 15

defintion for intraductal papilloma

Answer 15

benign proliferation of breast lesions occurring anywhere in the ductal system which can be solitary or multiple

Question 16

how common is intra-ductal papilloma

Answer 16

2-3% incidence rate

most common cause of bloody nipple discharge in women aged 20-40

mainly a disease of middle aged women

Question 17

causes of intra-ductal papilloma

Answer 17

genetic but not really know

Question 18

symptoms for intraductal papilloma

Answer 18

breast enlargement

breast pain

central or peripheral mass often too small to be palpated or felt

bloddy nipple discharge

usually asymptomatic and found incidentally on breast biopsies

Question 19

further investigation for intraductal papilloma

Answer 19

galactogram - fine needle aspiration/breast biopsies

exam of nipple discharge

Question 20

management of intraductal papilloma

Answer 20

surgical excision followed by biopsy to confirm that it is not cancer

Question 21

prognosis of intraductal papilloma

Answer 21

if central and solitary the excellent

if peripheral and muiltiple then higher risk of breast cancer

Question 22

Definition of breast carcinoma

Answer 22

malignancy of the breast tissue

can be ductal or lobular, in situ or invasive

Question 23

what is Paget’s disease of the breast

Answer 23

a type of breast carcinoma which infiltrates - 1& of all breast cancer

Question 24

how common is breast carcinoma

Answer 24

lifetime risk of female - 1 in 8

men can also get breast cancer but rare

Question 25

RF for breast cancer

Answer 25

FH 
female 
old age 
smoking 
previous history 
Genetic - BRCA1,2,3 and TP53 mutation 
no children 
never breastfeed
early menarche and late menopause 
radiation to chest 
high alcohol intake 
gynecomastia

Question 26

symptoms of breast carcinoma

Answer 26

lumps (80%) - painful in 20%, hard, irregular, fixed, painless, skin dimpling

nipple discarge

skin contour changer

nipple discharge

breast pain/mastalgia alone

bloody nipple

Question 27

differential for breast carcinoma

Answer 27

fibrocystic breast disease

Cyst

Question 28

further investigation for breast carcinoma

Answer 28

mammography

fine needle aspiration

core biopsy

Question 29

management for breast carcinoma

Answer 29

wide local excision or mastectomy with radio followed by reconstruction

adjuvant hormal therapy if tumour if +ve for hormonal receptors - tamoxifen

herceptin - used for HER2 gene

adjuvant chem