Conditions of the Breasts and Axilla Flashcards

1
Q

What age group is most susceptible to breast cancer?

A

50-70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for developing breast cancer?

A

Gender
Increasing Age
Nulliparity, first pregnancy over the age of 30, menarche< 12 years, menopause >55
Family hx of breast cancer ( greater if relative was first degree and menopause)
Obesity, high-fat diet, sedentary lifestyle
BRCA 1/2 gene mutation
>5 year hormone replacement, > 10 year oral contraceptive pill
Excessive Alcohol use; 2-3 servings per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the major types of breast cancer?

A

Non-Invasive
Ductal Carcinoma in Situ: cannot penetrate basement membrane; non-palpable, mammogram
Lobular Carcinoma in Situ: completely contained within breast lobule, rubbery and ill defined, non-palpable, mammogram

Invasive
Inflammatory Carcinoma: Ductal Carcinoma that invades into dermal lymphatics, most aggressive
Invasive Ductal Carcinoma of the Breast: infiltrates thoracic fascia to become fixed to chest wall; cooper ligaments
Invasive Lobular Carcinoma

Paget’s disease of the nipple
Inflammatory breast cancer IBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the early signs of breast cancer?

A

Unilateral, solitary, firm to hand, fixed and non-tender lump in the breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the later signs of breast cancer?

A

Erythema over the area
Local edema in breast and/or arm
Fixation of the part of the breast to chest wall
LAO: Left Anterior Oblique
Skin or nipple retraction/inversion
Orange Peel Skin
Nipple Discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is breast cancer diagnosed?

A

Biopsy of suspicious breast lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the DDX for breast cancer?

A

Fibroadenoma, fat necrosis, fibrocystic breast changes, intraductal papilloma, Paget’s disease of the nipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What carbohydrate antigen is associated with breast cancer?

A

CA 27-29

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common benign breast tumor in women?

A

Fibroadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does a fibroadenoma feel like?

A

Non-tender, firm, smooth, rubbery, mobile, well-circumscribed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is fibroadenoma diagnosed?

A

Core or excisional biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Does having a fibroadenoma increase your risk for breast cancer?

A

Yes, 1.5-2 times more likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the possible risk factors for fibrocystic breast?

A

Women of reproductive age: mostly age 25 through menopause
Hormone imbalance: estrogen dominance
Methylxanthine use: Coffee, tea, and chocolate
High or low iodine in the diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are signs and symptoms of fibrocystic breasts?

A

1) Generalized premenstrual breast tenderness and lumpiness
2) Often Bilateral
3) Multiple nodules and palpable lumps
4) Monthly increase in breast pain or lumpiness from mid-cycle (ovulation) to just before period
5) May regress during pregnancy
6) Symptoms improve with onset of menses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are fibrocystic breasts diagnosed?

A

Clinical breast exam on physical exam; followed by ultrasound and/or mammogram, biopsy if necessary

Ultrasound distinguish the difference between fluid-filled cyst and solid masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What’s in the DDx for fibrocystic breasts?

A

Fibroadenoma
Intraductal Papilloma
Fat Necrosis
Carcinoma

17
Q

A deficiency in what mineral is associated with fibrocystic breasts?

18
Q

What herb might be indicated in fibrocystic breast disease?

A

Phytolacca Americana

19
Q

What part of the breast does Paget’s disease of the breast affect?

A

Nipple and ducts (an intraductal carcinoma)

20
Q

What are the signs and symptoms of Paget’s Disease?

A

1) Eczema-like rash on and around the nipple
2) Unilateral
3) Palpable
4) Nipple retraction

21
Q

What population is at risk for Paget’s disease of the breast?

A

Affects Postmenopausal women; poor prognosis

22
Q

What do you do when, during the clinical breast exam, you find an eczematous rash on the nipple of a postmenopausal woman?

A

Order a mammogram and biopsy

23
Q

What are the symptoms of mastitis?

A

Unilateral localized breast pain
Tenderness
Erythema
Heat and Hardness of the breast
Possible fever, chills
Malodorous breast milk, feels worse with nursing

24
Q

What causes mastitis?

A

Usually S.aureus infection of the breast

25
What predisposes a woman to get mastitis?
Bacteria from baby's mouth entering milk duct through cracks in nipple
26
What kind of nipple discharge is seen with mastitis?
Creamy purulent discharge
27
What herbs are used for mastitis?
Baptisia tinctoria (internal) Berberis aquifolium (topical and internal) Echinacea spp. (internal) Hydrastis canadensis (topical and internal) Phytolacca Americana (topical and internal) Symphytum officinalis (topical)
28
What homeopathic remedy would you consider for mastitis especially if the pain radiates from nipple outward and is right sided?
Phytolaca
28
What are some causes of gynecomastia?
Low testosterone Excess estrogen exposure Drugs Idiopathic
28
What are some of the causes of low testosterone in men?
Kleinfelter's Syndrome Pituitary Syndrome Anorchia Orchitis Renal Failure Aging Obesity
29
What are the various causes of estrogen exposure in men?
Exogenous estrogen exposure Obesity leading to aromatization
30
What drugs can cause gynecomastia in men?
Spironolactone Testosterone inhibitors used for prostate cancer Methyldopa and isoniazid Tricyclic antidepressants and diazepam Marijuana and heroin Calcium Channel Blockers and ACE inhibitors Estrogen or Anabolic Steroids