Disorders of the breast

Question 1

breast abscess

Answer 1

local, exudate-filled pocket that forms within the breast tissue. It should be suspected in patients with presumed mastitis or cellulitis that does not resolve with antibiotic treatment

Question 2

Risk factors for the development of a breast abscess secondary to lactational mastitis

Answer 2

maternal age > 30 years, first pregnancy, gestational age ≥ 41 weeks, and tobacco use

Question 3

most common pathogen responsible for a breast abscess

Answer 3

Staphylococcus aureus, which presents in aspirated fluid cultures as gram-positive cocci in clusters

Question 4

sx and PE breast abscess

Answer 4

localized, painful inflammatory area of the breast with associated fever and malaise. The breast mass is palpable, tender, and fluctuant

Question 5

dx breast abscess

Answer 5

breast milk sample for culture, ultrasound can aid in both diagnosis and guidance of aspiration of the abscess

Question 6

tx for all breast abscess despite abx tx

Answer 6

Needle aspiration or surgical treatment with incision and drainage

Question 7

risk factors for methicillin-resistant S. aureus for breast abscess

Answer 7

recent surgery, hemodialysis, injection drug use, HIV infection

Question 8

abx tx breast abscess for ppl without RF

Answer 8

dicloxacillin or cephalexin

Question 9

tx breast abscess for ppl with RF

Answer 9

clindamycin or trimethoprim-sulfamethoxazole

Question 10

what is a good abx for breast abscess in ppl w hypersensitivity to beta lactams

Answer 10

clindamycin

Question 11

tx breast abscess in Patients who demonstrate hemodynamic instability or other signs of severe infection

Answer 11

admission with IV vanc

Question 12

should lactating mothers w breast abscess continue to nurse on affected breast

Answer 12

yes

promotes full drainage of the breast and provide pain relief

Question 13

what if pt has trouble nursing w breast abscess

Answer 13

If the patient experiences troubles with infant latching or pain secondary to the incision, pumping can be implemented until nursing can resume

Question 14

Which risk factor is associated with recurrent breast abscesses?

Answer 14

smoking

Question 15

What type of breast cancer is associated with breast abscess?

Answer 15

inflammatory breast CA

Question 16

What are possible complications of a breast abscess?

Answer 16

Recurrent infection, poor cosmetic outcome, mammary duct fistula, milk fistula, and antibioma (tough walled abscess due to inadequate pus drainage or inadequate use of abx)

Question 17

how often may needle aspiration need to be repeated to ensure adequate drainage

Answer 17

every 2-3 days

Question 18

when is mastitis MC seen

Answer 18

in lactating women within 3 months of delivery

Question 19

RF mastitis

Answer 19

first-time breastfeeding and difficulty with breastfeeding
prior history of mastitis, an oversupply of milk, infrequent feedings, nipple trauma, maternal stress, or maternal malnutrition

Question 20

MC bacterial cause of mastitis

Answer 20

staph aureus

Question 21

is mastitis usually unilateral or bilateral

Answer 21

unilateral

Question 22

sx mastitis

Answer 22

engorged breast or fissured nipple that progresses to breast tenderness, warmth, swelling, and erythema. Fever and chills may be present

Question 23

PE mastitis

Answer 23

central or peripheral breast induration and purulent nipple discharge.

The presence of fluctuance indicates a breast abscess!!!

Question 24

nonpharm tx mastitis

Answer 24

regular emptying of the breast through breastfeeding or a mechanical suction device to avoid the development of a breast abscess. A cool or warm compress and analgesics (e.g., acetaminophen, ibuprofen) may be used for pain management.

Question 25

pharm tx mastitis if MSSA

Answer 25

Dicloxacillin, cephalexin, or clindamycin may be used as empiric therapy for coverage against Staphylococcus and Streptococcus

7-10 days

Question 26

pharm tx mastitis MRSA

Answer 26

Trimethoprim-sulfamethoxazole

7-10 days

Question 27

infective mastitis vs noninfective mastitis

Answer 27

pain, redness, and fever, persist beyond 24 hours = infective

Question 28

tx noninfective mastitis

Answer 28

NSAIDs and cold compress

Question 29

What is the medical term for a painless, asymptomatic, cystic collection of milky fluid caused by an obstructed milk duct?

Answer 29

galactocele (milk retention cyst)

Question 30

in what population do breast fibroadenomas commonly occur

Answer 30

premenopausal women within 20 years of puberty. They can occur at earlier ages in Black women

Question 31

when do fibroadenomas increase in size and go away

Answer 31

they tend to increase in size during high estrogen states (e.g., pregnancy and with use of estrogen-containing contraceptives) and involute after menopause.

Question 32

how large are fibroadenomas

Answer 32

1-5 cm

Question 33

PE fibroadenomas

Answer 33

firm, round, and mobile with discrete borders
well-defined, rubbery, nontender mass
no axillary lymph node involvement or nipple discharge

Question 34

what can confirm fibroadenoma

Answer 34

US

Question 35

US fibroadenoma

Answer 35

echogenic well-defined solid mass

Question 36

dx fibroadenoma

Answer 36

For women under the age of 30 years, a clinical diagnosis can be made without ultrasound or core needle biopsy

Question 37

what tumor is indistinguishable from fibroadenoma

Answer 37

phyllodes tumor – except that these tumors grow rapidly; rarely malignant

Question 38

tx fibroadenomas that do not cause pain

Answer 38

surveillance with self-breast exams and repeat ultrasound after 3–6 months

Question 39

tx fibroadenomas that are painful

Answer 39

For painful masses, masses that are rapidly changing, or if the patient desires removal, surgical excision may be performed. Cryoablation is also a possible treatment for breast fibroadenomas but must only be done if the diagnosis has been confirmed with needle core biopsy

Question 40

MC benign tumor of the breast

Answer 40

fibroadenoma

Question 41

what fibroadenomas should be surgically excised

Answer 41

Fibroadenomas that are symptomatic, rapidly growing, or ≥ 3 cm

Question 42

definitive dx fibroadenoma

Answer 42

biopsy

Question 43

in what portion of the breast are fibroadenomas MC found

Answer 43

upper outer quadrants

Question 44

CA risk fibroadenomas

Answer 44

There is no increased risk of breast cancer for individuals with simple fibroadenomas, but a small increased risk of breast cancer is present in those with complex fibroadenomas or when there is a family history of breast cancer

Question 45

MC lesion of the breast

Answer 45

fibrocystic breast disease

Question 46

when does fibrocystic breast dz usually occur

Answer 46

usually occurs in women 30–50 years of age and rarely develops post menopause unless the woman is taking hormone replacement therapy

Question 47

factors that may increase risk of fibrocystic breast dz

Answer 47

estrogen
increased alcohol intake

Question 48

sx fibrocystic breast dz

Answer 48

pain or tenderness, a palpable asymptomatic mass, cysts that fluctuate in size rapidly, worsening pain and enlarged cysts during the premenstrual cycle, multiple or bilateral breast masses, and serous nipple discharge

Question 49

what is recommended If a discrete mass is found on a physical exam

Answer 49

mammography or ultrasonography is recommended for evaluation, with ultrasound being the imaging modality of choice for women under 30 years of age

Question 50

tx fibrocystic breast dz

Answer 50

conservative tx for at least 6 mos
avoiding trauma, wearing a supportive brassiere day and night, and taking acetaminophen or nonsteroidal anti-inflammatory medications for pain

eliminating caffeine from the diet and supplementing vitamin E 400 IU daily

decrease fat intake
decrease chocolate intake
use evening primrose oil

Question 51

tx severe fibrocystic breast dz

Answer 51

Danazol is a synthetic androgen approved for patients with severe pain. Its mechanism of action is to suppress the pituitary gonadotropins

Tamoxifen also reduces symptoms but should only be used to reduce cancer risk in those with high-risk changes and not as a treatment for pain (this is preferred over Danazol due to fewer ADE)

Gamolenic acid has been shown to reduce pain in about one-half of patients, and the dose is typically 3,000 mg (six 500 mg capsules) taken twice a day

Question 52

what findings for fibrocystic breast dz may increase CA risk

Answer 52

increased breast density on mammogram, epithelial proliferation (especially with atypia), and papillomatosis are at an increased risk of breast cancer

Question 53

PE fibrocystic breast dz

Answer 53

may feel dense on palpation, with rope-like or cobblestoning texture
smooth, firm, and discrete mobile mass that is often tender, with a texture similar to a grape, water balloon, or hard mass

Question 54

which types of cysts for fibrocystic dz have a higher risk of malignancy

Answer 54

complex cysts

Question 55

imaging fibrocystic breast dz

Answer 55

Complicated cysts can be observed with ultrasound imaging or diagnostic mammography every 6 months for 2 years. Lesions that undergo rapid change in size or develop a solid component require biopsy. A complex cyst must undergo definitive diagnosis using invasive techniques (e.g., fine-needle aspiration, core biopsy, excisional biopsy). Follow-up in proven benign complex cysts is warranted every 6 to 12 months for 1 to 2 years with imaging and clinical breast examination