Disorders of the Breast

Question 1

a 32-year-old lactating female with breast pain, swelling, fever, chills, and a fluctuant mass of her left breast. The area directly above the lesion is warm, erythematous and tender to touch.
What is the diagnosis

Answer 1

breast abscess

Question 2

should a patient with a breast abscess countinue to breastfeed on the affected side?

Answer 2

yes - encouraged to continue breastfeeding following breast infection - even in setting of I&D

Question 3

what is the most common cause of breast abscess

Answer 3

S. aureus

Question 4

what is the treatment of breast abscess

Answer 4

I&D and anti-staph antibiotics
Regimen: Nafcillin/oxacillin IV or cefazolin ++ metronidazole
alternative: vanco

Question 5

what is the most common type of non-cancerous breast tumor

Answer 5

fibroademona - solitary, mobile masses with distinct borders

Question 6

a 27-year-old female with a painless mass in the left breast. She discovered this mass three months ago while showering and reports it has been unchanged since that time. Her last menstrual period was 10 days ago. There is no family history of breast cancer. On physical exam, you palpate a 3 cm, firm, non-tender mass in the upper lateral quadrant of the left breast. The mass is smooth, well-circumscribed, and mobile. There are no skin changes, nipple discharge, or axillary lymphadenopathy
what is the diagnosis

Answer 6

fibroadenoma

Question 7

how is a fibroadenoma diagnosed

Answer 7

breast mammogram with Ultrasound - if indeterminant - FNA with pathology

Question 8

what is the treatment of fibroadenoma

Answer 8

avoiding trauma
wearing a bra with adequate support
combined OCP

Question 9

a 42-year-old woman with breast masses that changes in size, especially during her menstrual cycles. These masses are usually painful and pain radiates into the axillae. She reports that her breasts often feel full and heavy. Occasionally she has a small amount of greenish-brown nipple discharge. An ultrasound exam shows cystic masses within the breasts.
what is the diagnosis

Answer 9

fibrocystic disease

Question 10

how is fibrocystic disease diagnosed

Answer 10

breast cyst aspiration supplemented by US and/or mammo
(straw-colored fluid with no blood)

Question 11

what is the treatment of fibrocystic disease

Answer 11

NSAIDs, Heat or ice, support bra, decrease caffiene, fat and chocholate

Question 12

a breastfeeding woman 3 weeks postpartum complaining of a painful area of the breast that is reddened and warm. The patient feels very fatigued with a fever generally > 101 ° F and chills. She reports a burning pain present constantly or at times only while breastfeeding. On exam, the patient appears ill. Breast examination shows an erythematous right breast with a palpable mass, induration, erythema, and tenderness to palpation.
what is teh diagnosis

Answer 12

mastitis

Question 13

what is the most common causative organism in mastitis, breast infection or breast abscess?

Answer 13

S. Aureus

Question 14

what is the treatment of mastitis

Answer 14

warm compressess to breast and analgesics
if infectious: dicloxacillin,cephalexin or erythromycin
continue to breast feed on affected side