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OB/GYN > EXAM #1: BENIGN/MALIGNANT BREAST DISEASE > Flashcards

EXAM #1: BENIGN/MALIGNANT BREAST DISEASE Flashcards

1
Q

What should you do if there is a thickening of breast tissue on breast exam?

A

Re-eval in 2-3 months

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2
Q

What should you do if there is a clinically benign mass on breast exam?

A

Imaging

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3
Q

What should you do if there is a clinically suspicious mass on breast exam?

A

Imaging + biopsy

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4
Q

If a discrete mass is found on breast exam, what should you do?

A
  • Under 40, US

- Over 40, Mammogram

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5
Q

If a discrete mass is found on mammogram and is clinically suspicious, what should you do?

A

Core needle biopsy

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6
Q

What is duct ectasia?

A

Inflammation with dilation of subareolar ducts

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7
Q

How does duct ectasia typically present?

A
  • More common in multiparous postmenopausal women

- Green-brown nipple discharge

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8
Q

If you can’t determine if a breast cyst is cystic or solid, what should you do?

A

FNA

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9
Q

If no fluid can be obtained on FNA of a potential breast cyst, what should you do?

A

Core biopsy

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10
Q

If mastitis is caused by MRSA, what is the proper treatment?

A

1) Aspirate/drain

2) TMP/SMX or Vancomycin

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11
Q

What is a fibroadenoma?

A

Tumor of fibrous tissue and glands

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12
Q

How does fibroadenoma present?

A

Well-circumscribed, mobile, marble-like mass

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13
Q

What is the most common benign neoplasm of the breast?

A

Fibroadenoma (esp. in premenopausal women)

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14
Q

What is a lactating adenoma?

A

Benign stromal tumor seen in 3rd trimester of pregnancy through the time of lactation

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15
Q

What drug can be used to treat lactating adenoma?

A

Bromcriptine

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16
Q

What is the most common cause of bloody nipple discharge in premenopausal women?

A

Itraductal papilloma

*Fibrovascular projections lined by epithelial and myoepithelial cells that bleed

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17
Q

What must intraducal papilloma be distinguished from?

A

Papillary carcinoma

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18
Q

How is intraductal papillloma treated?

A

Excision

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19
Q

What is atypical ductal hyperplasia?

A

Hyperplasia of the cells lining the ducts in the TDLU

*Considered a step toward DCIS, increases risk of breast cancer 5x

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20
Q

What is atypical lobular hyperplasia?

A

Hyperplasia of the cells lining the lobules in the TDLU

*Considered a step toward LCIS, increases risk of breast cancer 5x

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21
Q

What is fibrocystic change in the breast? How does this present?

A

Development of fibrosis and cysts in the breast that presents as a “lumpy” breast (esp. in the upper outer quadrant)

*Varies with hormonal cycle

22
Q

What are the treatment options for fibrocystic breast change?

A

1) D/c contrceptives/hormone replacement therapy OR switch to lowest possible dose
2) D/c caffiene
3) Reassurance

23
Q

What is Mondor’s Disease?

A

Phlebitis of the throaco-epigastic vein

24
Q

What is the most common carcinoma in women by indidence?

A

Breast

25
Q

What are the risk factors for breast cancer?

A

1) Female
2) Age (post-menopausal)
3) Early menarche/late menopause
4) Obesity
5) Atypical hyperplasia
6) First-degree relative with breast cancer

26
Q

What assessment tool can be used to calculate risk in breast cancer?

A

Gail risk assessment score (1.67= high risk)

27
Q

What clinical features suggest hereditary breast cancer?

A

1) Multiple-first degree relatives with breast cancer
2) Tumor at early age (45 y/o or pre-menopausal)
3) Multiple tumors in single patient

Also,

  • Triple receptor negative under 60 y/o
  • Personal history of ovarian cancer
  • Family history of male breast cancer (BRCA2)
28
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

29
Q

What is the difference between Grade 1, 2, and 3 breast cancer?

A

Grade 1= well differentiated/ slow growing
Grade 2= moderate
Grade 3= poor differentiation/fast growing

30
Q

What type of cancer is Tamoxifen used to treat?

A

ER+

31
Q

What type of cancer is Trastuzumab (Herceptin) used to treat?

A

HER2/Neu+

32
Q

What is the receptor status of most invasive breast cancer?

A

ER/PR+ and HER2/neu-

33
Q

What is inflammatory breast cancer?

A

Carcinoma that invades the dermal lymphatics causing the classic “Peau d’ orange”

34
Q

How is inflammatory breast cancer distinguished from acute mastitis?

A

No response to antibiotics

35
Q

How can inflammatory breast cancer diagnosis be confirmed?

A

Punch biopsy

36
Q

Clinically, what is important about medullary, mucinous, papillary, and tubular breast cancer?

A

Better prognosis that invasice ductal carcinoma

37
Q

What is Paget’s Disease?

A

DCIS that extends to the nipple

*Presents as nipple ulceration and erythema

38
Q

What is the current screening recommendation for breast cancer?

A
  • 25-40 y/o Q1-3 year clinical breast exam

- 40+ y/o is annual breast exam and mammography

39
Q

Define BI-RADS 1.

A

Normal

40
Q

Define BI-RADS 2.

A

Benign finding

41
Q

Define BI-RADS 3.

A

Probably benign–recommend short follow-up

42
Q

Define BI-RADS 4.

A

Suspicious for malignancy

43
Q

Define BI-RADS 5.

A

Strongly suggestive for malignancy

44
Q

Define BI-RADS 6.

A

Imaging patient with known malignancy

45
Q

What is the single most important prognositc factor in breast cancer?

A

Axillary lymph nodes

46
Q

What is the sentinal lymph node?

A

First lymph node in the chain of drainage

47
Q

What has sentinal lymph node biopsy prevented?

A

Lymphedema

48
Q

What should you do if the sentinal lymph node is positive?

A

Axillary lymph node dissection

49
Q

What is the current recommendation for surgical intervention for breast cancer?

A

Overall survival is equal between lumpectomy + radiation compared to radical mastectomy

*Recurrence rate is higher with lumpectomy, but can be prevented with appropriate surveillance

50
Q

Is contralateral prophylaxtic mastectomy recommended for patients without BRCA mutations?

A

No–there is no advantage

OB/GYN (19 decks)

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