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AB 4th Year General Surg + GI > General Surgery - Breast > Flashcards

General Surgery - Breast Flashcards

1
Q

what is a fibroadenoma?

A

benign overgrowth of a breast lobule

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2
Q

features of a fibroadenoma?

A

painless
mobile
discrete

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3
Q

why is a fibroadenoma so mobile?

A

has no attachment to the suspensory ligaments of the chest wall

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4
Q

Ix for a breast lump?

A

examination
US <35/Mammogram >35
biopsy

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5
Q

how to differentiate a Phyllodes tumour and a fibroadenoma?

A

Phyllodes grow faster

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6
Q

when can a fibroadenoma be excised?

A

≥3cm and symptomatic

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7
Q

what features make up fibrocystic disease?

A

fibrosis
inflam
cysts
hormonal breast pain

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8
Q

Tx for fibrocystic disease?

A

NSAIDs
primrose oil/linoleic acid
COCP

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9
Q

what features will a breast cyst have?

A

smooth
mobile
distinct borders
soft

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10
Q

Ix for a cyst?

A

US + aspirate

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11
Q

Tx for a cyst?

A

aspirate if symptomatic

hormonal Tx e.g COCP

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12
Q

what causes lactational mastitis?

A

infection of the mammary ducts

bacterial or fungal

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13
Q

risk factors for lactational mastitis?

A

breastfeeding
poor position
infrequent feeding
trauma

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14
Q

what bacteria commonly causes lactational mastitis?

A

staph aureus

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15
Q

features of thrush lactational mastitis?

A 
pain 
itch
flaky
cracked nappy
baby has thrush (oral/nappy)
baby is windy and unsettled
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16
Q

features of bacterial lactational mastitis?

A

tender
red
pus and blood in milk
red stripes on breast

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17
Q

Tx for thrush lactational mastitis?

A

continue feeding
miconozole cream for mum
gel for baby

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18
Q

Tx for bacterial lactational mastitis?

A

continue feeding
warm compress + express
NSAIDs
fluclox or erythro if pen allergic

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19
Q

risk factors for duct ectasia?

A

smoking

menopause

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20
Q

features of duct ectasia?

A

recurrent infections
yellow/green discharge
pain under nipple
nipple inversion

21
Q

pathology behind duct ectasia?

A

subarealor mammary ducts are dilated and scarred due to chronic inflam

squamous metaplasia of ducts occurs

become keratinised and blocked

22
Q

what bacteria often causes infections in duct ectasia?

A

streptococci

23
Q

Ix for duct ectasia?

A

FBC (WCC raised)

US

24
Q

Tx of duct ectasia?

A

metronidazole

drain abscesses

25
Q

what complications can occur in duct ectasia?

A

peri areolar fistula

EXCISE

26
Q

what is fat necrosis?

A

damage to breast tissue causing an acute injury

27
Q

pathology of fat necrosis?

A

adipocytes are infiltrated with inflammatory cells

fibrosis and scarring occurs

28
Q

risk factors for fat necrosis?

A

trauma

warfarin

29
Q

what genetic conditions can give males gynecomastia?

A

kleinfelters (XXY)

prader wili

30
Q

what drugs can cause gynacomastia?

A 
steroids
spironolactone
alpha blockers
5 alpha reductase
cannabis
31
Q

e.g of an
alpha blocker
5 alpha reductase?

A

alpha blocker - doxasozin

5 alpha reductase inhibitors - finasteride

32
Q

risk factors for breast cancer?

A 
age
BRCA1/2
not breastfeeding 
HRT>5yrs
early menarche
hormonal contraceptives
low parity
late menopause
alcohol
33
Q

symptoms of breast cancer?

A 
lump
hard
gritty
immobile
ill defined
puckering 
pea d'orange
34
Q

what nipple changes can happen in breast cancer?

A

eczema (paget’s)
inverited
deviated
discharge

35
Q

what type is the most common in breast cancer?

A

ductal adenocarcinoma

36
Q

Ix for breast cancer?

A 
examination
Mammogram >35
US <35
biopsy/FNAC
CT
37
Q

T stages for breast cancer?

A 
Tis - DCIS
1 - <2cm
2 - 2-5cm
3 ->5cm
4 - chest wall, skin or inflammatory
38
Q

N stages for breast cancer?

A

1 - LN in armpit
2 - LNs stuck together
3 - LN below clavicle/above clavicle/behind sternum

39
Q

surgical options for breast cancer?

A

wide local excision (conserves breast)

mastectomy + reconstruction

40
Q

what options for reconstruction are there in breast cancer?

A 
prothesis
lastissmus dorsi flap
deep inferior epigastric artery flap
inferior gluteal artery flap 
abdo flaps
41
Q

what treatment is offered if nodes are affected?

A

radiotherapy

OR axillary node clearance

42
Q

what technique is used to identify if nodes are positive? why is this done?

A

sentinal node biopsy

avoid full clearance, which may cause lymphodema

43
Q

what is the treatment for Her2+ve tumours?

A

herceptin

44
Q

what treatment is used for ER +ve postmenopausal women? Rx and drug type?

A

letrozole
aromatase inhibitor
risk of osteoporosis

45
Q

what treatment is used for ER +ve premenopausal women? Rx and drug type?

A

tamoxifen
selective oestrogen receptor modulator
risk of VTE and endometrial cancer

46
Q

who gets breast cancer screening?

A

50-70yrs every 3 years

BRCA/FHx can get 2 yearly screening

47
Q

how can DCIS present?

A

asymptomatic

microcalcification

48
Q

Tx for DCIS?

A

wide local excision + radiotherapy

49
Q

what is DCIS?

A

pre cancerous condition

cells of milk duct are cancerous but haven’t spread into any surrounding normal tissue

AB 4th Year General Surg + GI (13 decks)

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