June 2019 Flashcards
June published helpful clinical facts and findings
Nipple inversion occurs as a normal finding in approximately what percent of women
3%
What are the 5 main causes of nipple inversion
It is often congenital
four acquired reasons:
- trauma
- scarring mastitis
- breast cancer
- breast surgeries
most common breast mass in women <40 years of age
Fibroadenoma
How to manage fibroadenoma
- Age appropriate imaging for solid breast masses to obtain dx
- clinical f/u if clinically stable
- biopsy for clinical change or if >6cm
What are the 11 major risk factors for breast Cancer
Age >50 years
Early menstruation
Late or no pregnancy
Late menopause
Overweight
Known genetic predisposition
Family history of breast cancer
Personal history of cancer
Intraductal proliferating lesions (eg, UDH and ADH)
Lobular neoplasia (eg, ALH and LCIS)
Intraductal papillary neoplasms
T/F A topical steroid challenge is not sufficient to rule out Paget disease because some patients will have symptomatic improvement with topical steroid use.
True. Very low threshold for breast biopsy.
Atopic dermatitis (AD) affects the breast and nipple in ≤20% of patients with AD and is the cause of approximately WHAT percentage of all breast and nipple dermatitis occurring during breastfeeding
50%
One series found that WHAT % of patients with breast and nipple dermatitis had a positive patch test to 5-chloro-2-methyl-4-isothiazolin-3-one, a common preservative in detergents and fabric softeners; 25% of patients had improvement upon avoidance of this contact allergen.
36%
Pathophyz of lactational mastitis
When stagnant milk in the ducts becomes infected, it creates a warm, tender, swollen, erythematous overlying plaque
Treatment of lactational mastitis
The treatment of choice is continued breastfeeding except in patients with HIV because lactational mastitis increases the risk of HIV transmission to the infant via breast milk.40 Patients that cannot continue breastfeeding should manually empty their breasts.
Who recommends abx (keflex, amox).
If mastitis goes on to abscess (30%), what is the treatment.
Needle aspiration instead of I&D (lower post procedure morbidity).
Besides MCN what other oral is commonly used to treat CARP?
Azithromycin
What can we use to prevent radiation dermatitis?
Potent topical corticosteroids are more effective than emollients for the prevention of severe radiation dermatitis and therefore their use is recommended.
On a patient >30y, recieving >30mg daily of prednisone for >3m, what needs to be done to prevent Glucocorticoid-induced osteoporosis?
-counseled on lifestyle modifications (weight-bearing activities, smoking
cessation, limiting alcohol consumption)
be prescribed calcium 1,200 to 1,500 mg daily
vitamin D 1,000 IU daily
oral bisphosphonate (fosamax 5mg daily (10mg for post menapausal females).
Patients who are taking glucocorticoids without concomitant nonsteroidal anti-inflammatory drugs are not at increased risk of developing gastrointestinal ulcers or bleeding and therefore should not receive proton pump inhibitors.
