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Breast > MedEd > Flashcards

MedEd Flashcards

1
Q 
22 year old woman presents to clinic with a three-month history of a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
A

fibroadenoma

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2
Q 
A 54 year old patient who is febrile, presents with an irregular, firm mass in her left breast. The overlying skin appears red and is warm to touch. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
A

breast abscess

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3
Q 
A 31 year old presents with an ill-defined, tender mass in her left breast, 2 weeks after giving birth. The affected segment is diffusely red and hot. Fine needle aspiration cytology (FNAC) of the mass shows neutrophils and inflammatory debris. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
A

acute mastitis

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4
Q

what is (lactational) acute mastitis

A

acute inflammation of the breast tissue

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5
Q

what is the main cause of acute mastitis

A

s aureus

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6
Q

what are the risk factors for acute mastitis

A

2Bs
Breastfeeding (hence lactational)
Birth

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7
Q

what are clinical features of acute mastitis

A

painful red swelling of the breast

skin is ‘hot to touch’

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8
Q

what is the main complication of acute mastitis

A

abscesses

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9
Q

what buzzwords are associated with acute mastitis

A

2Bs (breastfeeding + birth)

painful red swelling

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10
Q

what is periductal mastitis

A

inflammation around the dilated milk ducts

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11
Q

what are risk factors for periductal mastitis

A

smoking

non-lactating young women

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12
Q

of acute mastitis and periductal mastitis, which is not associated with birth or breastfeeding

A

periductal mastitis

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13
Q

what are clinical features of periductal mastitis

A

painful red subareolar mass

inverted nipple

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14
Q

what is a breast abscess

A

collection of pus in the breast

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15
Q

what are clinical features of a breast abscess

A

febrile patient

painful red lump near the nipple

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16
Q

what is the management for a breast abscess

A

aspirate (FNA) or surgical drainage

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17
Q

what is a fibroadenoma

A

benign neoplasm of a lobule arising from the stroma (fibro) and glandular epithelium (adenoma)

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18
Q

who is commonly affected by fibroadenomas

A

young women

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19
Q

what name are fibroadenomas also called

A

breast mouse due to being very mobile

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20
Q

what are clinical features of fibroadenoma

A

painless, smooth, well circumscribed mobile mass

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21
Q

what is a breast cyst

A

fluid filled cavity in the breast

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22
Q

who is commonly affected by breast cysts

A

women around menopause

>35yrs

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23
Q

what are clinical features of a breast cyst

A

fluctuant, distinct, round mass

often tender

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24
Q

what is the management for a breast cyst

A

aspirate (FNA)

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25
Q

what coloured aspirate is common with breast cysts

A

usually clear or green or yellow aspirates

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26
Q

what is duct ectasia

A

dilation of ducts due to blockage or clogging of lactiferous ducts

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27
Q

who commonly gets duct ectasia

A

post menopause

>50yrs

28
Q

what are clinical features of duct ectasia

A

similar features to cancer

nipple retraction or slit like nipple
a thick cheese discharge

29
Q

what is seen on imaging with duct ectasia

A

microcalcification

30
Q

what is the management for duct ectasia

A

reassure and discharge

31
Q

what are the buzzwords associated with duct ectasia

A

cheeky thick yellow green discharge

nipple retraction or slit like nipple

32
Q 
A 56 year old female presents with thick creamy discharge from the right nipple. USS shows dilated subareolar ducts. Cytology of discharge shows macrophages and debris but no epithelial cells. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
A

Duct Ectasia

33
Q 
A 55 year old presents with a firm, irregular, painless lump in her left breast. On examination you find an enlarged apical lymph node. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
A

Invasive Breast Cancer

34
Q 
A 48 year old woman presents with red, scaly lesions around the nipple of the right breast. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
A

Paget’s Disease of the Breast

35
Q

what are malignant breast cancer conditions

A 
non-invasive
-DCIS
invasive
-infiltrative ductal carcinoma
-infiltrative lobular carcinoma
-pagets disease of the breast
36
Q

what is DCIS

A

ductal carcinoma that has not invaded the basement membrane

37
Q

what are clinical features of DCIS

A

no lump

38
Q

what would be seen on imaging with DCIS

A

microcalcification

39
Q

what is a mneumonic for risk factors of breast cancer

A

History ALONE

History (PMHx/FHx of breast or ovarian cancer, or BRCA genes, or radiotherapy, DHx of OCP or HRT)
Age
Late menopause >51yrs
Obesity or Nulliparity
Early menarche <13yrs
40
Q

what are different types of invasive breast cancer

A

infiltrative ductal carcinoma

infiltrative lobular carcinoma

41
Q

what is the most common invasive breast cancer

A

infiltrative ductal carcinoma

42
Q

what are clinical features of invasive breast cancer

A

painless, immobile, irregular hard lump
lymphadenopathy
peau d’orange

43
Q

how is suspected invasive breast cancer investigated

A

triple assessment

44
Q

what biopsy is performed on a invasive breast cancer lump

A

sentinel lymph node biopsy

45
Q

what is the management for an invasive breast cancer

A

wide local excision

46
Q

what medication is used in oestrogen receptor positive tumours

A

tamoxifen (oestrogen antagonist)

47
Q

what medication is used in Her2 receptor positive tumours

A

trastuzumab (herceptin)

48
Q

what is pagets disease of the breast

A

presence of pagets cells in the nipple

spread of breast cancer to the skin!!

49
Q

what conditions is pagets disease of the breast seen in

A

DCIS

invasive breast carcinoma

50
Q

what are clinical features of pagets disease of the breast

A

red itchy lesion of the nipple

crusty and scaly skin

51
Q

what buzzwords are associated with pagets disease of the breast

A 
eczematous lesion (red, itchy lesion)
skin of the nipple
52
Q 
A 25 year old woman is seen in breast clinic as she has noticed a small lump in her right breast. This is confirmed on examination and she is sent for further investigation. What is the next investigation she should have?
Core Biopsy
Fine Needle Aspiration
Mammography
None Needed – Send Home
Ultrasound
A

Ultrasound

53
Q

what is the triple assessment

A 
clinical assessment
imaging
-USS <35yrs
-mammogram >35yrs
biopsy
-FNA for cytology (fluid)
-tru-cut core biopsy for histology (solid)
54
Q

what is fat necrosis

A

post trauma necrosis of fatty breast tissue

55
Q

what are the risk factors for fat necrosis

A

trauma

56
Q

what are clinical features of fat necrosis

A

painless, irregular hard lump

bruising overlying skin

57
Q

what is fibroadenosis

A

normal of physiological changes in breast tissue which leads to fibrous tissue and cyst formation

58
Q

what are the risk factors for fibroadenosis

A

hormonal changes in >35yrs

59
Q

what are features of fibroadenosis

A

appears just before period

multiple painful lumps

60
Q

what are buzzwords for fibroadenosis

A

multiple lumpy masses

61
Q

what is an intraductal papilloma

A

benign neoplasm within the ducts of the breast

62
Q

who gets intraductal papillomas

A

common around menopause

63
Q

what are clinical features of intraductal papillomas

A

bloody or clear nipple discharge

subareolar mass

64
Q

what is phyllodes tumour

A

phyllodes means life-like

a fibroepithelial tumour formed from periductal stromal cells

65
Q

is phyllodes tumour benign or malignant

A

can be either

66
Q

what are clinical features of a phyllodes tumour

A

rapidly growing

tear drop appearance of the breast

67
Q

what buzzwords would suggest a phyllodes tumour

A

rapidly growing tumour

Breast (7 decks)

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