Normal And Abnormal Breast Exam

Question 1

What are the two most common complaints when women have breast problems?

Answer 1

Breast pain and breast mass

Question 2

3 things to do during physical exam of the breast?

Answer 2

Evaluate Both breasts, axilla, and chest wall

Question 3

What are the 5 diagnostic tests available to us for the breast?

Answer 3

Mammogram, US, MRI, FNA, and core biopsy

Question 4

Which patient population do we use mammograms in, what is the ability of the mammogram, and what two ways do we use them?

Answer 4

Women over 40
Can detect a mass 2 years before it becomes palpable
Screening and diagnostic

Question 5

At what age should we start mammograms and what age do we start clinical exams?

Answer 5

40 and 20

Question 6

What patient population is US good to use for? What does the US allow us to do, 3 things?

Answer 6

Women younger than 40 with dense breast tissue

Solid vs. cystic lesions, inconclusive on mammogram, guide core needle biopsy

Question 7

2 things to use MRI for?

Answer 7

Once you make the diagnosis of breast cancer, you can get a better picture for staging.
Use it initially on women with high risk for cancer like BRCA carriers

Question 8

When we do do fine needle aspiration biopsy and what do we do after we get the results?

Answer 8

Useful to determine solid vs. cystic masses
If the cyst goes away, then come back in 3 months for a breast exam.
If cyst doesn’t go away, do mammogram/US and get biopsy of tissue.

Question 9

3 types of breast pain?

Answer 9

Cyclic (with menses), noncyclic, and extramammary.

Question 10

What is the only FDA approved drug for breast pain, but what is the catch?

Answer 10

Danazol, but it makes you into a man basically.

Question 11

What does she recommend for breast pain?

Answer 11

Symptom relief like losing weight and making sure the women has a properly fitting bra, etc.

Question 12

Bilateral discharge is most common with what breast condition?

Answer 12

Fibrocystic changes or ductal ectasia

Question 13

Milky discharge can indicate what 3 conditions?

Answer 13

Hyperprolactinemia
Hypothyroidism
Certain medications

Question 14

What are we thinking with bloody nipple discharge?

Answer 14

Cancer until proven otherwise

Question 15

What are three things that we are thinking it could be with the bloody nipple discharge, how do we evaluate it, and how woul we treat it?

Answer 15

Intraductal carcinoma, invasive ductal carcinoma, or intraductal papilloma
Ductography
Ductal excision

Question 16

When we find a mass in the breast, what are 7 features that heighten our concern for malignancy?

Answer 16

2 cm or bigger, Immobile, Firm, Poorly define margins, Changes in skin, bloody nipple discharge, ipsilateral LAD

Question 17

What is the most common benign tumor in females and what age are they typically?

Answer 17

Fibroadenoma

Late teens early 20s.

Question 18

How do we treat and manage LCIS and DCIS?

Answer 18

Treated with excision and managed with SERMs

Question 19

7 risk factors for breast cancer

Answer 19

Over 50, white, first degree relative with breast cancer, BRCA 1 and BRAC 2 genes, radiation exposure, obese, alcohol

Question 20

4 Histology types of breast cancer in order of decreasing frequency?

Answer 20

Ductal, lobular, nipple (pagets), and inflammatory

Question 21

2 things unique about ductal and 1 thing unique about lobular she said?

Answer 21

Ductal most common in ladies who are in 50s and spread to LN

Lobular are more likely multifocal and bilateral

Question 22

Two surgical options for breast cancer?

Answer 22

Lumpectomy with radiation

Mastectomy

Question 23

4 things we do for adjuvant therapy?

Answer 23

Chemo to kill cancer cells
Hormonal therapy like tamoxifen to be anti estrogen
Aromatase inhibitors to prevent conversion of estrogen
Trastuzumab anti her2/neu.

Question 24

Nasty side effect of trastuzumab?

Answer 24

Heart failure

Question 25

What is appropriate follow up after diagnosis of breast cancer?

Answer 25

First 2 years see them every 3-6 months.

After 2 years, see them annually

Question 26

8 risk factors for breast cancer?

Answer 26

Age, first degree relative of breast cancer or ovarian cancer, high breast tissue density, early menarche, late menopause, post menopausal obesity, long term oral contraceptive use, and alcohol use.