Ob/Gyn from PANCE Pearls

Question 1

What is mastitis

Answer 1

Inflammation of the breast

Question 2

What causes mastitis and what is the pathogen

Answer 2

Infection, usually in lactating women secondary to nipple trauma
Staph. Aureus
Strep
Candida

Question 3

What are some features of the different forms of mastitis
Infection
Congestive
Breast Abscess

Answer 3

Infection: Unilateral breast pain with tenderness, warmth, swelling, nipple discharge
Congestive: Bilateral breast pain and swelling
Breast Abscess: Induration with fluctuance

Question 4

Tx of Infectious Mastitis

Answer 4

Warm compress, breast pump, Abx (Dicloxacillin, Nafcillin, Cephalosporin)
Can continue to nurse or use breast pump

Question 5

Tx of Congestive Mastitis

Can you continue breastfeeding

Answer 5

Ice packs, tight fitting bras, analgestics, avoid breast stimulation
If wanting to continue breastfeeding, manually empty breast after baby finishes feeding

Question 6

Tx of Breast Abscess

Can you continue breastfeeding

Answer 6

Incision and Drainage

Stop breastfeeding from affected breast

Question 7

Sx of fibrocystic breast disorders

Answer 7

Multiple, mobile, well-demarcated areas in breast tissue
Tender, bilateral
Cysts may increase or decrease in size with menstrual hormonal changes

Question 8

Dx of fibrocystic breast disorder

Answer 8

Ultrasound

Biopsy shows straw-colored fluid

Question 9

Tx of fibrocystic breast disorder

Answer 9

Most resolve spontaneously

FNA to remove fluid if symptomatic

Question 10

What is a fibroadenoma

Answer 10

2nd most common benign breast disorder

Composed of glandular and fibrous tissue

Question 11

Sx of fibroadenoma

Answer 11

Smooth, well-circumscribed, mobile, rubbery lump
No axillary involvement or nipple discharge
Gradually grows over time and does not usually wax and wane with periods

Question 12

Tx of fibroadenoma

Answer 12

Most resolve with time if small enough

Excision

Question 13

What are risk factors for Breast Cancer

Answer 13

BRCA 1 and BRCA 2
1st degree relative with breast CA
Increased estrogen exposure
Increased number of menstrual cycles

Question 14

What are the two types of breast cancers

Answer 14

Intraductal Carcinoma

Lobular Carcinoma

Question 15

Sx of Breast Cancer

Answer 15

Breast mass, usually painless, hard, fixed lump
Usually found in upper outer quadrant
Unilateral nipple discharge, may be bloody, purulent or green
Asymmetric skin redness, ulceration, dimpling, Peau d’orange

Question 16

What is paget’s disease of nipple

Answer 16

Chronic Eczematous itchy, scaling rash on the nipples and areola

Question 17

Dx of Breast Cancer

Answer 17

Mammogram: Microcalcifications and spiculated masses suspicious for malignancy
Ultrasound: Recommended in women

Question 18

Tx of Breast Cancer

Answer 18

Lumpectomy followed by radiation
Mastectomy
Removal of regional/axillary lymph nodes

Question 19

How do you screen for breast cancer

Answer 19

Mammogram is best. Start at 40 yrs and do it annually

Breast exam annually after 40 yrs

Question 20

What are some skin changes noted with breast cancer

Answer 20

Asymmetric redness
Discoloration
Ulceration
Skin Retraction (Dimpling if Cooper's ligament is involved)
Changes in breast size
Nipple inversion
Skin Thickening
Peau d'orange (looks like peel of orange because of lymphatic obstruction)