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Clin Med > OBGYN: breast > Flashcards

OBGYN: breast Flashcards

1
Q

mc benign breast dz

second MC?

A

FIBROCYSTIC BREAST DISEASE

fibroadenoma is 2nd MC benign breast mass

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2
Q

MC benign brest tumor?

A

fibroadenoma

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3
Q

why is mamography not useful in adolescents

A

large amount of glandular tissue present in adolescents makes mammography difficult to interpret

too dense to create clear picture

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4
Q

main function of breast

A

secretion of milk

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5
Q

histologically breast is composed of

A

lobules/glands
milk ducts
CT
fat

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6
Q

breast sit atop?

A

intercostal muscles

pectoral muscles

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7
Q

BC commonly begins where

A

tail of spence

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8
Q

most benign and cancerous breast findings are

A
  1. felt on breast exam

2. seen on imaging

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9
Q

two MC types of imaging are

A

mammograms (x-rays)

sonograms/US

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10
Q

list benign breast conditions

A
  1. fibrocystic breasts
  2. cysts
  3. fibroadenomas
  4. abscess
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11
Q

Fibrocystic breast disease

  • aka?
  • define
  • % of women who experience this
  • MC in?
  • etiology
  • s/s
  • tx
A

fibrocystic changes/chronic cystic mastitis

*general, all inclusive term for a variety of benign breast conditions

90% of women get this at some point in life

MC In younger, premenopausal women

etiology
*estradiol and progesterone secreted during luteal phase (first day) of menses–>stimulate breast glands to swell–>mastalgia

s/s

  • breast pain and discomfort–MC during luteal phase
  • bilateral tender nodules

TX

  • NSAIDS
  • avoid caffeine +/- helpful
  • taking Combined contraceptives can help reduce severity
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12
Q

cysts

  • influenced by ?
  • diagnose
  • classifications
A

influenced by hormonal fluctuations of menstrual cycle

diagnose:
* sonogram/US

classifications

  1. simple
  2. complicated–“debris”
  3. complex–>if solid component, it needs to be biopsied to R/O CA
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13
Q

Fibroadenoma

  • define
  • MC in
  • etiology
  • s/s
  • diagnose
A

benign tumor

MC in 15-35YO

Etiology=hormones of menstrual cycle

S/s

  • mass feels firm, smooth, rubbery
  • freely mobile
  • well defined margins

diagnose:
* sonogram
* if cannot determine cancerous or not, biopsy is needed

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14
Q

Abscess

  • define
  • MC assoc with
  • s/s
  • tx
A

infection that produces a collection of pus

pus has to be drained out for abscess to heal***

MC assoc with complication of mastitis (breast infection)

s/s:
*regular s/s of infection + induration and an area of fluctuation

TX

  • I/D
  • systemic s/s= ABX
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15
Q

BCA is affected by what hormone

A

estrogen

***why risk is higher the “more” estrogen you are exposed to

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16
Q

RF for BCA (top 4)

-others (6)

A
  1. young menarche (ovulation-more estrogen)
    - –> before 12
  2. later menopause (ovulating for longer time=more estrogen)
    - –>after 55
  3. last first birth/pregnancy (pregnancy is lower estrogen state)
  4. no births or pregnancies
    __________________________
  5. breast tissue density–more dense
  6. female vs male
  7. incr age
  8. genetics
  9. fam hx
  10. DES exposure
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17
Q

family hx for BCA

  • 1st degree relative?
  • two 1st degree relatives
A

1st degree relative puts PT at 2 fold incr for BCA

2 1st degree puts PT at risk 3 fold for BCA

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18
Q

BCA protective factors

A

breastfeeding

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19
Q

list 2 things that are inconclusive regarding BCA risk

A
  1. estrogen and progesterone contraceptives

2. Post-menopausal hormone replacement therapy

20
Q

things that do NOT influence BCA risk (6)

A
  1. abortion
  2. chemicals
  3. tubal ligation
  4. caffeine
  5. hair dye
  6. cosmetic breast implants
21
Q

Gail model

A

risk-calculator model for PTs with RF for BCA

22
Q

what needs to be done with a PTs lifetime risk is >20% or their 5 year risk is over 1.7%?

A

supplemental screening with MRI

23
Q

how do we screen for BCA

A
  1. CBE

2. Mammos

24
Q

when do we start doing CBEs and Mammos and how often

A

CBE: every 1-3 years starting at age 21

Mammo: every 1-2 years starting age 40

25
Q

conflicting data regarding this exam and detection of BCA

A

SELF breast exams

-they can lead to unnecessary procedures

26
Q

when are self breast exams best done?

A

after menses

27
Q

findings that are suspicious for BCA (5)

A
  1. unilateral, spontaneous, nipple discharge–>bloody, clear or serous
  2. new onset nipple retraction or inversion
  3. asymmetric thickening/nodularity
  4. skin changes
    - erythema
    - scaling
    - peau d’orange
    - dominate mass that is painless, firm and non-mobile
28
Q

why is a CBE always done before a mammogram

A

because if something is felt on CBE— you know to then order a DIAGNOSTIC mammo and not a SCREENING mammo

29
Q

abnormal CBE, what do you order next

A
  1. diagnostic mammo
    and
    diagnostic sonogram
30
Q

list 12 signs of BCA from the know your lemons ad

A
  1. thickened area
  2. bump
  3. dimple
  4. growing vein
  5. nipple crust
  6. sunken nipple
  7. red or hot
  8. new shape/size
  9. new fluid
  10. orange peel skin
  11. skin sores
  12. hard lump
31
Q

list male BCA warning signs

A
  1. lump
  2. nipple discharge
  3. reddening
  4. inversion of nipple
  5. skin dimpling
32
Q

two standard views on screening mammograms

A
  1. craniocaudal (CC)

2. Mediolateral (MLO)

33
Q

pros/cons of mammograms

A

PROS
1. detect BCA two years before it is palpable

CONS
1. uses radiation–basic screening exposes patient to 0.5-1.0 rad

34
Q

if something is “seen” on screening mammo, what is done next

A

diagnostic mammo and/or sonogram

**diagnostic mammos have more types of views vs the screening mammos

35
Q

BI-RADS 0

A

not defined

needs additional evaluations

36
Q

BI-RADS 1

A

negative

37
Q

BI-RADS 2

A

benign

38
Q

BI-RADS 3

A

prbaby benign

*need to return in 6 MO for follow up imaging

39
Q

BI-RADS 4

A

suspicious abnormality

–need biopsy

40
Q

BI-RADS 5

A

highly suggestive of malignnacy

—need biopsy

41
Q

BI-RADS 6

A

known biopsy proven malignancy

42
Q

3 basic types of breast biopsies

A

Fine needle aspiration/biopsy

core needle biopsy

Excisional biopsy

43
Q

how to perform FNA

A

done by “feeling” the area and penetrating with the needle

  • aspirate the fluid in the area
  • fluid sent to lab

only works on fluid filled things like cyst*

*shows abnormal cells on pathology

44
Q

how to perform core needle biopsy

A

guided by sonogram or mammogram (sterotactic)

  • taking a piece of the core of the tumor
  • shows abnormal cells on pathology
45
Q

how to perform excisional biopsy

A

done to remove ALL the tissue and rule out any cancer cells

also called lumpectomy

  1. wire, hook or seed localization procedure with radiologist
  2. radiologist able to use imaging modality to insert wrie or seed into the area

Clin Med (52 decks)

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