OBGYN Breast Flashcards
What is acute mastitis?
MCC?
Symptoms?
Testing (if any)
Treatment
-What ABX
-What should moms keep doing?
-Infection of the breast MC in lactating women due to nipple trauma (especially in first 6 weeks postpartum)
-Staph Aureus is MCC
-Unilateral localized breast pain, tenderness, warmth, swelling, induration, redness. Cracked nipples or fissure. Purulent nipple discharge. Systemic symptoms.
-Clinical, but can do culture.
-Treatment
–Supportive: warm/cool compresses, breast pump.
–Dicloxacillin, Nafcillin. Erythromycin if PCN allergic.
–Mothers encouraged to continue breastfeeding. Mild drainage (pump, breast-feeding) to resolve infection.
Breast Abscess
-MC in who?
-MCC?
-Symptoms
-Testing (if any)
-Treatment (procedure and ABX)
-MC in lactating women secondary to nipple trauma
-Staph Aureus MCC
-Symptoms of acute mastitis with induration and fluctuance (due to pus). Purulent nipple discharge.
-Clinical. US can be ordered if there is a question of cellulitis vs abscess
-Drainage via needle aspiration or I&D
-ABX: Dicloxacillin, Cephalexin, Clindamycin. If MRSA, give Bactrim or Clindamycin.
-Continue breastfeeding!!
Congestive Mastitis
-Definition (due to what)
-Symptoms
-Management
-Bilateral breast enlargement 2-3 days postpartum due to milk stasis
-Bilateral breast pain and swelling
-Breast drainage (manually or breast pump)
MC benign breast disorder in reproductive age women?
-Symptoms
-Testing (DOC)
-What is seen on FNA
-Treatment?
-Fibrocystic Breast Changes (noncancerous fluid filled breasts due to exaggerated response to hormones)
-Multiple, painful or painless breast masses that may increase or decrease in size with menstrual hormonal changes (worse prior to menstruation)
-Multiple, nodular, mobile, smooth round or ovoid lumps in both breasts - MC in upper outer sections of breasts
-US DOC
-FNA: straw-colored or green fluid (no blood)
-Supportive: observation, supportive bra, warm/cool compresses, analgesia. OCP’s can reduce symptoms
MC breast tumor in women < 30 years old
-Definition
-Symptoms
-Clinical diagnosis, but what is seen on US and FNA
-Treatment
-Fibroadenoma of the breast (benign solid tumor composed of glandular and fibrous tissue)
-Breast mass that grows gradually over time. May enlarge in pregnancy. Does not change in size with menstrual cycle. Firm, nontender, solitary, smooth, well-circumscribed freely mobile, rubbery lump in the breast. No axillary involvement.
-US: Solid well-circumscribed, avascular mass
-FNA: Definitive diagnosis: fibrous tissue and collagen arranged in a swirl
-Observation, reassurance, and follow-up. Excision if enlarging. Most resorb with time though.
Gynecomastia
-Enlargement of breast tissue in males due to _______ or _______
-3 Causes: Hormonal (seen in what three groups), and what two other causes.
-Symptoms
-Testing?
-Treatment (Supportive, Medical, Surgical)
-Due to increased effective estrogen or decreased androgens
-Hormonal: infants (due to high maternal estrogen), puberty (10-14 years), or older males. Other Causes: Idiopathic, Spironolactone, Malignancies (LCLC, Cirrhosis, Hyperthyroidism, CKD, Klinefelter)
-Palpable mass of tissue at least 0.5cm in diameter, centrally located, bilateral, tender to palpation.
-Clinical diagnosis. Check testosterone levels.
-Stop offending meds, observation if early or physiologic.
-Tamoxifen (estrogen antagonist in the breast)
-Surgery if cosmetically unappealing, fibrosis, etc.
Breast Cancer
-Risk Factors
-MC type
-Symptoms of this type
Risk Factors:
-Genetics: BRCA 1 and BRCA 2. First degree relative with breast cancer.
-Increasing age: > 60 years old
-Increased number of menstrual cycles: nulliparity, > 35 years old, early onset menarche, large menopause, never having breastfed
-Increased estrogen exposure: obesity, alcohol use, endometrial cancer
-MC Type: Infiltrative ductal carcinoma: associated with axillary metastases
-Symptoms: Painless, hard fixed immobile lump, may have unilateral discharge. Upper outer quadrant MC. Asymmetric erythema, discoloration, nipple inversion, skin thickening (skin changes).
–Axillary LAD
–MC site for metastases are bone, lungs (cough, dyspnea), liver (jaundice, nausea, ab pain), or brain. 2B’s and 2L’s
What is Paget Disease of the Breast?
-Symptoms
-Ductal carcinoma presenting as eczematous nipple lesion. May have bloody discharge from the nipple.
-Chronic eczematous itchy scaly rash on nipples and areola.
What is inflammatory breast cancer?
-Symptoms
-Red, swollen, warm, itchy breast. Peau d’Orange (skin changes that look like an orange peel due to lymphatic obstruction, associated with poor prognosis.
-Usually not associated with a lump.
Diagnostics for Breast Cancer
-Initial modality if the patient is < 40 years old
-Initial modality if patient is > 40 years old (what is suspicious for malignancy)
-FNA (advantages and disadvantages)
-Large needle (core biopsy) (advantages and dis)
-Most accurate diagnostic test (advantages)
-If < 40 years old: US due to high density of breast tissue
-If > 40 y/o: Mammography (microcalcifications and spiculated masses are highly suspicious)
-FNA: removes least amount of tissue. If positive, does not allow for receptor testing
-Large Needle: allows for receptor testing if positive, but leaves greater deformity and needle may miss the lesion
-Open Biopsy: Most accurate diagnostic. Allows for frozen section to be done followed by immediate resection and sentinel node biopsy.
Breast Cancer Management (based on TNM staging)
-Breast conservation therapy (lumpectomy) with sentinel node biopsy + follow up radiation
–May need radical mastectomy if diffuse, large tumor, prior radiation of breast
-Radiation Therapy: done post lumpectomy or mastectomy to destroy residual tumor cells
-Tamoxifen if ER positive tumors: most useful in premenopausal patients.
-Aromatase inhibitor hormonal therapy (Letrozole, Anastrozole, Exemestane) used in post-menopausal patients for ER positive
-Anti-HER2/neu Hormonal Therapy (Trastuzumab) is used for aggressive tumors (HER2 is associated with aggressive tumors)
Breast Cancer Screening
-Best modality if patient is > 40
-Average Risk Patient, what should be done and at what age, how often
-Moderate Risk Patient
-Women with breast implants…
-Clinical Breast Exam: How often?
-mammogram if > 40 years old
-Average Risk: Mammogram every 2 years at 50 years old until 74 years old.
-Moderate Risk: 50 years, every 2 years, or 10 years prior to age of first-degree relative was diagnosed, whichever is earlier
-Women with breast implants should undergo stem screening schedule as women without implants.
-Clinical breast exam: every 3 years in women 20-39 (annually after age 40)
What two drugs can be used in postmenopausal or women > 35 years old who are high risk for breast cancer?
What are some adverse effects of ________.
Tamoxifen or Raloxifene
-Tamoxifen: Endometrial cancer, DVT
