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USMLE STEP 1, 2, 3 > OBGYN_1 > Flashcards

OBGYN_1 Flashcards

Breast

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USMLE® Step 1 flashcards
1
Q

T/F, breast cancer is the most common type of cancer in females?

A

True.

Lung cancer is still the most common cancer resulting in death.

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2
Q

What are the screening recommendations for women under 40?

A

Age <40: Screening not indicated for average-risk women.

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3
Q

How often should women aged 40-75 undergo breast cancer screening?

A

Between the ages of 40-50:
Screening per patient preference/shared decision-making.

Between the ages of 50-75:
Screening recommended every 1-2 years.

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4
Q

Name three criteria that define high-risk breast cancer patients.

A

Age > 70 (very high relative risk)

BRCA+ (first degree relative)

family history will increase risk by 20%

history of ovarian/breast cancer

high estrogen states

first child after 30 years old

drinking 2 or more alcoholic beverages more per day

chest radiation therapy

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5
Q

What is the screening recommendation for patients at higher risk?

A

Should screen early if the patient has a family history.

Use mammogram and MRI annually.

Mammography is the primary imaging modality even for patients with dense breasts. U/S is used to follow up certain lesions on mammography. MRI is used for the high-risk patient population.

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6
Q

In breast cancer screening usually indicated beyond age 75?

A

Only if the patient is expected to life for at least 10 more years.

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7
Q

List three factors that reduce breast cancer risk.

A

Reduced risk:
Breastfeeding, increased parity, normal BMI, regular exercise.

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8
Q

How does hormonal exposure influence breast cancer risk?

A

Hormonal exposure:
Early menarche, late menopause, nulliparity.
COC or HRT

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9
Q

What is the recommended imaging for women with dense breasts?

A

U/S to screen.

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10
Q

What family history risk threshold necessitates early screening?

A

BRCA1: Breast cancer 50-70%

Ovarian cancer 40%

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11
Q

What are the cancer risks associated with BRCA1 mutation?

A

BRCA1:
50-70% risk of breast cancer.
40% risk of ovarian cancer.

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12
Q

What are the cancer risks associated with BRCA2 mutation?

A

BRCA2:
50-70% risk of breast cancer.
15% risk of ovarian cancer.
Increased risk of Male breast/prostate cancer.

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13
Q

How are BRCA mutations inherited?

A

Mutations lead to autosomal dominant inheritance patterns.

Incomplete penetrance.

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14
Q

When should screening for BRCA mutations be performed?

A

Personal history of breast cancer before age 45.
Family history of BRCA gene variant.
Strong family history of breast/ovarian cancer.

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15
Q

What are the screening recommendations for BRCA mutation carriers?

A

Breast and ovarian cancer screens

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16
Q

At what age should BRCA+ individuals begin annual MRI/mammogram screening?

A

Annual MRI/mammogram starting age 25-30.

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17
Q

How are the breast screening recommendations started for BRCA mutation carriers?

A

Starting at age 25-30.

Permed annually with both a mammogram and MRI.

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18
Q

When and how are ovarian cancer screening recommendations started for BRCA mutation carriers?

A

Starting at age 30, ovarian cancer is screened every 6 months with a TVUS and CA125.

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19
Q

What is the management approach for BRCA-positive patients diagnosed with early-stage breast cancer?

A

Mastectomy or breast-conserving therapy (BCT) (lumpectomy + radiation).

Adjuvant hormonal therapy for ER/PR-positive tumors (e.g., tamoxifen, aromatase inhibitors).

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20
Q

What is the prophylactic measure for ovarian cancer for BRCA-positive patients?

A

Bilateral salpingo-oophorectomy between 35 and 45 after childbearing years.

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21
Q

How should BRCA-positive ovarian cancer be managed?

A

Debulking surgery + chemotherapy.

Consider targeted therapy such as PARP inhibitors.

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22
Q

What pharmacotherapy is recommended for BRCA+ patients not undergoing mastectomy?

A

Consider tamoxifen if no mastectomy performed.

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23
Q

What type of calcifications in breast imaging are considered benign?

A

Skin or vascular calcifications, eggshell, or rim calcifications.

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24
Q

What type of calcifications in breast imaging are considered pathologic?

A

Spiculated mass
Clustered or granular microcalcifications
Fine pleomorphic, linear, or linear-branching calcifications.

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25
Q

What is the follow-up for a BI-RADS category 3 lesion?

A

Category 3: Probably benign, follow-up in 6 months.

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26
Q

What does BI-RADS category 4 require?

A

Category 4: Suspicious, requires core needle biopsy.

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27
Q

What does BI-RADS category 5 signify?

A

Category 5: Highly suggestive of malignancy.

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28
Q

What are the mammographic findings of DCIS?

A

DCIS: Growth of atypical ductal cells, microcalcifications detected on mammography.

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29
Q

What is the most common type of invasive breast cancer?

A

The most common type of breast cancer is Invasive ductal carcinoma.

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30
Q

What are the distinguishing features of invasive lobular carcinoma?

A

Lobular carcinoma: Loss of E-cadherin, bilateral disease risk.

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31
Q

What is the clinical presentation of fibrocystic breast changes?

A

Fibrocystic changes: Painful lumps improving with menses.

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32
Q

What are the features of a fibroadenoma?

A

Fibroadenoma: Mobile, rubbery mass, hormone sensitive.

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33
Q

What are the characteristics of a Phyllodes tumor?

A

Phyllodes tumor: Large, painless, rapid growth, requires excision.

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34
Q

What is the treatment for early-stage (I-II) breast cancer?

A

Early-stage (I-II): Surgery + endocrine therapy (ER/PR+).

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35
Q

What is the treatment for locally advanced (stage III) breast cancer?

A

Locally advanced (III): Neoadjuvant chemo, mastectomy/radiation.

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36
Q

What is the treatment for metastatic (stage IV) breast cancer?

A

Metastatic (IV): Systemic chemotherapy, palliative care.

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37
Q

What are the early findings associated with breast cancer?

A

Single, nontender, firm mass with ill-defined margins
Mammographic abnormalities on routine screening

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38
Q

What are the late findings of breast cancer?

A

Regional lymphadenopathy
Metastatic disease
Peau d’orange skin changes (due to lymphatic obstruction)
Dimpling (tethering of Cooper ligament)

39
Q

What skin change in breast cancer is described as having an orange peel appearance?

A

Peau d’orange, often seen as a late finding due to lymphatic obstruction.

Metastatic disease is usually found at presentation.

40
Q

Lesions suspicious of breast cancer are usually (tender/nontender)

A

nontender

41
Q

What is the most common type of breast cancer?

A

Adenocarcinoma derived from epithelial tissues.

42
Q

What are the most common types of invasive breast cancer?

A

Invasive Ductal Carcinoma (IDC):

Most common type of breast cancer.
Cords and nests of cells with possible gland formation.

Invasive Lobular Carcinoma (ILC):

Single-file cellular infiltrate of mammary stroma and adipose tissue.
Loss of E-cadherin.
Associated with bilateral disease.
43
Q

What is inflammatory breast cancer, and how does it present?

A

Aggressive subtype with dermal lymphatic invasion.
Presents with edema, erythema, and peau d’orange changes.
Often associated with metastatic disease.

44
Q

What is Paget disease of the breast?

A

Epidermal spread of malignant ductal cells
(intraepithelial adenocarcinoma cells).

Causes eczematous changes to the nipple.

Often associated with underlying invasive carcinoma.

Make sure a bilateral mammogram is performed with punch biopsy.

45
Q

What type of malignant breast cancer is associated with growth of atypical ductal cells, filling the ductal lumen, but restricted to just above the ductal basement membrane?

A

ductal carcinoma in situ (DCIS)

46
Q

What is ductal carcinoma in situ (DCIS), and how is it managed?

A

Premalignant lesion with proliferation of atypical ductal cells.
Forms microcalcifications detected on mammography.

Management:
Mastectomy OR breast-conserving therapy (lumpectomy + radiation).
Adjuvant hormonal therapy if ER positive (tamoxifen or anastrozole)

47
Q

What breast cancer is usually found incidentally from biopsy of breast?

A

LCIS

Can be multicentric and bilateral.

Premalignant expansion of epithelial cells in lobules.

Management is usually observation unless there are high risk features found histologically.

48
Q

What breast cancer is usually similar but less significant than DCIS?

A

Atypical Ductal Hyperplasia

Proliferation of atypical cells

Perform an excisional breast biopsy.

49
Q

What is the preferred diagnostic method for breast cancer?

A

Core needle biopsy (preferred over FNA due to higher diagnostic yield and ability to test receptor status - ER/PR/HER2).

FNA is reasonable for simple cysts.

Surgical excision is used when CNB is non-diagnostic.

50
Q

How is breast cancer managed in early stages (stages I, IIA, and IIB)?

A

Localized and limited LN to axillary nodes.

Perform a sentinel lymph node biopsy with dissection if positive.

Mastectomy or breast-conserving therapy (BCT).

Adjuvant therapy (if applicable) with hormonal therapy if ER/PR-positive (tamoxifen or aromatase inhibitors).

51
Q

When is chemo indicated for breast cancer in early stages
(stages I, IIA, and IIB)?

A

Large tumors

LN spread

a High 21-gene recurrence score

52
Q

How is locally advanced breast cancer (stage III) managed?

A

Expansion to chest wall or skin, > 5 cm, or with more LN spread.

Neoadjuvant chemotherapy followed by surgery.

HER2-positive tumors: Trastuzumab.
ER/PR-positive tumors: Tamoxifen or aromatase inhibitors.

53
Q

How is metastatic breast cancer (stage IV) managed?

A

Endocrine therapy and/or systemic chemotherapy.

54
Q

What is the diagnostic approach for a new breast mass for patients Under age 30?

A

Start with ultrasound.

55
Q

What is the diagnostic approach for a new breast mass for patients between the Ages 30-40?

A

Ultrasound ± mammogram.

56
Q

What is the diagnostic approach for a new breast mass for patients Age > 40 ?

A

Start with mammogram ± ultrasound.

For suspicious masses: Core needle biopsy or fine needle aspiration.

57
Q

What are the types of nonproliferative breast lesions, and how are they managed?

A

Cyst:

Appears as solitary, fluid-filled lesion.
Management: Observation (if asymptomatic) or FNA drainage.

Fibrocystic changes:

Bilateral breast swelling, pain, and tenderness.
Management: Supportive bras and NSAIDs.
58
Q

How does the complexity of a cyst change management?

A

Complex cysts (thick walled with sepations)

Should be evaluated with FNA and follow-up imaging.

59
Q

How would this type of cyst be managed?

A

Simple cysts are ovoid, homogenous and anechoic

usually they are observed, and the patient is given NSAIDs and told to wear a supportive bra, and if asymptomatic, simply left alone.

they can be surgically removed if they recur and are bothersome.

60
Q

Fibrocystic changes usually occur … ?

A

Bilaterally

Along with menses (worse before, improve after)

Tender

Lumpy

Usually they are observed, and the patient is given NSAIDs and told to wear a supportive bra, and if asymptomatic, simply left alone.

61
Q

A cystic collection of fluid resulting from an obstructed milk duct, commonly seen during breastfeeding, or shortly after cessation, is called?

A

Galactocele

Soft cystic mass on breast examination.
Typically non-tender and mobile.

Patients are usually just reassured.

62
Q

How is a galactocele diagnosed?

A

Diagnosis is made via fine needle aspiration (FNA), which confirms milky drainage.

Imaging (ultrasound) can be used if necessary to exclude other causes. Usually the U/S is a complex cyst.

63
Q

How can galactocele be distinguished from other breast masses?

A

Galactocele is benign, soft, and mobile with milky drainage on FNA.

Usually they are fluctuant.

Differentiated from malignant lesions or abscesses, which may present with firmness, erythema, or tenderness.

64
Q

What is the management of a galactocele?

A

Reassurance:
Galactoceles are benign and require no intervention unless symptomatic.

FNA drainage:
Performed for symptom relief if the cyst is painful or causes discomfort.

65
Q

What is the most common benign breast tumor in women?

A

fibroadenoma

Composed of a proliferation of stromal and glandular tissue.
Occurs primarily in premenopausal women (20–40 years old).

66
Q

What are the clinical features of a fibroadenoma?

A

Presents as a well-defined, mobile, rubbery mass.

Typically non-tender

Hormone-sensitive:
may enlarge during pregnancy or with hormonal contraceptives.

67
Q

How is a fibroadenoma diagnosed?

A

Ultrasound: Shows a well-defined, solid mass.

Core needle biopsy (CNB) or repeat imaging may be used for confirmation, especially if atypical features are present.

68
Q

What is the management of fibroadenomas?

A

Reassurance for small, asymptomatic masses.

Biopsy for masses > 2.5 cm or getting larger.

Repeat imaging in 3 to 6 months.

Surgical excision if:

Mass is symptomatic or enlarging.
Atypical features are identified on imaging/biopsy.
69
Q

What is the most common cause of bloody nipple discahrge?

A

Intraductal Papilloma

Benign proliferation of ductal epithelial cells within a lactiferous duct.
Most common cause of bloody nipple discharge in premenopausal women.

70
Q

What are the differential diagnoses for pathologic nipple discharge?

A

Intraductal papilloma (most common cause for unilateral bloody discharge).

Malignancy.

Duct ectasia.

Mastitis or abscess.

71
Q

How is an intraductal papilloma diagnosed?

A

Mammography or ultrasound to locate the lesion.

Diagnosis confirmed via core needle biopsy or galactography.

72
Q

What is the management of intraductal papillomas?

A

Surgical excision to remove the affected duct and exclude malignancy.

73
Q

What is the management for a breast abscess?

A

Breast abscesses are found to be fluctuant, tender, accompanied by fever, and often unilateral.

They require incision and drainage along with antibiotics like dicloxacillin (for MSSA).

DO NOT breast feed if there is an abscess (varied from mastitis).

74
Q

What is fat necrosis of the breast, and what causes it?

A

Benign inflammatory process of the breast.
Caused by trauma, surgery, or radiation therapy.
Leads to fatty tissue breakdown.

75
Q

What are the clinical and imaging features of fat necrosis?

A

Clinical:
Firm, irregular, painless mass.

Imaging:
Often mimics malignancy with calcifications on mammography.

76
Q

How is fat necrosis diagnosed?

A

Ultrasound: Irregular hypoechoic mass with possible calcifications.
Confirmed with biopsy showing fat globules and foamy macrophages.

77
Q

What is the management of fat necrosis?

A

Reassurance: No treatment needed as it is benign.
Surgical excision only if symptomatic or for diagnostic uncertainty.
No treatment is required unless symptomatic.

78
Q

What breast cancer is similar, but has a more aggressive growth, to fibroadenomas but occurs in older women (>40).

A

Phyllodes Tumor

Rare, fibroepithelial tumor with stromal overgrowth.

Occurs more frequently in older women (> 60 years old).

Can be benign, borderline, or malignant.

79
Q

What are the clinical features of a phyllodes tumor?

A

Large, irregular, painless mass.
Rarely associated with nipple discharge.
Rapid growth with potential for local recurrence or malignancy.

80
Q

A Large, irregular, painless mass with rapid growth seen in a post-menopausal, elderly. patient could be a …. ?

A

phyllodes tumor

Large, irregular, painless mass.
Rapid growth.
Rarely associated with nipple discharge.

81
Q

How is a phyllodes tumor diagnosed?

A

Mammography or ultrasound: Shows a large, lobulated mass.
Core needle biopsy: Confirms diagnosis.

Rapid growth with potential for local recurrence or malignancy.

82
Q

What is the management of phyllodes tumor?

A

Surgical excision with wide margins to reduce risk of recurrence.

Malignant cases may require mastectomy if margins cannot be obtained.

Malignant phyllodes may require additional radiation therapy.

83
Q

What are the general categories of nipple discharge?

A

Lactation: Milk production during or shortly after pregnancy, occasionally bloody but typically benign.

Galactorrhea: Bilateral milky, clear, or straw-colored discharge caused by hyperprolactinemia.

Pathologic discharge: Usually unilateral, serous, or bloody, arising from a single duct.

84
Q

What conditions can cause lactation-related nipple discharge?

A

Pregnancy

Postpartum (up to 6 months after cessation of breastfeeding).

85
Q

What are the causes of galactorrhea?

A

Chronic breast stimulation (e.g., tight clothing).

Medications (e.g., antipsychotics).

Prolactinoma.

Hypothyroidism.

For galactorrhea:
Screening mammogram (if >40 years old), medical evaluation (e.g., pregnancy test, prolactin, TSH).

86
Q

What is the typical presentation of galactorrhea?

A

Bilateral milky, clear, or straw-colored nipple discharge caused by hyperprolactinemia.

87
Q

What are the characteristics of pathologic nipple discharge?

A

Unilateral, from a single duct.

Fluid may be serous or bloody-tinged.

88
Q

How is nipple discharge evaluated for malignancy or pathologic causes?

A

If there is a palpable breast mass:
Perform mammography and/or ultrasound.

If discharge is pathologic:
Ultrasound and/or mammogram (if >30 years old).

89
Q

What is duct ectasia?

A

Inflammation and fibrosis of the ductal system.
Presents with green, sticky nipple discharge.

90
Q

What are the clinical features of breast engorgement?

A

Bilateral painful breast distention.
Often associated with fever.
Occurs in the context of delivering a baby.

91
Q

How does breast engorgement present compared to lactational mastitis?

A

Breast Engorgement:
Bilateral, painful breast distention, often with fever.

Lactational Mastitis:
Unilateral breast erythema, warmth, fever, and pain, often with associated infection.

92
Q

What is the management of breast engorgement?

A

Frequent breastfeeding/pumping.
Supportive care: Cold compresses, analgesics.

93
Q

What is the management of lactational mastitis?

A

Antibiotics (e.g., dicloxacillin or cephalexin).

Continue breastfeeding or pumping to relieve milk stasis.

USMLE STEP 1, 2, 3 (45 decks)

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