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Clin Med II - Exam 5 > Paulson - Disorders of the Breast and Lactation > Flashcards

Paulson - Disorders of the Breast and Lactation Flashcards

1
Q

found along the milk line

not dangerous

may increase w. hormonal changes in pregnancy

A

supernumerary nipple

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2
Q

milk line

A
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3
Q

enlargement/swelling of breast tissue that can be unilateral or bilateral

A

gynecomastia

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4
Q

gynecomastia is an indicator of increased __

A

estrogen

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5
Q

what 2 male pt populations are often affected by gynecomastia dt

A

males during puberty

elderly

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6
Q

why do elderly males experience gynecomastia

A

decreased testosterone

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7
Q

breast tenderness that is often cyclical dt hormonal changes

A

mastodynia (same-same mastalgia)

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8
Q

what patients often experience mastodynia/mastalgia

A

women taking OCPs/HRT

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9
Q

tx for mastodynia/mastalgia

A

reassurance

vit B6

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10
Q

what is this showing?

A

mastitis

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11
Q

mastitis is an __ of the breast,

often caused by __

A

infection

staph aureus

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12
Q

mastitis mc occurs in __

dt __

A

lactating women

poor latch/incomplete emptying

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13
Q

sx of mastitis

A

unilateral tenderness

heat

significant f/c

body aches

flu-like sx

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14
Q

mastitis is unilateral and affects __ of the breast

A

one quadrant/lobule

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15
Q

is culture of purulent milk/material commonly used for mastitis

A

no!

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16
Q

tx for mastitis

A

abx: dicloxacillin OR cephalosporin

warm compress

+/- surgery if abscess

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17
Q

can women breastfeed w. mastitis

A

yes!

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18
Q

painful swollen area of redness, tenderness, and induration (filled w. pus)

A

breast abscess

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19
Q

pt at risk for breast absess

A

lactating women

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20
Q

tx for breast abscess

A

I&D

abx → dicloxacillin

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21
Q

what type of breast abscess might you see in a non lactating woman

A

subareolar abscess

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22
Q

what do you think when you see refractory breast abscess

A

inflammatory breast ca

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23
Q

what sx might especially make you consider inflammatory breast ca in a pt w. a refractory breast abscess

A

axillary LAD

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24
Q

what is this showing

A

fat necrosis of the breast

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25
Q

what might you see on a hx with a pt that has fat necrosis of the breast (2)

A

trauma/surgery

beast bx, surgery, or xrt

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26
Q

fat necrosis of the breast is a __ condition,

but may look like __ on imaging,

and needs __ for definitive dx

A

benign

carcinoma

bx

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27
Q

do you need to treat fat necrosis of the breast

A

no! → excision not needed

no increased risk for breast ca

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28
Q

mc benign condition of the breast

A

fibrocystic breast changes

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29
Q

fibrocystic breast changes are usually __

and __,

and are related to __

A

bilateral

mobile

hormonal changes

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30
Q

what distinguishes fibrocystic breast changes from carcinoma

A

multiple lesions

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31
Q

pt’s w. fibrocystic breast changes may experience __ (2)

during __ (2)

A

cyclic pain, breast tenderness

premenstruation and menstruation

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32
Q

tx for fibrocystic breast changes

A

supportive bra

avoid caffeine, low fat diet, vitamin E, primrose oil

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33
Q

benign solid tumor containing glandular and fibrous tissue

A

fibroadenoma

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34
Q

2nd mc benign breast d.o

A

fibroadenoma

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35
Q

fibroadenoma is more common in what pt populations (2)

A

young women

AA women

36
Q

describe fibroadenomas

A

round/ovoid

firm

smooth

rubbery

discrete

mobile

non-tender

37
Q

management of fibroadenoma

A

core needle bx

OR

3-6 mo f.u w. repeat US/breast exam

+/- surgery or cryoablation

38
Q

fibrocystic changes may be __,

whereas fibroadenomas are typically __

A

painful

painless

39
Q

fibrocystic changes may need __ for dx,

fibroadenomas need __

A

needle aspiration

bx

40
Q

3 types of nipple discharge

A

normal lactation

galactorrhea

pathologic nipple discharge

41
Q

milky white discharge, usually bilateral that results from hyperprolactinemia

A

galactorrhea

42
Q

2 common causes of hyperprolactinemia

A

meds

tumor

43
Q

3 causes of pathologic nipple discharge

A

ectasia

intraductal papilloma

carcinoma

44
Q

describe pathologic nipple discharge

A

unilateral from single duct

serous vs bloody vs serosanguineous

purulent if abscess

45
Q

management of nipple discharge

A
  1. imaging
  2. refer
46
Q

imaging for pathologic nipple d.c (2)

A

mammography

US

47
Q

tx and dx for pathologic nipple d.c

A

surgical excision of involved duct

48
Q

genetic predisposition for breast ca

A

BRCA1

BRCA2

49
Q

rf for breast ca

A

increasing age

nulliparity

early menarche

late menopause

long-term estrogen or xrt

dealyed childbearing > 30 yo

first degree relative (esp > 1)

hx endometrial ca

50
Q

2 non invasive types of breast ca

A

ductal carcinoma in situ

lobular carcinoma in situ

51
Q

2 types of invasive breast ca

A

invasive ductal carcinoma

invasive lobular carcinoma

52
Q

80-85% of breast cancers are

A

invasive ductal carcinoma

53
Q

5 stages of ductal carcinoma

A

normal duct → ductal hyperplasia → atypical hyperplasia → DCIS → invasive ductal carcinoma

54
Q

very rare form of breast ca that presents w. eczematous or ulcerated lesion of the nipple that may be pruritic, burning, or painful

A

paget dz of breast

55
Q

what do you think when you see paget dz w. underlying palpable mass

A

invasive infiltrating ductal carcinoma

56
Q

what do you think when you see paget dz of breast w. no palpable mass

A

DCIS

OR

noninvasive breast ca

57
Q

management of paget dz of breast

A
  1. refer for full thickness bx and mastectomy
58
Q

lobular carcinoma is usually found __

A

incidentally

“l for lucky find”

59
Q

why do we care about lobular breast carcinoma

A

increased risk for breast ca

60
Q

management options for lobular carcinoma

A

excise

chemoprevention

refer

61
Q

mc location for breast cancer to occur

A

upper outer quadrant

62
Q

sx of invasive breast carcinoma (lots!)

A

fixed firm nodule

non-tender (can be painful)

dimpling of skin

nipple retraction

nipple d.c

breast size changes

peau d’ orange

eczematous changes

axillary node enlargement

arm edema

palpable suprclavicular/infraclavicular nodes

63
Q

what is this showing

A

peau d’ orange

64
Q

has research shown a clear benefit to clinical OR self breast exams for women getting mammograms

A

no!

65
Q

when should women get mammograms

A

annually starting at 40 yo

biennial (every other year) at 55 yo (or 50-74 yo)

66
Q

what pt population is most likely to avoid breast ca death dt screening mammographies

A

60-69 yo

67
Q

for high risk women, what is recommended annually in addition to mammogram starting at 30 yo

A

MRI

68
Q

indications for high risk for breast ca

A

known BRCA mutation

untested for BRCA but have 1st degree relative w. BRCA

greater than 15-20% lifetime risk based on fam hx using risk calculator

prior xrt to chest

69
Q

benefit of mammogram

A

early carcinoma may appear w. mammographic changes but no palpable mass

70
Q

best screening tool for breast carcinoma

A

mammogram

71
Q

dx for breast carcinoma

A

combo of:

PE

mammogram

US

fine needle or core needle bx

+/- excisional bx

+/- MRI, CT, CXR, bone scan, PET

72
Q

bx for breast carcinoma are tested for (3)

A

estrogen and progesterone receptor analysis

HER2/neu testing

histologic analysis

73
Q

what should occur before tx begins for breast carcinoma

A

staging

74
Q

preferred tx for early stage breast ca

A

lumpectomy w. sentinel node bx

75
Q

other tx options for breast ca

A

mastectomy

xrt

adjuvant chemo or HRT

palliative

76
Q

4 major prognostic factors for breast ca

A

tumor size

tumor grade

lymph node involvement/metastasis

age

77
Q

after tx for breast ca, pt’s should be monitored q __ for the first 2 years

and __ after

A

6 months

annually

78
Q

what do you think when you see painless lump beneath the areola in a man > 50 yo

A

male breast ca

79
Q

male breast ca is rare, but is associated with __ than female breast ca

A

poorer prognosis

80
Q

which genetic mutation is common in male breast ca

A

BRCA 2

81
Q

t/f: breastfed infants have reduced incidence of SIDS

A

T!

82
Q

growth of the breast, increased fat deposition, and branching of the ductal system during pregnancy leads to what hormonal changes

A

estrogen

prolactin

GH

adrenal glucocorticoid

insulin

83
Q

the letdown reflex is associated w. what 2 hormones

A

prolactin

oxytocin

84
Q

prolactin is released by the __,

oxytocin is released by the __

A

prolactin: anterior pituitary
oxytocin: posterior pituitary

85
Q

prolactin is stimulated by __

and promotes __

A

nipple signals to hypothalamus

milk and colostrum production/secretion

86
Q

oxytocin is stimulated by __

and promotes __

A

suckling/crying

milk letdown from mammary gland

Clin Med II - Exam 5 (23 decks)

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