PKM Breast Disease lecture - aa Flashcards
Your patient, who is a nursing mother, has a breast that is hard, red, tender, hot, and swollen. She has fever, myalgia, chills, malaise, and flulike sx. What is it and what is the treatment?
Lactational mastitis
Tx 10-14 days of diclox, Augmentin with continued nursing
When a nursing mother has mastitis, the baby should stop nursing.
T/F
FALSE. So false. Big false.
What are three specifics you need to keep in mind about draining a breast abscess?
- make a generous incision
- make the incision below the nipple/in a dependent location to aid drainage
- break up loculations with finger (or swab, come on)
What comes out of a galactocele when you drain it?
Thick creamy/cheesy substance (milk with the fluid reabsorbed)
If there is pain in the breast, it is less likely to be ____.
Cancer is rarely associated with pain.
An eczematous area around the nipple, lasting more than one month and with discharge, should be biopsied because…?
Could be Paget disease of the breast, a rare cancer
If a cyst is fluid only, there’s no risk for cancer.
T/F
True.
If solid component present (on ultrasound) –> concern for cancer, biopsy is warranted (rare)
Who gets fibrocystic changes?
60% of premenopausal women
What causes fibrocystic changes?
Normal but exaggerated response of breast tissue to female hormones and caffeine
Fibrocystic changes cause no increase in breast cancer risk.
T/F
True.
Well-defined, mobile, rubbery, possibly tender:
Well-defined, mobile, rubbery, painless:
tender: cyst
painless: fibroadenoma
Name 3 features of benign nipple discharge.
~bilateral
~multiductal
~occurs with breast manipulation (have to work to get it out)
Name 5 features of nipple discharge that would make you suspicious.
~spontaneous ~bloody or guaiac positive ~unilateral or uniductal ~with a mass ~woman over 40 years old
What is the most common cause of pathologic nipple discharge?
a papilloma
What is the USPSTF recommendation for mammography?
~The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
~insufficient evidence to recommend screening beyond age 75; or for CBE
What is the ACOG recommendation for mammography?
~Women aged 40 years and older should be offered screening mammography annually. (Level B)
~Clinical breast examination should be performed annually for women aged 40 years and older. (Level C)
~For women aged 20–39 years, clinical breast examinations are recommended every 1–3 years. (Level C)
Ultrasound is an effective way to screen for breast cancer.
T/F
False.
It is NOT used to screen for breast cancer. It is used after a suspicious mammogram to gather more information about the suspected lesion - to determine if it is solid or cystic, which can eliminate the need for a biopsy (if cystic).
70-80% of invasive breast cancer is what?
infiltrating ductal carcinoma
What is the pre-cancerous lesion of infiltrating ductal carcinoma?
DCIS
ductal carcinoma in situ
Name 3 things you might evaluate after deciding on a diagnosis of breast cancer.
- breast cancer receptor testing: estrogen receptors, progesterone receptors, HER2 receptors
- TNM staging
- bone scan if bone pain, abd CT if abd pain, chest CT if coughing/hemoptysis
Your patient has a hx of total mastectomy. What was removed?
all breast tissue
Your patient is scheduled for a modified radical mastectomy. What will be removed?
breast tissue and associated lymph nodes
What are the USPSTF and ACOG statements regarding breast exams?
~USPSTF: against breast self-exam; insufficient evidence for clinician breast exam (CBE)
~ACOG: annual CBE for women 40+; every 1-3 years for women 20-39
What is the early finding of breast cancer?
Later findings?
~early: single, nontender, firm/hard mass with ill-defined margins, or mammographic abnormalities with no palpable mass
~later: skin or nipple retraction, axillary lymphadenopathy, pain, redness, edema
