PKM Breast Disease lecture - aa

Question 1

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?

Answer 1

Lactational mastitis

Tx 10-14 days of diclox, Augmentin with continued nursing

Question 2

When a nursing mother has mastitis, the baby should stop nursing.
T/F

Answer 2

FALSE. So false. Big false.

Question 3

What are three specifics you need to keep in mind about draining a breast abscess?

Answer 3

1. make a generous incision
2. make the incision below the nipple/in a dependent location to aid drainage
3. break up loculations with finger (or swab, come on)

Question 4

What comes out of a galactocele when you drain it?

Answer 4

Thick creamy/cheesy substance (milk with the fluid reabsorbed)

Question 5

If there is pain in the breast, it is less likely to be ____.

Answer 5

Cancer is rarely associated with pain.

Question 6

An eczematous area around the nipple, lasting more than one month and with discharge, should be biopsied because…?

Answer 6

Could be Paget disease of the breast, a rare cancer

Question 7

If a cyst is fluid only, there’s no risk for cancer.

T/F

Answer 7

True.

If solid component present (on ultrasound) –> concern for cancer, biopsy is warranted (rare)

Question 8

Who gets fibrocystic changes?

Answer 8

60% of premenopausal women

Question 9

What causes fibrocystic changes?

Answer 9

Normal but exaggerated response of breast tissue to female hormones and caffeine

Question 10

Fibrocystic changes cause no increase in breast cancer risk.

T/F

Answer 10

True.

Question 11

Well-defined, mobile, rubbery, possibly tender:

Well-defined, mobile, rubbery, painless:

Answer 11

tender: cyst
painless: fibroadenoma

Question 12

Name 3 features of benign nipple discharge.

Answer 12

~bilateral
~multiductal
~occurs with breast manipulation (have to work to get it out)

Question 13

Name 5 features of nipple discharge that would make you suspicious.

Answer 13

~spontaneous
~bloody or guaiac positive
~unilateral or uniductal
~with a mass
~woman over 40 years old

Question 14

What is the most common cause of pathologic nipple discharge?

Answer 14

a papilloma

Question 15

What is the USPSTF recommendation for mammography?

Answer 15

~The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
~insufficient evidence to recommend screening beyond age 75; or for CBE

Question 16

What is the ACOG recommendation for mammography?

Answer 16

~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)

Question 17

Ultrasound is an effective way to screen for breast cancer.

T/F

Answer 17

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).

Question 18

70-80% of invasive breast cancer is what?

Answer 18

infiltrating ductal carcinoma

Question 19

What is the pre-cancerous lesion of infiltrating ductal carcinoma?

Answer 19

DCIS

ductal carcinoma in situ

Question 20

Name 3 things you might evaluate after deciding on a diagnosis of breast cancer.

Answer 20

1. breast cancer receptor testing: estrogen receptors, progesterone receptors, HER2 receptors
2. TNM staging
3. bone scan if bone pain, abd CT if abd pain, chest CT if coughing/hemoptysis

Question 21

Your patient has a hx of total mastectomy. What was removed?

Answer 21

all breast tissue

Question 22

Your patient is scheduled for a modified radical mastectomy. What will be removed?

Answer 22

breast tissue and associated lymph nodes

Question 23

What are the USPSTF and ACOG statements regarding breast exams?

Answer 23

~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

Question 24

What is the early finding of breast cancer?

Later findings?

Answer 24

~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