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Women's Health > Week 8 The Breast > Flashcards

Week 8 The Breast Flashcards

1
Q

What nodes are accessible to palpation?

A 
midaxillary
supraclavicular 
lateral axillary (brachial)
subscapular
anterior axillary (pectoral)
subclavicular (infraclavicular)
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2
Q

What 3 tests are used to dianosis benign breast disorders?

A

Mammography
ultrasonography
biopsy

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3
Q

What does an US differentiates between ?

A

solid and cystic masses

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4
Q

Young women’s breasts are?

A

radiodense

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5
Q

What are s/s of Mastodynia (Mastalgia)?

A

common and cyclical breast tenderness or pain

swelling from edema and engorgement of the vasculature and ductal systems

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6
Q

What is the treatment options of Mastodynia (Mastalgia)?

A 
A. Reassurance
B. Acetaminophen NSAIDs 
C. Vitamin B6 
D. Bromocriptine
E. Tamoxifen 
F. Danazol
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7
Q

What is role of Vitamin B6 in Mastodynia (Mastalgia)?

A

can relieve breast pain in both cyclical and noncyclical mastalgia but is more effective in cyclical mastalgia by reducing the prevalence of severe pain

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8
Q

What is role of Bromocriptine in Mastodynia (Mastalgia)?

A

dopaminergic agonist inhibits the release of prolactin from the anterior pituitary.

Effective, but side effects of HA and dizziness severe.

Danazol preferred > bromocriptine

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9
Q

What is role of Tamoxifen in Mastodynia (Mastalgia)?

A

Low dose (10 mg) tamoxifen has been found to have a high response rate (90%) in patients with severe mastalgia.

Side-effects were relatively few in short term use.

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10
Q

What is role of Danazol in Mastodynia (Mastalgia)?

A

synthetic testosterone which binds to progesterone and androgen receptors; precise mechanism of action for treatment of mastalgia is unknown

Response rate has been reported as 70% in cyclical mastalgia and 31% in noncyclical mastalgia.

Don’t use with DVT hx; is potentially teratogenic and can interact with OCPs - need barrier contraception.

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11
Q

What is most common benign breast condition between the ages of 30 and 50?

A

Fibrocystic Disease

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12
Q

What is Fibrocystic Disease cause by and what is it associated with?

A

Due to exaggerated stromal response to hormones

Associated with a long follicular or luteal phase of the menstrual cycle

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13
Q

What does Fibrocystic Disease cause?

A 
cysts
papillomatosis
fibrosis
adenosis
ductal epithelial hyperplasia
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14
Q

What are the clinical manifestations Fibrocystic Disease?

A 
A. May be asymptomatic
B. breast swelling
pain, and tenderness.
C. May involve both breasts 
D. Are typically multiple, well demarcated, and mobile.
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15
Q

What condition has no axillary LN involement or nipple d/c?

A

Fibrocystic Disease

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16
Q

What is important to know in regards to lesions in Fibrocystic Disease?

A

Multiple lesions distinguish fibrocystic changes from carcinoma

Sizes vary through menstrual cycle.

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17
Q

What is the diagnosis of Fibrocystic Disease?

A

Biopsy for carcinoma

FNA is both diagnostic and therapeutic

Cysts usually contain straw-colored fluid

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18
Q

What is the treatment of Fibrocystic Disease?

A

supportive bra

Decrease nicotine and caffeine

low-salt diet
Vit E supplements
HCTZ prementrually

If symptoms are severe s/s => danazol

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19
Q

What is Mastitis?

A

Regional infection of the breast.

lactating women!!

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20
Q

What causes Mastitis?

A

patient’s skin flora or oral flora of infant

S. aureus

Organism enters through erosion or crack in the nipple.

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21
Q

What are the clinical manifestations of Mastitis?

A

fever
chills
malaise/flu-like sxs.

unilateral
tenderness
red
warm to the touch

one quadrant or a lobule of one breast

elevated WBC count

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22
Q

How is Mastitis diagnosed?

A

physical exam findings

23
Q

What is the treatment of Mastitis?

A 
A. PCN-resistant antibiotic 
dicloxacillin
nafcillin
OR 
cephalosporin
B. hot compress
24
Q

What is important for a new mother to know with Mastitis?

A

Patients should be instructed to continue to breast-feed or use a breast pump to prevent accumulation of infected material.

Source is likely the infant’s mouth

25
Q

What are the complications of Mastitis?

A

breast abscess
duct ectasia

May require surgical intervention

26
Q

What are many breast abscesses?

A

lactational

d/t S. aureus

27
Q

A breast abscess may develop in patients with?

A

acute mastitis

28
Q

Subareolar breast abscess is typically due to?

A

a mixed infection

anaerobes
staphylococci
streptococci

29
Q

What are the clinical manifestations of a breast abscess?

A

painful erythematosus mass

drainage through the skin or nipple duct

30
Q

What is the treatment of a Breast Abscess?

A

Incision and drainage required

r/o carcinoma

Antibiotics are needed

31
Q

What is treatment of Lactational abscess?

A

nafcillin
cefazolin
vancomycin

32
Q

What is the treatment of Subareolar abscess?

A

broad-spectrum antibiotics

33
Q

What is a complication of a subareolar abscess?

A

Fistula

34
Q

What is Galactorrhea?

A

Lactation or nipple discharge

not associated with childbearing

35
Q

What cause Galactorrhea?

A

Elevated levels of prolactin ->
milk production ->
a result of disruption of the communication between the pituitary and hypothalamus glands

36
Q

What are the clinical features of Galactorrhea?

A

random/bilateral/ multiductal serous or milky nipple discharge in the nonlactating breast

No mass

37
Q

How can you clue in on the involved duct in Galactorrhea?

A

may be identified by pressure at different sites around the nipple at the margin of the areola.

38
Q

The most common causes of pathologic nipple discharge are?

A

Intraductal papillomas

Carcinoma and fibrocystic change with ectasia of the ducts (less frequent)

39
Q

What are the clinical features of pathologic nipple discharge involved in Galactorrhea?

A

unilateral from a single duct, and can

serous, bloody, or serosanguinous

+/- mass

40
Q

What are the common causes of

Galactorrhea?

A 
CNS lesions 
Hypothalamic-pituitary disorders
Systemic diseases 
Medications and herbs 
Chest wall lesions
41
Q

What is involved with CNS lesions causing Galactorrhea?

A

Pituitary secreting tumors
empty sella
hypothalamic tumor
head trauma

42
Q

What is involved with Systemic diseases causing Galactorrhea?

A 
Chronic renal failure
sarcoidosis
Schüller-Christian disease
Cushing's disease 
hepatic cirrhosis
hypothyroidism
43
Q

What is involved with Chest wall lesions causing Galactorrhea?

A

Thoracotomy, herpes zoster

44
Q

What is diagnosis of Galactorrhea with normal physical examination, negative imaging, and the discharge is multiductal and nonbloody?

A

Pregnancy test
Prolactin levels
Renal and thyroid function tests
Endocrinology follow-up

45
Q

What is the diagnosis Galactorrhea with pathologic discharge?

A

Cytologic examination NOT helpful

mammography and/or US may reveal underlying abnormalities in the duct

ductography can be used to delineate an intraductal filling defect, which may be causing the nipple discharge.

46
Q

What is Fibroadenoma?

A

Benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit

47
Q

Second most common benign breast disorder?

A

Fibroadenoma

48
Q

Clinical manifestations od Fibroadenoma ?

A

smooth/well-circumscribed/rubbery/nontender, mobile/firm lesion

Usually bilateral; single or multiple

change during menstrual cycle or pregnancy.

1 to 5 cm

No axillary involvement or nipple discharge.

49
Q

What is the diagnosis of Fibroadenoma?

A

based on physical examination and biopsy results

50
Q

What is the treatment of Fibroadenoma?

A

If no FH of breast cancer and the patient is stable => followed clinically.

> 25 yo => biopsy

If suspicious for cancer => FNA

Large fibroadenoma => excisional biopsy

51
Q

Fibrocystic Changes

A 
20 to 49 
Usually bilateral 
Multiple or single 
Round 
Soft to firm; tense 
Mobile 
Absent retraction signs 
Usually tender 
Well delineated boarders
Varies with menses
52
Q

Fibroadenoma

A 
15 to 55 
Usually bilateral 
Single; may be multiple 
Round or discoid 
Firm, rubbery 
Mobile 
Absent retraction signs
Usually nontender 
Well delineated boarders
No variation with menses
53
Q

Cancer

A 
30 to 80 
Usually unilateral 
Single 
Irregular or stellate 
Hard, stonelike 
Fixed 
Often present retreaction signs 
Usually nontender 
Poorly delineated; irregular boarders
No variation with menses

Women's Health (8 decks)

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