Women's Health

Question 1

What are the main considerations on history for breast pain?

Answer 1

• cyclical, ie: related to menses
• both or one
• diffuse or local
• Age
• infective symptoms
• past history of breast cancer/family hx
• lump felt
• exclude IHD symptoms

Question 2

What are the most likely and must not be missed diagnoses of breast pain?

Answer 2

Likely: pregnancy, cyclical (benign mammary dysplasia), cracked nipple
Must not bed missed: IHD, breast cancer - mastitis carcinomatosis, mastitis

Question 3

What features on hx would make you consider candida mastitis?

Answer 3

• recent abx course
• hot, burning, stabbing pain on breast feeding
• white nipple d/c

Question 4

What investigations would you consider for breast pain?

Answer 4

-USS age<40
-mammogram age >40
maybe USS FNA if lump found
ECG and CXR
FBC infection

Question 5

What is your management for mastitis?

Answer 5

Continue breast feeding/expressing mil
simple analgesia regularly
abx - fluclox, cephlex (10 days), IV if severe
antifungal - 200-400mg daily for 2-4 weeks or nystatin TDS
attend to engorgement/cracked nipples topically