Womens

Question 1

Is Flucloxacillin a safe antibiotic when breastfeeding?

Answer 1

Yes

Question 2

Define Phyllodes tumour?

How are you able to distinguish this from a fibroadenoma?

Answer 2

Breast cancer originating from fibroepithelial tissue. Commonly present as a smooth, hard, mobile breast mass which can grow rapidly in size over a period of weeks or months. Advanced stages -ulceration of the breast may be present. Rarely Metastasise

Usually found in womens in their 40s or 50s. Histological analysis will be required to determine whether this is a benign or malignant tumour.
Mammography - Appears as round breat lesion with well-defined edges.

Fibroadenomas, tend to appear in younger women. Not as fast-growing.

Question 3

Breast Abscess

Presentation?
Risk Factors?

Answer 3

Palpable breast lump, fluctuant/growing in size.

HPC - Recent Hx of mastitis with fever, malaise and a painful, erythematous breast.

RF - Postpartum, breastfeeding women as well as smokers

Question 4

Puerperal Mastitis?

Explain

Answer 4

inflammation of the breast (mastitis) is associated with lactation in postpartum women.

Diagnosis is clinically w/ following symptoms:
Painful, tender, red and hot breast.

Systemic symptoms - Fever, rigors, myalgia, fatigue, nausea and headache

Normally unilateral and presents 1 week post-partum.
Some cases there may be development of a breast abscess which presents as a fluctuant, tender mass with overlying erythema.

Question 5

When do you prescribe antibiotics for mastitis?

Answer 5

Should prescribe an oral abx if the woman has a nipple fissure that is infected, symptoms have not improved (or are worsening) after 12–24 hours despite effective milk removal, and/or breast milk culture is positive.

IV abx if patient becomes systemically unwell an abscess is suspected and patient fails to improve after oral abx.

Question 6

Mastitis 2nd Milk stasis

Management?

Answer 6

Conservative management
Simple analgesia, effective milk removal (expression, starting with affected side
Gentle massage to encourage milk flow
Referral to a health visitor for assistance with optimising feeds

Question 7

Which patients require urgent referral for breast lumps?

Answer 7

Any patient aged 30 or over with an unexplained breast lump or aged 50 or over with unilateral nipple changes should be urgently referred (appointment within 2 weeks) for further assessment.

Question 8

Reddening and thickening of nipple + areola?

What condition do you want to rule out?

Answer 8

Paget’s disease of the nipple

Will need urgent referral to breast clinic

Question 9

Paget’s Disease of Nipple

Define
Investigation
Clinical presentation

Answer 9

Eczematoid change of the nipple associated with underlying breast malignancy.

Presentation
Redding and thickening of nipple + Areola
Involves the nipple primarily and only latterly spreads to the areolar.

Investigations
USS of breast
Mammography
Punch biopsy