04b: The Breast

Question 1

T/F: Progesterone plays role in pubertal breast development.

Answer 1

True, but only AFTER menses

Question 2

List the hormones that play role in pubertal breast development

Answer 2

1. Estrogen, progesterone
2. GH
3. Prolactin
4. Adrenal steroids
5. Insulin

Question 3

Early pregnancy: (X) hormone(s) causes (Y) changes in breast tissue.

Answer 3

X = beta-hCG
Y = alveolar development

Question 4

Late pregnancy: (X) hormone(s) causes (Y) changes in breast tissue.

Answer 4

X = prolactin, E, P, GH, glucocorticoids, insulin
Y = secretory differentiation (increase number of glands)

Question 5

Colostrum synthesis/accumulation begins in (early/late) pregnancy. What are the components of colostrum?

Answer 5

Late (secretory differentiation);

Lactose, milk proteins (casein, whey, a-lactalbumin), IgG, IgA

Question 6

Maternal benefits to breastfeeding: decreased risk for which disease(s)?

Answer 6

Breast and ovarian cancer and DM II

Question 7

Lactation is regulated by (nervous/endocrine) system.

Answer 7

Both!

Question 8

Lactation: Suckling triggers (X) which stimulates (Y).

Answer 8

X = 4-6th intercostal n (signal travels up SC)
Y = anterior pit (prolactin secretion) and post pit (oxytocin secretion)

Question 9

List some short-term maternal benefits of breastfeeding.

Answer 9

1. Decrease post-partum blood loss
2. Weight loss
3. Prolongs post-partum anovulation (high prolactin)

Question 10

Direct benefits of breastfeeding on infant.

Answer 10

Decreased risk of illness (diarrhea, U/LRT infections, otitis media, UTIs)

Question 11

Long-term benefits of breastfeeding on infant.

Answer 11

Decreases risk of:

Acute illnesses, obesity, allergies, GI infections, leukemia, DM I

Question 12

Recommended length of breastfeeding.

Answer 12

At least 6 mo exclusively; then up to 1 year afterwards non-exclusively

Question 13

T/F: HIV positive mothers cannot breastfeed unless they are on antiretroviral meds.

Answer 13

False - can’t breast feed, even if on meds

Question 14

29 yo 2-day postpartum woman presents with swollen, lumpy, tender breasts. She reports that she has been breastfeeding her newborn. What is the likely cause?

Answer 14

Engorgement (baby isn’t latching adequately; edema and accumulated milk)

Question 15

29 yo postpartum woman presents with swollen, lumpy, tender breasts. She reports that she has been breastfeeding her 7 month-old child. What is the likely cause?

Answer 15

Engorgement (likely due to weaning kid off breastmilk and producing more than he/she needs)

Question 16

Breastfeeding: Rx for engorgement

Answer 16

Empty breasts (more feeding/pumping) and cool/warm compress

Question 17

29 yo postpartum woman presents with swollen, erythematous, tender R breast and fever of 102o. She reports that she has been breastfeeding her 3 month-old child. What is the likely cause?

Answer 17

Mastitis (due to abrasion/cut from breastfeeding)

Question 18

Most common organisms that cause mastitis:

Answer 18

1. S. aureus
2. Strep
3. E. coli

Question 19

Mastitis Rx:

Answer 19

1. Antibiotics (dicloxicillin, keflex, clindamycin)
2. NSAIDs
3. Keep breast feeding to empty breast

Question 20

1% of breastfeeding women may develop (X) complication from mastitis. What’s the Rx?

Answer 20

X = abscess

Serial drainage with GS/culture, along with antibiotics

Question 21

T/F: Non-proliferative breast lesions do not increase risk for breast cancer.

Answer 21

True

Question 22

T/F: Proliferative breast lesions without atypia do not increase risk for breast cancer.

Answer 22

False - some may

Question 23

Which imaging modalities would you use to evaluate breast lump in 25 yo woman?

Answer 23

Ultrasound (if between ages 21-30);

Note: Add mammogram if patient over age of 30

Question 24

Breast imaging rating: BIRADS (X) for lump that’s highly suggestive of malignancy. Next step is (Y).

Answer 24

X = 5
Y = biopsy

Question 25

Breast imaging rating: BIRADS (X) for lump that's benign. Next step is (Y).

Answer 25

``` X = 2 Y = annual follow-up ```

Question 26

Breast imaging rating: lump is BIRADS 3. What's the next step?

Answer 26

Probably benign, but short interval (6 mo) repeat imaging recommended

Question 27

Breast imaging rating: lump is BIRADS 4. What's the next step?

Answer 27

Suspicious abnormality; | Biopsy should be considered

Question 28

Pt with proven breast malignancy undergoes imaging to stage/evaluate cancer after round of chemo. She would be placed in BIRADS (X).

Answer 28

X = 6

Question 29

Nipple discharge: which characteristics make it concerning for cancer?

Answer 29

1. Bloody/purulent 2. Unilateral 3. Spontaneous 4. Breast mass 5. Woman over 40

Question 30

Pt presents with L nipple discharge. On ultrasound, you see fluid-filled duct with extensions/growths extending into lumen. Likely diagnosis is (X) and Rx is (Y).

Answer 30

``` X = intraductal papilloma (common cause of unilateral nipple discharge) Y = excision ```

Question 31

T/F: Intraductal papilloma is cancer.

Answer 31

F - but increases risk of cancer

Question 32

What are some peripheral causes of galactorrhea?

Answer 32

Nerve stimulation! 1. Shingles (activating 4-6th intercostal nerve) 2. Poorly fitting bra 3. Nipple stimulation

Question 33

T/F: One risk of mammography is radiation exposure.

Answer 33

False - very low dose that does not increase risk of cancer

Question 34

Rx GOALS of premature ovarian failure includes:

Answer 34

1. Psychosocial support 2. Prevent osteoporosis (HRT, Ca, vit D, exercise) 3. Yearly screening for endocrine abnormalities (hypothyroid, adrenal insuff) 4. Contraception to prevent spontaneous conception 5. Fertility (IVF)

Question 35

Physiology of menopause: what's the first step?

Answer 35

Follicular depletion in ovary

Question 36

Menopause: follicular depletion causes (rise/fall) in (X) levels, which causes (rise/fall) in (Y) levels.

Answer 36

Fall X = inhibin B Rise Y = FSH (fluctuates)

Question 37

Best Rx hot-flashes/vasomotor Sx in peri-menopausal woman.

Answer 37

Estrogen (short duration, low dose; give with progestin if uterus present)

Question 38

T/F: Female sexual dysfunction is more common with increased age (ex: 65 y or older).

Answer 38

False - more common in 45-64 yo women (likely due to menopause)

Question 39

List the four forms/complaints that can cause F sex dysfunction.

Answer 39

1. Lack of sex desire 2. Impaired arousal 3. Inability to orgasm 4. Pain

Question 40

T/F: Lab evaluation is not useful to F sex dysfunction.

Answer 40

True

Question 41

First FDA-approved drug for F sex dysfunction:

Answer 41

Flibanserin

Question 42

Flibanserin MOA and side effects.

Answer 42

Unknown (maybe impacting DA and SA neurotransmitters?) Hypotension, syncope

Question 43

T/F: Flibanserin has been shown to be effective in up to 60% of women.

Answer 43

False - only 10%

Question 44

When prescribing your 50 yo F patient Flibanserin, it's important that she takes it every (X) hours for (Y) weeks before it takes effect. She should also avoid (Z).

Answer 44

``` X = 24y (daily) Y = 4-8 Z = alcohol ```