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obstetric - gynecol STEP 2 > breast > Flashcards

breast Flashcards

1
Q

Gynecomastia - ages?

A
  1. newborn
  2. pubertal (but may perists after puberty
  3. elderly males
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2
Q

causes of pathologic gynecomastia

A
  1. cirrhosis
  2. hypogonadism (eg. Klinefelter)
  3. testicular tumors
  4. drugs
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3
Q

drugs that causes gynecomastia

A
  1. spironolactone
  2. Hormones
  3. cimetidine
  4. Ketoconazole
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4
Q

Benign breast disease - DDX

A
  1. breast cyst –> solitary, well circumscribed, mobile mass, +/- tenderness
  2. Fibrocystic changes: multiple, diffuse nodulocystic masses, cyclic premenstrual tenderness
  3. fibroadenoma: solitary, well circumscribed mobile mass, cuclic premensrual tenderness
  4. Fat necrosis: post-trauma/surgey, firm irregular mass +/- ecchymosis, skn/nipple retraction
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5
Q

Fat necrosis - definition/presentation

A

Benign, usually painless, lump due to injury to breast tissue
Up to 50% patients may not report trauma
calcification on mammo

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6
Q

Fibroadenoma - epidemology/presentationsituations

A

MC under 35. Small, well-defined marble-like, mobile mass

increased size with estrogen (pregn, prior to menstr)

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7
Q

Fibrocystic changes - epidemiology/cancer

A

MC in premenopausal over 35

no risk for cancer

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8
Q

Fibrocystic changes - presentation

A

premenstrural breast pain or lumps, often bilateral or multifocal

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9
Q

Palpable breast mass - algorithm

A

A: younger than 30: U/S +/- mammo:
- simple cyst –> aspiration if patient desires
- complex cyst or sold mass –> image-guide core biop
B: 30 or older –> Mammo +/- U/S
- suspicious for malignancy –> core biopsy

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10
Q

MCC of physiologic galactorrhea

A

hyperprolactinemia

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11
Q

Common problems related to lactation (which of them have fever)

A
  1. engorgement
  2. nipple injury
  3. plugged duct
  4. galactocele
  5. mastitis - fever
  6. abscess - fever
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12
Q

breast engorgement?

A

BILATERAL symmetric fullness, tenderness + warmth
common 3-5 days after delivery when colostrum is replaced by milk (or after abrupt stopping of lactation)
production exceeds the release
treatment: NSAID, year supportive bra, avoid nipple stimulation and manipulation, ice packs

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13
Q

plugged duct?

A

focal tenderness + firmness + or erythema, no fever

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14
Q

galactocele?

A

subareolar, mobile, well-circumscribed, nontender mass, no fever

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15
Q

mastitis vs abscess in breast

A

mastitis: tenderness/erythema + fever

abscess all above + FLUCTUANT MASS

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16
Q

Lactational mastitis - clinical presentation

A

ever
firm red tender, swoellen quardrant of unilateral breast
+/- myalgia, cholld malaise

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17
Q

Lactational mastitis - treatment

A

analgesia
frequent breastfeeding or pumping
antibiotcs

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18
Q

Lactational mastitis - RF

A 
history of mastitis
engorgement + inadequate milk drainage due to 
- sudden increase in sleep duration
replacing nurcsing with formula
weaning
presure on the duct (prone sleeping, tight clothing
cracked or clogged nippl e pore
poor latch
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19
Q

Lactational mastitis - pathogenesis

A

skin flora (S. aureus) enters duct nipple + multiplies in stagnat milk

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20
Q

Phyllodes tumor - definiton/appearance / cancer?

A

large mass of connective tissue and cysts with leaf-like lobulations (AT STROMA)
- some may becoma malignant

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21
Q

Phyllodes tumor - age

A

MC in 5th decade (postmenopausal)

22
Q

Periductal mastitis - definition/epidemiology

A
  • inflammation of subareolar ducts
  • in smokers (low vit A –> epithelial become squamous
  • -> keratin –> plag –> inflammation behind –> granoulation tissue –> retraction
23
Q

Periductal mastitis - presentation

A

subareolar mass with nipple retraction

24
Q

Sclerosing adenosis? / cancer?

A

increased number of the acini and their glandsi and stromal fibrosis –> associated with calcification
- 1.5-2x increased risk

25
Q

Mammary duct ectasia - definition/epidemiolgy/presentation

A
  • inflammation with dilation (ectasia) of subareola ducts
  • multiparous postmenopauseal
  • -> green brown nipple discharge
26
Q

Mammary duct ectasia - biopsy

A

chronic inflammation with plasma cells

27
Q

benign breast conditions - cancer?

A
  1. Fibroadenoma - no
  2. fibrocystic changes - no
  3. sclerosing adenonis - 1.5-2 x cancer
  4. Intraductal papilloma –> 1.5-2 x cancer
  5. epithelial hyperplasia –> x5 if atypical, x2 if not atypical
  6. Phylloid tumor –> some may become malignant
  7. Fat necoris
  8. Lacational mastitis
  9. Gynecomastia
  10. Periductal mastitis
  11. Mammary duct ectasia
28
Q

evaluation of nipple discharge

A
  • unilateral or bloody or serous –> breast U/S or mammo if older than 30
  • if bilateral, milky, nonbloody –> palpable lump or skin changes?
    yes: U/S or mammo
    no: pregnancy test, Guaiac test, prolactin, TSH, consider MRI of pituitary
29
Q

breast Ca RF

A

modifiable: Hormones, nulliparity, increased age at first live birth, alcohol
non-modifiable: mutation or breast ca in 1st degree relatives, white, age, early menarche or later menopause

30
Q

Ductal carcinoma in situ of breast - presentation

A
  • often seen early as MICROCALCIFICATIONS in mammography

- usually does not produce mass

31
Q

when to check somebody for BRCA

A

breast Ca under 50

ovarian ca in any age

32
Q

alcohol - breast ca

A

dose dependent

33
Q

breast abscess - treatment

A

needle aspiration + antibiotics

34
Q

different methods of biopsy in breast cancer (only names)

A
  1. fine needle aspiration
  2. core needle biopsy
  3. open biopsy
35
Q

breast cancer - best initial biopsy / characteristics

A

FNA

- FP rate less than 2%, but because is small sample, FN rate of 10%

36
Q

breast cancer - core needle biopsy characteristics

A

larger sample, MORE DEFORMING but you can test for estrogen, progesterone and HER 2/neu receptors.
difficulties include greater deformity and possibility that the needle will miss the lesion

37
Q

breast cancer - the most accurate biopsy / characteristics

A

open
allows for frozen section to be done while the patient is in the operating room followed by immediate resection of cancer followed by sentinel node

38
Q

If a breast biopsy is going to be performed, what is the point in doing a screening test like mammography

A

5-10% of patients have bilateral disease. In addition, there is huge difference in the management of the patient if there is a single or multiple lesions within the same breast

39
Q

breast cancer - indications for PET

A

to determine the content of abnormal lymph nodes or masses that are not easily accessible to biopsy

40
Q

breast cancer - surgery

A

lumpectomy with radiation is equal in efficacy to modified radical mastectomy but much less deforming

41
Q

modified radical mastectomy

A

mastectomy (removal of the nipple, areola, and breast tissue) as well as removing the majority of lymph nodes from under the arm, referred to as an axillary lymph node dissection (no muscles are removed and only lymph nodes I and II are removed not the III vs radical

42
Q

breast cancer - radiation after lumpectomy

A

indispensable in preventing recurrences at the breast

43
Q

breast cancer - contraindication for lumpectomy

A

multifocal cancer or contraindication of radiation

44
Q

breast cancer - when Radical mastectomy

A

NEVER

45
Q

aromatase inhibitors vs tamoxifn

A

slightly superior in efficacy (BETTER –> if both arematase inh are the answer for the most likely to benefit)
aromatase inhibitors are generally for postmenopausal and tamoxifen in premenopausal

46
Q

hallmark features of inflammatory carcinoma

A

breast erythema, warm, pain and edema

47
Q

situations with calcification in mammography

A
  1. Ductal in situ and invasive
  2. sclerosing adenosis
  3. fat necrosis
48
Q

intraductal papilloma - clinical features

A

unilateral bloody nipple discharge
no mass or lymphadenopathy
nothing in mammo

49
Q

intraductal papilloma - management

A

mammography + U/S

- biopsy +/- excision

50
Q

MCC of nipple discharge (serous or body)

A

Intraductal papilloma

obstetric - gynecol STEP 2 (22 decks)

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