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Breast Flashcards

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1
Q

characteristics of referred mastalgia

A
  • Exacerbated by exercise
  • Unilateral
  • Chest wall tenderness
  • Pain is very lateral/ medial in the breast
  • Can be reproduced by pressure in area of chest wall
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2
Q

treatment of referred mastalgia

A
  • Reassurance
  • Topical NSAIDS
  • Last resort steroids or local anesthetic
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3
Q

characteristics of true breast pain

A
  • Worse before onset of menstruation

- Exacerbated by hormones

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4
Q

treatment of true breast pain

A
  • Reassurance
  • Well fitted bra
  • Low fat diet (increased hormones)
  • Tamoxifen
  • Mammogram
  • USS for any women with focal breast pain
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5
Q

possible causes of referred breast pain

A
  • Intercostobrachial nerve to inner aspect of arm
  • T3-T5 nerve irritation
Chronic Breast Pain from Surgery:
Neuropathic pain from scar tissue, intercostobrachial neuralgia 
-	Gabapentin
-	Amitriptyline 
-	Pregabalin 
-	Electrical current
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6
Q

theories for true breast pain

A
  • Too much estrogen/ prolactin
  • Not enough progesterone
  • Increased receptor sensitivity in breast tissue/ abnormal fatty acids
    (more sensitive to effects of estrogen)
  • High caffeine intake? (overstimulation of breast cells by methylxathines)
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7
Q

stages of breast life

A

development
cyclical activity
involution

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8
Q

what is ANDI

A

aberration of normal development and involution

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9
Q

normal breast development

A
  • Breast tissue is identical until puberty in males and females
  • Growth begins at 10
  • Initially asymmetrical
  • No biopsy at young age damage to breast bud
  • Lobules and ducts and glandular tissue are supported by fibrous tissue and stroma
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10
Q

aberration in breast development stage

A

Juvenile hypertrophy

Fibroadenoma

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11
Q

cyclical activity

A
  • Normal hormonal changes cause localized benign nodularity
  • Common reason for referral as ‘lump’
  • Peak age 30-40
  • Old terms: fibroadenosis/ fibrocystic disease
  • Pregnancy results in doubling of breast mass
  • Breast involutes after pregnancy
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12
Q

involution

A

Breast stroma is replaced by fat so breast is less radiodense, softer and more droopy

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13
Q

Fibroadenoma

  • what type of abberation
  • clinical features
A

developmental

highly mobile
rubber lump

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14
Q

management of a patient with fibroadenoma who is <25

A

discharge

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15
Q

management of a patient with fibroadenoma who is 25-35

A

core biopsy and discharge if biopsy is benign

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16
Q

management of a patient with fibroadenoma who is 35

A

core biopsy and excise

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17
Q

what must you be precautious about with fibroadenomas

A

phyllodes tumour: Tumor of stroma, epithelium lining cells of glands in breast- can be malignant

  • Histology
  • Rapid growth
  • > 3cm
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18
Q

juvenile hypertrophy management

A

investigations only needed if there is sexual maturation

breast reduction if it causes pain and discomfort

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19
Q

lobular cyst

  • what type of aberration
  • clinical features
A

involution

smooth, discrete lump

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20
Q

management of lobular cyst

A

aspirate FNA

send fluid for cytology if theres blood or residual lump

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21
Q

what is duct ectasia

A

dilated shortened ducts in involution that become blocked

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22
Q

clinical features of duct ectasia

A

nipple discharge and inversion

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23
Q

management if duct ectasia

A

reassurance

surgery only if symptomatic discharge or want the nippled everted

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24
Q

nipple inversion vs retraction

A

inversion is benign and reversible

retraction is malignant and irreversible and asymmetrical

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25
fluid distribution in the body
1/3 extracellular | 2/3 intracellular
26
what consists of extracellular fluid
transcellular, interstitial and plasma
27
characteristics of water movement in the body
osmosis- water moves from areas of high water concentration to low water concentration areas
28
characteristics of water movement in the body
osmosis- water moves from areas of high water concentration to low water concentration areas through a semipermaeble membrane equalizing solute concentrations on either side of the membrane
29
types of passive diffusion
simple and facilitated
30
average total body water
42L
31
Osmolality
Osmolar concentration of a solution when it is expressed as osmoles/ kg of water o Number of osmotically active partilces per kg of solvent
32
Osmolarity
Osmolarity: osmolar concentration of a solution expressed as osmoles/ L of water o Number of osmotically active particles per litre of solution
33
Osmotic Gradient
difference in osmolarity of two solutions on either side of a semi permeable membrane
34
what are the three types of fluids
hypertonic, hypotonic and isotonic
35
Hypertonic fluid
water moves out of the cell
36
hypotonic fluid
water moves into the cells
37
isotonic
no movement of water
38
blood colloid osmotic pressure/ oncotic pressure
osmotic pressure exerted by proteins in the blood vessel plasma (usually pulls water into vessels)
39
filteration action and why
Fluid exits capillaries Capillary hydrostatic pressure is greater than blood colloid pressure osmotic
40
what are the two pressures that determine which way substances move in the body
hydrostatic pressure blood colloid osmotic pressure
41
no net movement action and why
No movement Cap hydrostatic pressure = blood colloid pressure
42
reabsorption action and why
Fluid re-enters capillary Capillary hydrostatic pressure is less than blood colloid odmotic pressure
43
main hormone in fluid balance
ADH
44
organs involved in fluid balance
o Kidneys o Heart o Hypothalamus o Pituitary gland
45
what happens when there is a high Na concentration in the blood (ADH)
osmoreceptors pick up high Na, posterior pituitary releases ADH, targets cells in collecting duct to reabsorb water
46
outcome of ADH
reduces osmolarity, increases plasma volume and decreases urine output
47
fluid balance vs fluid status
fluid balance: fluid in vs. out bal
48
fluid balance vs fluid status
fluid balance: fluid in vs. out status: how hydrated you are in a certain point in time
49
fluid input sources
``` oOral fluids oIV fluids oIV medication fluid oIV flushes for cannula oEnteral/ Parenteral feed ```
50
fluid output sources
oUrine output - Urine appearance (urine darkens with time so not always accurate if youre checking their catheter bag) oDrains, stomas, NG tubes oFaeces oSerial weights oInsensible losses (sweat etc- can loose upto 600ml in good health)
51
assessment of fluid status
History Examination Lab results Put in vs. out (fluid balance charts
52
what is normal urine output
- 0.5ml/kg/hr | - Roughly 30-35ml/hr
53
anuria
less than 100ml urine a day
54
oligouria
less than 400ml urine per day
55
3 reasons we give fluids
- Resuscitation - Routine maintenance - Replacement- replace increased losses
56
causes of dehydration
output of fluid is greater than input o Not taking in enough fluids (unable to tolerate oral fluids) o Loosing too much fluid - Stomas - Diaherria - Insensible losses like sweating with fever
57
symptoms of dehydration
o Feeling thirsty o Confusion o Headache o Dizziness
58
signs of dehydration
``` o Sunken eyes o Sunken fontanelles in babies o Skin mottling o Dry skin o Delayed cap refill o Skin turgor o Tachycardia o Hypotension o Pyrexia o Orthostatic hypotension ```
59
complications of dehydration
``` o Acute Kidney Injury o Confusion o Falls o Skin Wounds o Infection o DVT ```
60
causes of fluid overload
Fluid overload occurs when fluid input exceeds fluid output o Blood products o Too much fluid given
61
symptoms of fluid overload
shortness of breath
62
signs of fluid overload
``` o Increased JVP o Peripheral edema legs o Crackles at lung bases o Increased weight o Ascites ```
63
complications of fluid overload
o Cardiac dysfunction (heart failure) o Respiratory dysfunction (pulmonary edema) o Multi-organ dysfunction

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