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Year 3 Conditions > Breast > Flashcards

Breast Flashcards

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1
Q

What are 4 most common diagnoses for a breast lump

A

Benign cystic change
Fibroadenoma
Cyst
Carcinoma

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2
Q

Most common breast lumps in under 30s

A 
Physiologically normal lumpy breast
Benign cystic change
Fibroadenoma
Abscess
Galactocele if breast feeding
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3
Q

Most common breast lumps 30-45s

A

Benign cystic changes
Cyst
Abscess
Carcinoma

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4
Q

Most common breast lump in 45-60

A

Cyst
Abscess
Carcinoma

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5
Q

Who are breast abscesses especially prevelant in

A

Smokers

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6
Q

In what ages do fibroadenomas occur

A

Teenagers to mid 30s mainly

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7
Q

In what ages do breast cysts occur

A

Any age but peak at 55

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8
Q

What breast lump do you get after cessation of lactation

A

Galactocele

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9
Q

Where do galactoceles tend to appear on breasts

A

Subareolar

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10
Q

How do galactoceles form

A

Caused by obstruction in duct which leads to build up of milk and epithelial cells

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11
Q

How can galactoceles become complicated

A

Secondary abscess

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12
Q

What do galactoceles appear like

A

Cysts

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13
Q

What is mastitis

A

Superficial infection of breast by commensal staph aureus and staph epididermis

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14
Q

What is periductal mastitis

A

Inflammation of periductal ducts under the skin

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15
Q

Who is at risk of mastitis

A

Breast feeding

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16
Q

Difference in infective cause mastitis vs periductal mastitis

A

Periductal will include anaerobic bacteria

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17
Q

What are main risk factors for breast cancer

A 
Previous breast cancer
Family history of breast cancer
Any previous endometrial cancer, bowel or ovarian
Irradiation to chest wall
Increased exposure to oestrogens
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18
Q

Risk factors where get increased exposure to oestrogen

A 
Early menarche
Late menarche
Having first child after 30
Not breast feeding
HRT
COCP
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19
Q

Difference in onset of breast lumps

A

Abscess or cyst rapid

Fibroadenoma or cancer insidious

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20
Q

What would trauma or iatrogenic to breast suggest

A

Abscess or fat necrosis

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21
Q

What does breast lump that changes shape or size cyclically suggest

A

Benign cystic change

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22
Q

Which breast lumps tend to be more painful

A

Abscess
Benign cystic changes
Acute mastitis
Carcinoma rarely painful

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23
Q

Tender breast lumps

A

Abscess
Benign cystic changes
Acute mastitis
Potentially a cyst

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24
Q

What does warm skin above lump suggest

A

Inflammatory or infection
Mastitis
Abscess

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25
What is peau d'orange
Skin resembling an orange where looks like holes in skin
26
What is peau d'orange indicative of
Cancer
27
What does change in nipple appearance suggest
Cancer
28
What does milky discharge with lump suggest
Galactocele
29
What does green or yellow discharge suggest about breast lump
Preductal mastitis
30
What does bloody discharge from nipple suggest
Cancer
31
What does serous discharge from nipple suggest
Intraductal papilloma
32
What is intraductal papilloma
Benign lump that grows inside ducts close to nipple
33
What does recent distortion of nipple suggest
Cancer
34
Do breast cancer tend to present with b sx
No
35
What other symptoms should you ask about in breast lumps
Back pain or any other common met site
36
What to look for in inspection of breasts on examination
``` Asymmetry Contours Skin changes Nipple changes or discharge Radiotherapy tattoos ```
37
What radiation is particularly relevant for breast cancer
Mantle radiotherapy seen in Hodgkins lymphoma
38
What does highly mobile breast lump suggest
Fibroadenoma
39
What does solitary cyst feel like
Smooth Distinct borders Firm to lax
40
What does fibroadenoma feel like
Smooth distinct borders Rubbery
41
What lumps are very mobile
Fibroadenomas
42
What does cancer lump feel like in breast
Irregular Indistinct Hard
43
What does fixation to skin always suggest
Cancer
44
What assessments must be done if breast lump pt presents
Full examination Imaging depending on age FNA or core biopsy
45
How does age affect imaging of breast
Under 35 do US | Over do mammogram
46
Why cant mammograms be done on under 35s
Breast tissue too thick
47
Treatment options for fibroadenoma
Harmless so ideally watchful waiting | Excision
48
What are indications for removal of fibroadenoma
Patient choice Growing in size Beginning to cause discomfort
49
What does term breast mouse refer to
Fibroadenomas
50
4 most common sites of breast mets
Liver Bone Lung Brain
51
What breast mets are always investigated regardless of clinical signs and how are they investigated
Liver- CT | Bone- bone scintilligraphy, calcium ALP etc can be good adjunct
52
Which breast mets are sometimes only investigated based on clinical presentation
Brain | Lungs
53
What are the majority of breast cancers
Infiltrating duct carcinoma
54
What are some local treatment options for breast cancer
Surgery | Radiotherapy
55
What treatment is always given to ladies whos tumours are ER positive
Hormonal 80% are ER positive which means that mutation on ER leads to growth of these lobule cells themselves whereas they should just act as beacon
56
How to differentiate between lobular and medullary breast cancer histologically
Lobular – the tumour has some resemblance of the architecture of the gland (there are tubules of some form) Medullary – the tumour cells don’t look anything like the epithelial cells from the mammary gland
57
Systemic treatments for breast cancer
Hormonal therapy Chemotherapy Monoclonal antibodies
58
Examples of hormonal therapy for breast cancer
Aromatase inhibitors | ER blockers
59
What is ER blocker used in breast cancer and what is its main side effect
Tamoxifen | Increased risk of endometrial cancer
60
Monoclonal antibody therapy used in breast cancer
Herceptin
61
How does breast abscess present and appear on examination
``` Painful sudden onset lump Skin tethering Erythema Fever May also be lymphadenopathy ```
62
Management of breast abscess
ABx with anaerobic cover Surgical drainage If there is a mass left over will require triple assessment
63
How does a cyst appear on US
Hypoechoic (solid mass will be hyperechoic)
64
Are cysts painful in breast
Yes
65
What colour is fluid if drain the cyst
Normally green
66
After draining breast cyst what should be done if mass persists
Triple assessment again as tumour can be present within the cyst
67
Presentation of benign cystic change
Diffuse nodularity | Cyclical variance in prominence and tenderness
68
Management of benign cystic changes
Triple assessments as are signs of nodularity
69
What percentage of breast cancers occur in men
10%
70
When is gyaecomastia common in men
Occurs at times of hormonal fluctuation | Neonatal, puberty and old age
71
Most common causes of gynaecomastia in men
``` Liver disease Primary testicular therapy Acquired testicular failure Secondary testicular failure Endocrine tumours Ectopic production from other tumours ```
72
Drugs causing gynaecomastia
Spironalactone Finasteride Anabolic steroids Cimetidine
73
What are fibroadenomas caused by
Increased sensitivity to oestrogen
74
Who do fibroadenomas normally appear in
Under 30s
75
What causes cysts in breasts
Proliferation of terminal ducts
76
How does mastitis with lactation present
Erythema streaking away from the nipple Breast tenderness Axillary lymphadenopathy Can also have fever and malaise
77
Management of mastitis with lactation
10 day course of flucoloxacillin
78
What is an intraductal papilloma
Wart like lump that is normally found behind nipple | It is a benign growth
79
Difference in presentation of intraductal papilloma with age
Older women likely to have just 1 whereas under 40s can have many
80
Examination finding from intraductal papilloma
Sticky or bloody discharge that can be spontaneous | Small lump
81
What is atypical duct hyperplasia
Genetic condition that leads to hyperplasia of cells in ducts and lobes which comes with increased risk of carcinoma- must be screened regularly
82
What does fat necrosis feel like on examination
Tender firm lump | Skin changes- red, bruised and dimpled
83
Who does fat necrosis occur in
People with bigger breasts and obese | Always post trauma

Year 3 Conditions (33 decks)

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