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Breast Flashcards

(59 cards)

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1
Q

What is the most common bacteria in mastitis?

A

S. Aureus

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2
Q

How is lactational mastitis treated?

A

Continue milk drainage or feeding
If serious: cabergoline to stop breastfeeding (dopamine agonists)

Lactation mastitis in first 3 months of breast feeding

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3
Q

What are some causes of non-lactational mastitis?

A

Duct ectasia
Peri-ductal mastitis
Tobacco smoking

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4
Q

How can mastitis lead to duct fistula

A

Periareolar or peripheral mastitis

Peri-aeroplane mastitis in younger patients can lead to duct fistula

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5
Q

How are breast abscesses treated?

A

US-guided needle therapeutic aspiration

Co-amoxiclav/ flucloxacillin

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6
Q

What are breast cysts?

A

Epithelial-lined fluid-filled cavities

Form when lobules become distended

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7
Q

Which age group are prone to breast cysts?

A

Perimenopausal

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8
Q

Management of breast cysts

A

Aspiration if large and causing pain or discomfort

Usually self-resolve

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9
Q

What are some complications of breast cysts?

A

Breast cancer
Fibroadenois (fibrocystic change)
Can mask malignancy
Cyclical pain (give high dose gamolenic acid or danazol)

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10
Q

Treatment of breast cysts

A

Gamolenic acid: for fibrocystic change, relieves cyclical symptoms

Danazol: inhibits pituitary gonadotropin secretion, side effects are acne and hirsutism

Bromocriptine: inhibits pituitary prolactin release and can produce dizziness

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11
Q

What is the mechanism of action of danazol?

A

Inhibits pituitary gonadotropin secretion
SE: acne/hirsutism
Treatment for breast cysts, moderate to severe cyclical pain

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12
Q

What is the mechanism of action of Bromocriptine?

A

Inhbiits pituitary prolactin release and can produce dizziness
Used for breast cysts

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13
Q

What is mammary duct ectasia?

A

Dilation and shortening of the major lactiferous ducts

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14
Q

Clinical features of mammary duct ectasia

A

Green/yellow nipple discharge
Palpable mass
Nipple retraction
Peri-menopausal women

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15
Q

What will you see on a mammogram of mammary duct ectasia?

A

Calcification

Dilated ducts

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16
Q

Management of mammary duct ectasia

A

Duct excision

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17
Q

Causes of fat necrosis

A

Trauma, previous surgical or radiological intervention

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18
Q

Clinical features of fat necrosis

A

Asymptomatic lump
Fluid discharge
Skin dimplinG
Pain and nipple inversion

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19
Q

Management of fat necrosis

A

Self-limiting

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20
Q

Findings on investigations of fat necrosis

A

Hyperechoic mass on US, positive traumatic history

Area of calcification on mammography

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21
Q

What is a fibroadenoma

A

Proliferation of stromal and epithelial tissue of duct lobules
In women of reproductive age

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22
Q

Clinical features of fibroadenoma

A

Highly mobile
Well defined and rubbery
Multiple and bilateral
Smooth and discrete lumps

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23
Q

Management of fibroadenoma

A

Often left alone

Excision if >4cm or changing or suscpicious history

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24
Q

What are the different types of fibroadenoma?

Study These Flashcards
A

Juvenile fibroadenoma
Giant fibroadenoma >5cm
Phyllodes tumour
Common fibroadenoma

25
What are the features of an adenoma?
Nodular Benign glandular Older population
26
What is a papilloma?
Benign epithelial mass growing exophytically Sub areolar region 40s/50s
27
What are some examples of benign breast disease?
``` Phyllodes tumour Breast haematoma Galactocele Lipoma Papilloma Adenoma Fibroadenoma ```
28
What are phyllodes tumours?
``` Rare fibroepithelial tumours Large, occur in older age groups In both epithelial and stromal tissue Grow easily One third have malignancy potential ```
29
Breast haematoma
Most common problem following breast trauma | Spontaneously in patients on anticoagulants
30
What is a galactocele?
Cystic lesion filled with milk Contains breast milk which may Be inpissated Women who stop breast feeding suddenly
31
Pathological causes of gynaecomastia
``` Lack of testosterone Increased oestrogen Medication Idiopathic Pubertal ```
32
Conditions causing low testosterone
Klinefelter’s syndrome Androgen insensitivity Testicular atrophy Renal disease
33
Causes of increase oestrogen
``` Liver disease Hyperthyroidism Obesity Adrenal tumours Leydig cell tumours ```
34
Medications causing gynaecomastia
``` Digoxin Metronidazole Spironolactone Chemotherapy Goserelin Antipsychotic Anabolic steroids Hormonal treatment for prostate cancer Ranitidine CCB ```
35
Clinical features of gynaecomastia
Rubbery or firm mass <2cm in diameter | Starts from underneath nipple and spreads outwards over breast region
36
Management of gynaecomastia
Tamoxifen for pain
37
What is Galactorrhea
Bilateral, multi-ductal milky discharge Not associated with pregnancy or lactation Milk production 6-12months after pregnancy and cessation of breast feeding
38
What are some causes of hyperprolactinaemia
* Idiopathic * Pituitary adenoma (prolactinoma) * Drug-induced: SSRIs, anti-psychotics, H2 antagonists * Neurological: varicella zoster/ spinal cord injury inhibits dopamine release * Hypothyroidism: elevated thyrotropin-releasing hormone can simulate prolactin released. Cushing’s disease, Acromegaly, Addison’s disease * Renal or liver failure * Damage to pituitary stalk, reduced dopamine inhibition to pituitary, from surgical resection, multiple sclerosis, sarcoidosis, or tuberculosis
39
Management of galactorrhea
Dopamine agonists therapy for confirmed pituitary tumors. Cabergoline and Bromocriptine Potential trans sphenoidal surgery Bilateral total duct excision
40
Causes of cyclical mastalgia
Both breasts Hormonal changes Actively menstruating HRT
41
Non cyclical causes of mastalgia
Medication Hormonal contraceptives Anti depressants (sertraline) Anti psychotics (haloperidol)
42
Clinical features of mastalgia
Lumps, skin changes, fevers, discharge Association with menstrual cycle Drug history, breast feeding, pregnancy
43
Causes of nipple discharge
``` Physiological Duct papilloma Duct ectasia Periductal mastitis Carcinoma Galactorrhea ```
44
Management of mastalgia
First line: paracetamol, NSAIDs, evening primrose oil, supportive bras Second line: danazol, anti-gonadotropin agent
45
What are the two types of breast carcinoma in situ
Ductal (more common) and lobular (more likely to become invasive)
46
Types of ductal carcinoma in situ
Comedo (microcalcifications) cribiform (multi focal) micropapillary (multifocal)
47
Ductal carcinoma in situ features in mammography
Micro calcifications, either localised or wide spread
48
Management of ductal carcinoma in situ
Complete wide excision Widespread or multifocal DCIS Normally requires complete mastectomy
49
Management of lobular carcinoma in situ
Low grade LCIS Monitoring Bilateral prophylactic mastectomy if patient possesses BRCA 1/2 genes
50
Types of invasive ductal carcinoma
``` Tubular Cribriform Papillary Mucosal (colloid) Medullary carcinomas ```
51
Invasive lobular carcinoma
More common in older women Diffuse (stromal) pattern of spread makes detection more difficult Can spread to GI and skin
52
Sites of metastases
Lung (pleural effusion) Liver (ascites) RICP (brain metastases)
53
Risk factors for breast cancer
Female sex and age BRCA 1/2 FH Previous benign disease, developed country, obesity, alcohol Degree of exposure to unopposed oestrogen, early menarche, late menopause, nulliparous women, oral contraceptives/HRT, first pregnancy after 30years of age
54
Clinical features of breast cancer
``` Breast lump Asymmetry Swelling Abnormal nipple discharge Nipple retraction Skin changes Mastalgia Palpable lump in axilla ```
55
What is Nottingham prognostic index?
Sizex0.2) + nodal status + grade (Bloom-Richardson)
56
Investigations for breast cancer
``` Triple assessment Histology Grade Vascular invasion Receptor status ```
57
What is Paget’s disease of the nipple?
* Roughening, reddening and slight ulceration of the nipple * Underlying neoplasm in most (in situ or invasive) * Involvement of epidermis microscopically by malignant ductal cells
58
Clinical presentation of paget’s
Itching or redness in nipple and/or areola, with flaking and thickened skin on or around nipple Area often painful and sensitive Flattened nipple with or without yellowing or bloody discharge
59
Management of paget’s
Surgical removal of nipple and areola | Radiotherapy if there’s an underlying malignancy

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