Breast Disorders

Question 1

List some differential diagnoses of a breast mass

Answer 1

Fibrocystic changes of the breast
Fibroadenoma
Carcinoma
Intra-ductal papilloma
Little benign growths that cause bloody nipple discharge
Fat necrosis
Duct ectasia
abscess
cyst

Question 2

What is the most common organism in mastitis?

Answer 2

S. aureus

Question 3

Mastitis in a non-lactating female need to rule out what?

Answer 3

inflammatory carcinoma

Question 4

Most common reason for fever after the immediate puerperium in nursing mothers

Answer 4

Mastitis

Question 5

More common within three months of delivery and in first time mothers

Answer 5

Mastitis

Question 6

What is the treatment for mastitis?

Answer 6

Ibuprofen
Cold compress
Frequent nursing
Dicloxaxillin or Cephalexin if indicated

Question 7

What are some risk factors for breast abscess development?

Answer 7

obese
smoking
black
blocked milk duct
nipple piercings

Question 8

Female appearing male breast

Enlargement of the male breast, often asymmetric or unilateral

Answer 8

Gynecomastia

Question 9

Gynecomastia must be distinguished from what?

Answer 9

tumors or mastitis

Question 10

Which type of gynecomastia is characterized by tenderness, while the other type of gynecomastia is typically non-tender?

Answer 10

Glandular gynecomastia

Fatty gynecomastia

Question 11

What genetic disorder is it common to see gynecomastia?

Answer 11

Klinefelter Syndrome

Question 12

Lactation that occurs in the absence of nursing

Answer 12

Galactorrhea

Question 13

Evaluation of galactorrhea should be done if present in nulliparous female, or if associated with what symptoms?

Answer 13

headache
amenorrhea
visual changes
systemic symptoms

Question 14

What are some causes for galactorrhea?

Answer 14

Medications
CNS lesions (i.e. pituitary microadenomas (measure prolactin))
Medical conditions

Question 15

What is the test of choice for galactorrhea?

Answer 15

MRI

Question 16

Indications for an MRI in galactorrhea?

Answer 16

Prolactin >200mg/dL in the non-pregnant

Patients with headaches, vision changes

Persistent increase in prolactin

Question 17

In fibrocystic breast disease, size and tenderness fluctuates with what two factors?

Answer 17

menstruation cycle and caffeine

Question 18

Most common etiology of breast “lump” – benign solid mass

Common benign neoplasm in young women

Fibrous and glandular tissue

Answer 18

Fibroadenoma

Question 19

Firm, round, non-tender, mobile

“rubbery”

Usually solitary and unilateral

Palpable and visible on ultrasound

Answer 19

Fibroadenoma

Question 20

On physical exam of a fibroadenoma, what are the 5 Rs?

Answer 20

R – round
R – rubbery
R – recluse (unilateral)
R – roaming (mobile)
R – really doesn’t hurt (non-tender)

Question 21

Second most common malignancy in women

Answer 21

breast cancer

Question 22

Second most common cause of cancer death in women

Answer 22

breast cancer

Question 23

What is the most common type of breast cancer?

Answer 23

infiltrating ductal carcinoma (80%)

Question 24

What is the most lethal type of breast cancer?

Answer 24

inflammatory

Question 25

What is the largest risk factor for breast cancer?

Answer 25

age

Question 26

List some risk factors for breast cancer

Answer 26

Age BRCA1 and 2 mutations Family history in a first-degree relative Early age of menstrual onset (<12 years old) Delaying childbearing or nulliparity (First pregnancy after 30) Radiation exposure Overweight after menopause 2-4 alcoholic drinks per week Hormone therapy Not breast feeding White History of atypical hyperplasia Tobacco use

Question 27

What are common sites of metastases for breast cancer?

Answer 27

Lymph notes (most common) Lung/pleura Liver Bone Brain

Question 28

What is the most common site for breast cancer metastases?

Answer 28

Lymph notes (most common)

Question 29

How do you get a definitive diagnosis of solid breast tumor?

Answer 29

Excisional breast biopsy

Question 30

What type of breast cancer is described below? Pre-maligment lesion Arises from ductal hyperplasia Asymptomatic Usually not palpable Contained within the mammillary ducts

Answer 30

Ductal Carcinoma In-Situ

Question 31

What type of breast lesion is described below? Contained within breast lobules Usually bilateral Not palpable and doesn’t show up on a mammogram Diagnosis is usually incidental on biopsy

Answer 31

Lobular Carcinoma In-Situ

Question 32

What type of breast cancer is described below? Most common breast malignancy Worse and most invasive Typically post-menopausal women Firm, fibrous, rock-hard mass with sharp margins Likes to metastasize

Answer 32

Infiltrating Ductal Carcinoma

Question 33

What type of breast cancer is described below? Second most common breast malignancy Usually bilateral Arises from lobular epithelium

Answer 33

Infiltrating Lobular Carcinoma

Question 34

What is the most common breast malignancy?

Answer 34

Infiltrating Ductal Carcinoma

Question 35

What type of breast cancer is described below? Infiltrating intra-ductal carcinoma in the nipple and ducts of nipple Often associated with DCIS Eczematous changes of the nipple Crusting, scaly lesion

Answer 35

Paget’s Disease of the Nipple

Question 36

What type of breast cancer is described below? Extremely aggressive malignancy Poorly differentiated tumor with dermal lymphatic invasion Edema, erythema, peau d’orange, warm skin overlying the breast May present like mastitis in a non-lactating woman Most malignant form of breast cancer Tends to occur in younger women Characterized by rapid enlargement of breast without underlying mass

Answer 36

Inflammatory Breast Carcinoma

Question 37

Most malignant form of breast cancer

Answer 37

Inflammatory Breast Carcinoma