breast disorders trigger

Question 1

what happens to breast epithelial cells after menstruation

Answer 1

they undergo programmed cell death at the END of luteal phase

Question 2

when are fatty tissues almost completely replaced by breast parenchyma

Answer 2

In late pregnancy

Question 3

psychiatric medications and nervous system medications cause what SE

Answer 3

galactorrhea

Question 4

Anabolic steroids/Androgens are associated with what condition

Answer 4

gynecomastia

Question 5

gynecomastia nipple retraction is suggestive of what diagnosis

Answer 5

cancer:(

any of the following = cx:
Asymmetry
Enlargement not beneath the areola
Unusual firmness
Nipple retraction
Bleeding or discharge

Question 6

MC during 2nd/3rd week of puerperium

Answer 6

mastitis

Question 7

CI if breastfeeding an infant thats <1month old or if there is a hx of G6PD, jaundice, or prematurity

Answer 7

bactrim for mastitis.

must use a different abx

Question 8

where do non-puerperal peripheral breast abscesses arise from? how do you treat it?

Answer 8

skin infections (tx w I&D and same abx as mastitis)

Question 9

this is d/t Keratin-plugged milk ducts behind the nipple.

how would you treat this.

Answer 9

non-puerperal subareolar breast abscess

• simple I&D (40% reoccurence)
• subareolar duct excision and complete removal of sinus tracts
• biopsy.

Question 10

what would suggest karyotyping for klinefelters syndrome

Answer 10

suspicious gynecomastia

Question 11

Subareolar duct excision and removal of sinus tracts is used for what diagnosis

Answer 11

subareolar breast abscess

Question 12

what is the etiology of fat necrosis and how do you diagnose it?

Answer 12

etiology - trauma, radiation or surgery
dx: US or mammogram. i think you can use watchful waiting though.

Question 13

Drinking alcohol while 18-22 is the main risk for what dx

Answer 13

fibrocystic breast changes

Question 14

s/s may be worsened w the use of caffiene in what dx?

Answer 14

fibrocystic breast changes

Question 15

a 27 year old patient presents with cyclic breast pain that is worse just prior to menstruation. She reports multiple small bumps found in her breasts. what diagnostic will be used in this patient to assess dx?

Answer 15

US. mammograms are not indicated in pts <30!

Question 16

what are some treatment options for fibrocystic breast changes

Answer 16

• CAM (primrose oil/vit E)
• NSAIDS/tylenol
• may consider drainage of large cysts
• severe pain - danazol, tamoxifen (limited by SE)
• refractory severe cases = surgery.

Question 17

MC in young women within 20 years of puberty

Answer 17

fibroadenoma

Question 18

patient presents with complaints of left breast mass. on exam you see a 3cm mass that is firm, nontender, and relatively mobile. US shows well-defined solid mass with benign features. what is your diagnosis?

Answer 18

fibroadenoma

Question 19

nulliparity, early menarche, and late onset menopause are all risks for what dx

Answer 19

breast cancer

Nulliparity
First full term pregnancy after 30
Early menarche (b4 12)
Late natural menopause (after 50)
Postmenopausal combinattion HRT
Hx of uterine cx
PERSONAL HX of Breast Cx

Question 20

when do you order CBC, LFTs and ALP in this lecture

Answer 20

in initial evaluation of breast cancer

Question 21

eczematous eruption arising from the nipple with ulceration spreading to the areola. may be painful, itchy or burning

Answer 21

pagets carcinoma

Question 22

orange peel skin is assocaited with what diagnosis

Answer 22

inflammatory breast carcinoma

Question 23

blocked dermal lymphatics by a tumor emboli leading to lymphedema and hyperemia. Leads to diffuse brawny edema of skin with erysipeloid border.

what diagnosis

Answer 23

inflammatory carcinoma (orange peel skin)

Question 24

this type of cancer tends to metastasize to the liver, lungs, and brain

Answer 24

no estrogen or progesterone or HER receptors.

Question 25

this type of cancer tends to metastasize to the bone, soft tissue and genital organs

Answer 25

ER+
PR+
HER2+

Question 26

what types of breast cancer are treated w tamoxifen (TOC) or aromatase inhibitors

Answer 26

ER/PR/HER2+ cancer

tamoxifen for 5 yrs is TOC

Question 27

when is pembrolizumab used?

Answer 27

ER/PR/HER2 negative breast cancers

Question 28

this medication blocks estrogen receptors in the breast and uterus but mimics them in the bones

Answer 28

raloxifene

tamoxifen = blocks in breast, minics in bones and uterus

Question 29

this medication blocks estrogen receptors in the breast but mimics it in the uterus and bone

Answer 29

tamoxifen

raloxifene blocks breast &uterus but mimics in bone

Question 30

which SERM has less SE

Answer 30

raloxifene

Question 31

cimetidine can reduce the efficacy of this drug. this drug should also be avoided with other QT prolonging drugs

Answer 31

SERMS (raloxifene and tamoxifene)

Question 32

what are the 3 aromatase inhibitors

Answer 32

anastrazole
exemestane
letrozole

Question 33

these medications are used for metastatic breast cancer and ER or PR+, HER - cancers

Answer 33

fulvestrant
elacestrant

does not mimic estrogen, instead attatches to and causes destruction of estrogen receptors

Question 34

does not mimic estrogen, instead attatches to and causes destruction of estrogen receptors

Answer 34

fulvestrant
elacestrant

Question 35

what is the follow up regimen for breast cancer after tx

Answer 35

Question 36

what is the most specific feature of breast cx to show up on a mammogram

Answer 36

spiculated focal mass

Question 37

If a patient has a breast density of 43 what category does that put her in?

Answer 37

scattered fibroglandular densities

Predominantly fatty (0-25% dense)
Scattered fibroglandular densities (26-50% dense)
Heterogeneously dense (51-75% dense)
Dense (76% or greater dense)

Question 38

which BI-RADS score indicates screening recommendations of: Diagnostic mammo/US every 6 months x1 year, then annually for x2 years.

Answer 38

BI-RADS 3

Question 39

BI-RADS scale

Answer 39

• 0 = not enough info, poor scan
• 1 = negative, just routine f/u. (Q1-2 years)
• 2 = benign, just routine f/u (Q1-2 years)
• 3 = tiny chance of cancer, f/u (Q6 mo)
• 4ABC = wide range, could be cancer
• 5 = very sus!
• 6 = yea you have cancer