Breast DO

Question 1

What is the #1 breast problem seen in primary care?

Answer 1

Breast pain

Question 2

The vast majority of mastalgia is ??

Answer 2

Hormonally regulated

Question 3

Does breast pain = cancer?

Answer 3

Rarely

Question 4

What is cyclic breast pain often associated with?

Answer 4

Hormonal changes - usually 1 week prior to onset of menses

Question 5

What can cause cyclic breast pain?

Answer 5

Proliferation of normal glandular breast tissue

Question 6

If a patient presents with cyclic breast pain, what should you do?

Answer 6

US, add mammogram if over 30!

Question 7

Sharp or burning breast pain is characterized as?

Answer 7

Non-cyclic breast pain

Question 8

Non-cyclic breast pain is often _____

Answer 8

unilateral

Question 9

How do you manage non-cyclic breast pain?

Answer 9

US, add mammogram if over 30

Question 10

How do you treat breast pain?

Answer 10

Usually self-limited
Supportive garments
Analgesics
Evening primrose oil

Question 11

What is the only FDA approved Rx for treatment of mastalgia? Why do people usually not use it?

Answer 11

Danazol

Significan androgenic effects!

Question 12

Nipple discharge is usually?

Answer 12

Benign

Question 13

Bilateral milky nipple discharge involving multiple ducts

Answer 13

Galactorrhea - physiologic nipple discharge

Question 14

What causes galactorrhea?

Answer 14

Hyperprolactinemia

Question 15

What is suspicious nipple discharge?

Answer 15

Secretory production of fluids other than milk

Question 16

What is the most common cause of pathologic nipple discharge?

Answer 16

Papilloma - papillary tumor growing from lining of breast duct

Question 17

What should clue you in to pathologic breast pain?

Answer 17

Spontaneous
Unilateral
Confined to one duct
Bloody
Clear, yellow, white, dark green
Associated with a mass
Women age over 40

Question 18

What tests should you order to evaluate nipple discharge?

Answer 18

hCG
Prolactin
TSH
Renal function

Question 19

What is a crucial step in diagnosing a benign breast lump/mass?

Answer 19

EXCLUDING BREAST CA

Question 20

What do you need to make sure to document when evaluating a breast mass?

Answer 20

Clock or vertical system

Question 21

Solid, firm, mobile mass “rolled to an edge” that is typically found in young women 15-35

Answer 21

Fibroadenoma

Question 22

Fluid-filled mass, compressible or ballotable that is typically found in premenopausal or perimenopausal women

Answer 22

Cyst

Question 23

Diffuse, tender, does not form discrete or well-defined mass that is associated with cyclic breast pain and premenopausal women

Answer 23

FIbrocystic changes

Question 24

What should you suspect if you find nodular breast tissue on PE?

Answer 24

Fibrocystic changes

Question 25

Due to milk retention cyst in breast feeding women

Answer 25

Galactocele

Question 26

Can develop after trauma, surgery, radiation, or after breast augmentation/reduction procedures

Answer 26

Fat necrosis

Question 27

What is the "triple test" to diagnose a breast mass?

Answer 27

1. Physical exam 2. Mammography 3. Needle biopsy

Question 28

What is the most common solid benign breast mass?

Answer 28

Fibroadenoma

Question 29

Definitive diagnosis of a fibroadenoma?

Answer 29

CNB or excision

Question 30

Influenced by hormonal fluctuation, can change in size with menstrual cycle

Answer 30

Breast cyst

Question 31

Breast cysts are uncommon in postmenopausal women unless they are using??

Answer 31

Hormone therapy

Question 32

How do you confirm a breast cyst?

Answer 32

US (simple cyst) or fine needle aspiration

Question 33

When do you refer someone with a breast cyst to surgery?

Answer 33

If the aspirate is bloody, does not result in complete collapse with aspiration, or recurs multiple times in a short period

Question 34

Localized, painful inflammation of breast associated with fever and malaise

Answer 34

Lactational mastitis

Question 35

What happens if you don't treat mastitis?

Answer 35

Local abscess formation

Question 36

What bacteria usually causes mastitis?

Answer 36

S. aureus

Question 37

What is the treatment for mastitis?

Answer 37

Dicloxacillin or clindamycin for MRSA coverage

Question 38

Benign proliferation of glandular tissue in male breast that is unilateral or bilateral

Answer 38

Gynecomastia

Question 39

What causes physiologic gynecomastia?

Answer 39

Hormonal imbalance

Question 40

What causes pathologic gynecomastia?

Answer 40

Drugs, cirrhosis, hypogonadism, tumors, CKD

Question 41

Definitive diagnosis of breast mass is made by ???

Answer 41

Breast biopsy

Question 42

What is better, a breast biopsy or imaging?

Answer 42

Biopsy always!