OB-Gyn Flashcards
a 66-year-old female with mass she felt in her left breast on recent breast self-examination.
No nipple discharge, hx of breast or other cancers.
Physical examination confirms painless, firm, irregular and immobile lump in the superolateral quadrant of the left breast
there are no evident overlying skin changes and there is no notable axillary lymphadenopathy on palpation.
This presentation is concerning for…
breast CA
Patient p/w:
- unilateral localized breast pain w/ associated tenderness, erythema, warmth
- Cracked nipples/fissure +/- purulent d/c
- systemic sxs
Acute mastitis
Acute mastitis is most common in what population?
lactating women
MC pathogen responsible for acute mastitis and breast abscess?
staph aureus
1st line tx for acute mastitis…
supportive care/NSAIDs, breast pump
Anti-staph abx available for acute mastitis
dicloxacillin, nafcillin, cefazolin
Tx for breast abscess…
I & D or needle aspiration
+
nafcillin/dicloxacillin/cefazonlin + metronidazole
MC breast d/o in women 30-50 yo (reproductive age)?
fibrocystic breast
30-50 yo patient presents with breast mass on both breasts that changes in size with menstruation.
Reports worsening just before period begins.
initial DDx?
fibrocystic breast
On physical examination of a reproductive aged female, you notice multiple nodular, mobile, smooth round lumps bilaterally
Found in upper-outer /tail of spense
fibrocystic breast
Patient complains of a firm, nontender, solitary well circumscribed lump in the breast
it is freely mobile and feels rubbery to the touch.
doesn’t change with menstrual cycle
Fibroadenoma
First diagnostic test performed for breast mass that has suspicious features?
mammogram
Imaging of choice for fibrocystic/fibroadenoma?
ultrasound
what offers definitive dx of fibroadenoma?
FNA/Bx showing “swirl” collagen
Patient presents with:
mass felt in left breast
immobile, painless, firm, irregular lump
+/- bloody nipple d/c
breast CA
4 risk factors for breast cancer?
- BRCA1 and 2
- increasing age (> 60 yo)
- Increased number of menstrual cycles (early menarche, late menopause, late pregnancy)
- increased estrogen exposure
MC type of breast CA?
infiltrating intraductal carcinoma
60 yo women presents with chronic eczematous itchy, scaly rash on nipples and areola with a breast lump at the tail of spence…
paget disease
60 yo women presents with red, swollen, warm and itchy breast
nipple retraction and peau d’orange.
What is suspected and what is the prognosis?
inflammatory breast CA
Poor prognosis
What is a sign of locally advanced breast CA?
axillary LAD
Which type of breast CA is responsible for 10% of cases and is often bilateral?
infiltrating lobular carcinoma
Red flags for malignancy on mammogram… (2)
spiculated, microcalcification
Which imaging modality should be used as first line image for women < 40 yo with breast mass?
ultrasound
What is a disadvantage of FNA for breast CA testing?
doesn’t allow receptor testing
