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Description
Flashcards by Andrew Street, updated more than 1 year ago
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Created by Andrew Street
over 7 years ago
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| Question | Answer |
| Give a DDx for a breast lump in women. | Common: * Fibroadenoma * Fibrocystic breast * Fat necrosis * Intraductal papilloma * Breast abscess * Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) * Invasive breast CA * Ductal carcinoma insitu Uncommon: * Phylloides tumour * Adenoma * Radial scar * Lobular carcinoma insitu http://bestpractice.bmj.com/best-practice/monograph/1179/diagnosis/differential-diagnosis.html |
| Give a DDx for a breast lump in men. | * Gynecomastia * Lipoma * Cyst * Myofibroblastoma * Angiolipoma * Fat necrosis * Intramammary lymph node * Haematoma * Seroma * Breast CA - 80% are invasive ductal CA, 5% are DCIS, 5% are papillary carcinoma https://www.umassmed.edu/globalassets/radiology/rsna-2014-posterspresentations/rsna-male-final.pdf |
| What is mastalgia & what are some causes? | Breast P. Causes (breast origin): * Abscess * Mastitis * Fibrocystic DS Causes (non-breast origin): * Musculoskeletal - eg costochondritis * Visceral - eg atypical angina, ACS * Skin pathology - infected sebaceous cysts, cellulitis, skin abscesses OHOCS p248. |
| Emergency Mx of acute breast P. | Establish a Dx: • Inspection & Hx is usually all that is required. • Imaging - rarely necessary & often P if pathology is primary breast. Mammography should be avoided due to breast compression required. US may help, particularly in the Dx of breast abscess. • Consider specialist referral or opinion if PE, cardiac ischaemia, or pneumonia suspected. CXR is simple, but often unhelpful. Early Rx: • Analgesia - NSAIDs (diclofenac (Voltarol®) 50mg PO or 100mg PR) are effective in most causes. Opiates if necessary. • Breast abscesses may be aspirated for relief of pressure Sx under local anaesthetic. Formal incision & drainage often avoided, especially in lactational abscesses. Definitive Mx: • Breast abscess. If lactational, oral ABx's (including flucloxacillin 500mg TDS) & aspirational drainage (often repeated). If associated with chronic mastitis, oral ABx's (to include metronidazole 400mg PO TDS or co-amoxiclav 750mg PO TDS). • Fibrocystic DS. NSAIDS (e.g. ibuprofen 400mg PRN), γ-linoleic acid, danazol, occasionally tamoxifen. OHOCS p248 |
| What is ANDI and what does it cause? | Most benign breast conditions arise from pathology related to *abnormalities of the normal development and involution of the breast* (ANDI). Other benign DS are related to infxn or trauma. OHOCS p246. |
| Breast lumps should be assessed using 'triple assessment' - what is it? | 1) Examination 2) Radiological tests 3) Biopsy - FNA or core biopsy K & C p474. |
| What is fibroadenosis (aka fibrocystic DS)? | Combination of localized fibrosis, inflammation, cyst formation, and hormone-driven breast P. Occurs almost exclusively between menarche & menopause (15–55y). |
| What are the features of fibroadenosis? | * Cyclical P & swelling * Lumpy breasts * Multiple breast cysts OHOCS p246. |
| Fibroadenosis - Dx & Rx. | * Dx - triple assessment (even once a Dx of fibrocystic DS is made—any woman may develop a carcinoma) * Rx - reassurance, anti-inflammatories, hormone or ‘cellular’ manipulation (e.g. γ-linoleic acid/evening primrose oil, COC pill, cyst aspiration) OHOCS p246. |
| What is fibroadenoma & in whom is it most likely to occur? | Benign overgrowth of one lobule of the breast. Usually isolated, may be multiple or giant, especially in Afro-Caribbeans. Commonest under age 30, but may occur at any age up to menopause. OHOCS p246. |
| Features of fibroadenoma. | Painless, mobile, discrete lump. OHOCS p246. |
| Fibroadenoma - Dx & Rx. | * Dx - US usually conclusive * Rx - excision if concern over Dx, cosmesis, or Sx OHOCS p246. |
| DDx for nipple discharge. | * Pregnancy * Duct papilloma – harmless growth inside the breast duct. Typically causes bloodstained discharge from one breast. * Duct ectasia – harmless, age-related breast change that can result in a cheesy or discoloured discharge from both breasts * Breast or nipple abscess – P'ful collection of pus forming in breast tissue or around the nipple, usually as a result of bacterial infxn http://www.nhs.uk/conditions/nipple-discharge/Pages/Introduction.aspx |
| What is duct papilloma? | Duct papilloma: If the discharge is bloodstained & from a single breast, the cause is likely to be a duct papilloma. A papilloma is a harmless wart-like growth, usually about 1-2cm in size, found inside one of the breast ducts. The papilloma is usually just behind the nipple and can cause fluid or blood to seep out of the nipple. You'll usually just have one papilloma, and a simple procedure to remove it will often be recommended. http://www.nhs.uk/conditions/nipple-discharge/Pages/Introduction.aspx |
| What are the two main hormones involved in lactation? | |
| What is lactational mastitis & how is it Rx'd? | * Acute staphylococcal infxn of mammary ducts * May degenerate into an acute lactational abscess * Rx with oral ABx's & (repeated) aspiration if abscess occurs - no need to stop lactating OHOCS p246. |
| What is recurrent mastitis/mammary duct ectasia & how is it Rx'd? | * Due to dilated, scarred, chronically inflamed subareolar mammary ducts * Associated with smoking * Present with recurrent yellow-green nipple discharge or recurrent breast abscesses * Infxn is usually mixed anaerobic based * Rx - metronidazole & drainage of acute abscesses. Surgery is rarely necessary. OHOCS p246. |
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