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gyn-breast medicine
| Question | Answer |
|---|---|
| each breast contains ___-___ glands/lobules that are separated by adipose tissue | 20-40 |
| 97% of the lymph drainage is via the ______ nodes | axillary |
| Breast tissue consists of...? | lobular, ductal, connective, adipose tissue |
| breast CA is the leading cause of death overall for women aged ____-____ | 40-59 |
| abnormal breast masses are evaluated by ____ in women <30yo and by _____ in women >30yo | sonogram, mammography |
| what age women usually get cysts? | middle aged women |
| PE reveals a palpable, unilateral, soft-firm, round, mobile mass that is often TENDER | cyst |
| how to tx a cyst? what does this tell you? | aspirate the cyst. clear fluid=no further eval. blood/turbid=send to cytology |
| indications for excising a cyst | blood fluid, palpable mass after aspiration, fluid reaccumulates in 2 wks, or cyst recurs even after 2 aspirations |
| a condition where cysts of microscopic or larger size develop in the breasts and surrounding tissue becomes ticketed, bumpy, and fibrous (glandular and ductal tissue may also change) | fibrocystic breast dz/fibrocystic condition |
| fibrocystic breast dz usually occurs in what age women? | middle aged women |
| fibrocystic condition RARELY develops in _________ women | postmenopausal |
| PE of fibrocystic condition? | bilateral, clumpy, mobile, symmetrical masses, and possible multiple masses. tenderness if CYCLIC |
| if dx of fibrocystic condition remains uncertain after sono/mammo, what do you do? | aspirate for biopsy |
| tx of fibrocystic condition should center around what? | alleviation of pain |
| fibroadenomas usually occur in who? | young women (<30yo) |
| PE of a fibroadenoma? | unilateral, round, smooth, mobile, firm/rubbery, usually 1cm or larder, and NON-TENDER |
| if sono/mammo of fibroadenoma leaves any doubt, what do you do? | biopsy w/ fine needle aspiration (FNA) |
| how to tx biopsy-confirmed fibroadenoma? | can be left alone, tx w/ cryoablation of excised if large |
| if a fibroadenoma grows quickly and becomes large (>5cm), what is it called? how do you tx? | phyllodes tumors. requires excision |
| pts w/ breast CA often present with what? | a mass |
| is the CA is progressed, pt may also present with what? | weight loss, anorexia, night sweats, fatigue |
| PE of breast CA? | firm-hard, usually NON-TENDER, difficult to distinguish from surrounding tissue, non-mobile, usually unilateral |
| most breast CA are what? | infiltrating ductal carcinoma |
| crusting, scaling, erosion around the nipple. discharge common. a form of ductal carcinoma | paget disease of the nipple |
| erythematous, warm, peau d'orange skin. axillary lymph nodes palpable but no detectable mass | inflammatory breast carcinoma |
| a new-onset breast mass in women >___ yo, is considered CA until proven otherwise | 50yo |
| ___-___% of breast CA are a result of BRCA1 and BRCA2 | 5-10 |
| risk-reducing meds for breast CA | tamoxifen or raloxifene |
| if a 1st degree relative had PRE-menopausal breast CA, start annual screen ___ yrs earlier than the CA was first detected in the relative | 10 |
| HER2/neu is ______ aggressive CA than other cancers w/o this mutation | more |
| hormonal therapy is highly effective in decreasing recurrence in hormone receptor ______ CAs and should be prescribed for ___ yrs follow CA tx. | positive, 5yrs |
| Aromatase inhibitors are only for ________ women w/ hormone receptor _____ CA. | post-menopausal women, positive |
| when is chemo used? | if lymph nodes test positive or tumor is larger than 1cm |
| if biopsy shows HER2/neu over expression there is an indication for what? | chemo plus a tissue-targeted med |
| who should you NEVER give HRT to? | breast CA survivors |
| when should you be concerned about nipple discharge? | blood, unilateral and persistent, associated w/ a mass, or is spontaneous |
| most common cause of bloody nipple discharge? tx? | intraductal papilloma (benign). excise the duct |
| what are some causes of galactorrhea? | high levels of prolactin in blood. caused by pregnancy, a pituitary tumor, hypothyroidism, excessive exercise or a side-effect of certain meds |
| meds that lower _____ levels will trigger a rise in ______ levels | dopamine, prolactin |
| some meds that cause galactorrhea? | antipsychotics, cimetidine, ranitidine, metoclopramine, SSRIs, TCAs, verapamil, opiates |
| if _____ is normal, but prolactin is ______, order a MRI of ____ _____ to evaluate for a ______ tumor | thyroid, high, sella turcica, pituitary |
| mastitis is most often caused by? | Staphylococcus aureus |
| presentation of mastitis? MC in? | localized redness, warmth, tenderness. fever and lymphadenopathy are common. MC in breast feeding women |
| tx of mastitis | Dicloxacillin. pt can continue to breast feed |
| presentation of breast abscess? | localized collection of pus, usually in a blocked milk duct/galactocele |
| tx of breast abscess? | Dicloxacillin. drain the abscess w/ either needle or incision |
| imaging is not usually necessary for breast pain, but if pain is _____, and no cause can be identified or if pt has risk factors, consider imaging | focal (not diffuse) |
| breast extends from the _____ to the _____ _____ and from the _____ to the _______ line | clavicle, 6th rib; sternum, midaxillary |
| best time for breast eam | soon after menses |
| most common location of malignant lesion is in the _______ | upper outer quadrant |
| if common reasons for gynecomastia are ruled out order a ______. any detectable level could mean what? | B-hCG. could mean a testicular tumor or other malignancy, or hypogonadism |
| other rare causes of gynecomastia? | Klinefelter syndrome, liver dz, hyperthyroidism, renal failure |
Created by:
rjerome09
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