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gyn-breast medicine

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