Breast Mushkies Flashcards Preview

Medicine and Surgery Mushkies > Breast Mushkies > Flashcards

Flashcards in Breast Mushkies Deck (35)
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1
Q

Breast exam components?

A
  1. Inspection
  2. Palpation
  3. Completion
2
Q

Breast inspection?

A
  1. Positions x 4 = hands by sides, leaning forwards, behind head, pressing hips
  2. Shape = asymmetry, masses
  3. Skin = scars, radiotherapy tattoos, eczema, erythema, peau d’orange
  4. Nipple = inversion, discharge, discoloration, destruction
  5. Peripheral = axillae, arm, abdomen (DIEP), back (lat dorsi flap harvest)
3
Q

Breast palpation?

A
  1. Breast
  2. Axillae
  3. Supraclavicular and cervical nodes
  4. Lateral chest wall
4
Q

Breast exam completion?

A
  1. Palpate/percuss spine for tenderness, masses
  2. Examine abdomen for hepatomegaly
  3. Percuss and auscultate lungs
5
Q

Axillary lymph nodes?

A
  1. Apical
  2. Anterior
  3. Posterior
  4. Medial Lateral
6
Q

Breast scars?

A
  1. Periareolar

2. Submammary

7
Q

Breast lump Ix?

A

Triple assessment

  1. History and Examination
    2a. <35 years old = US
    2b. >35 years old = US + mammogram
  2. Solid lump = Tru-Cut biopsy, Cystic lump = FNAC
8
Q

Breast Ca RFs?

A

BOOBYS

  1. Bleeding = early menarche <13, late menopause >55
  2. Oestrogen = OCP, HRT
  3. Other breast disease = Ca, DCIS, atypia
  4. Breast feeding = protective
  5. Young’un = first child >35 y/o
  6. Sister = FHx
9
Q

Classification of breast disease?

A

Benign or Malignant

10
Q

Malignant breast disease?

A
  1. Ductal carcinoma NOS = 70%
  2. Lobular carcinoma = 20%
  3. Phylloides tumours
  4. Other = mucinous, medullary, papillary
11
Q

Benign Breast disease?

A
  1. Stromal = fibroadenomas
  2. Epithelial = fibroadenosis, cysts, papillomas
  3. Inflammatory = mastitis, abscess, fat necrosis, duct ectasia
12
Q

Commonest single breast lumps?

A
  1. Fibroadenoma
  2. Cyst
  3. Fat necrosis
  4. Cancer
13
Q

Features of a malignant breast lump?

A
  1. Irregular, nodular surface
  2. Poorly defined edge
  3. Hard/scirrhous consistency
  4. Painless
  5. Fixation to skin or chest wall
  6. Nipple involvement
14
Q

4 indications for mastectomy?

A
  1. Multifocal tumour
  2. Central tumour
  3. Large lesion in small breast
  4. DCIS > 4cm
  5. Pt choice
15
Q

4 indications for wide local excision?

A
  1. Solitary lesion
  2. Peripheral tumour
  3. Small lesion in large breast
  4. DCIS < 4cm
  5. Pt choice
16
Q

Drain removal post breast op features?

A
  1. Typically 2 drains = axilla and site of surgery
  2. Left for 3-5 days or until draining <50ml/d
  3. Pts can go home with drains and district nurse support
17
Q

2 types of breast reconstruction?

A
  1. Implant reconstruction

2. Myocutaneous flap reconstruction

18
Q

Implant reconstruction features?

A
  1. Rounder shape than normal breast
  2. Breast usually lies higher
  3. Becker implant may have palpable SC filling port in the axilla
19
Q

Implant reconstruction advantages?

A

Simpler technique, can be primary or delayed

20
Q

Implant reconstruction disadvantages?

A
  1. Cosmetic result not as good
  2. Requires plenty of available skin
  3. Lies higher than other breast
  4. Late complications = capsular contracture, implant leakage, infection requiring removal
21
Q

Myocutaneous flap features?

A
  1. Scars extend over back or abdominal wall
  2. Recess on back where lat dorsi has been removed
  3. Ask pt to lift head off bed when lying supine to see recess in the rectus muscle
22
Q

Myocutaneous flaps advantages?

A
  1. Useful when little remaining skin.muscle
  2. Good cosmetic result
  3. Primary or delayed
23
Q

Myocutaneous flaps disadvantages?

A
  1. Increased blood loss
  2. Increased op times and complications
  3. Use of rectus impossible if pt has had abdo surgery
  4. Late complications = flap necrosis and infection
24
Q

Types of myocutaneous flap?

A
  1. Lat dorsi flap = often augmented w/ an implant
  2. TRAM flap = transverse rectus abdominis myocutaneous, risk of abdominal hernia, C/I if poor circulation, no implant necessary and combined tummy tuck
  3. DIEP flap = deep inferior epigastric perforator, may not be possible if small perforators
25
Q

Gynaecomastia examination?

A
  1. Inspection = unilateral/bilateral breast swelling
  2. Palpation = must feel glandular tissue to differentiate from pseudo
  3. Completion
26
Q

Completion of gynaecomastia exam?

A
  1. Look for cause = external genitalia, thyroid, CLD, visual fields
  2. History
  3. Prescription and recreational drugs
27
Q

Causes of gynaecomastia?

A

3Ps

  1. Physiological
  2. Pathological
  3. Potions
28
Q

Physiological gynaecomastia?

A

Usually resolves by adulthood

29
Q

Pathological gynaecomastia?

A
  1. Decreased androgen production

2. Increased oestrogen production

30
Q

Causes of reduced androgen production?

A
  1. Hyperprolactinaemia
  2. Renal failure
  3. Testicular = atrophy, orchitis, torsion, Klinefelters
31
Q

Causes of increased oestrogen production?

A
  1. Increased production = sex cord stromal tumours, lung Ca

2. Increased peripheral aromatisation = CLD, thyrotoxicosis

32
Q

Potions that cause gynaecomastia?

A
  1. Recreational = Marijuana, Diazepam, Anabolic Steroids

2. Prescription

33
Q

Prescription drugs that cause gynaecomastia?

A
  1. Spironolactone
  2. Digoxin
  3. Captopril
  4. Verapamil
  5. Ranitidine
34
Q

Gynaecomastia Ix?

A
  1. Testicular Ca = AFP, bHCG
  2. Hypogonadism = testosterone and LH
  3. Prolactinoma = PRL
  4. TFTs
35
Q

Gynaecomastia suggestive of Ca Fx?

A
  1. Older age
  2. FHx
  3. Unilateral
  4. Firm or hard nodules w/in breast tissue
  5. Axillary LNs