Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| S. aureus, strep, MRSA, S. epidermitidis |
|
|
Term
| risk factors for mastitis - 3 |
|
Definition
| poor latch, incomplete emptying, cracking |
|
|
Term
| initial treatment for mastitis - 4 |
|
Definition
| massage, heat, NSAIDS, pumping (controversial) |
|
|
Term
| antibiotics for mastitis - 3 |
|
Definition
| dicloxacillin, clinda if PCN allergy, TMP-SMX if suspect MRSA |
|
|
Term
| when do you admit for mastitis |
|
Definition
|
|
Term
| when do you US for mastitis - 2 |
|
Definition
| suspect abscess, failed treatment |
|
|
Term
|
Definition
|
|
Term
| when do you resume feeds after mastitis and abscess |
|
Definition
| mastitis never stop, abscess when redness goes away |
|
|
Term
| recurrence rate breast abscess |
|
Definition
|
|
Term
|
Definition
| superficial thrombophlebitis due to surgery or trauma, can be idiopathic |
|
|
Term
|
Definition
| red cord spanning a vein (goose quill, drumstick, bowstring) |
|
|
Term
| treatment mondors disease |
|
Definition
|
|
Term
| 6 benefits of breastfeeding |
|
Definition
increased: growth, development
decreased: GI/resp illness, nec, PPH, depression |
|
|
Term
| 5 promotors of breastfeeding |
|
Definition
| within 1h of birth, frequent feeds, skin to skin, decrease stress, schedules |
|
|
Term
| what is higher in foremilk - 3 |
|
Definition
| protein, fatty acids, fat soluble vitamins |
|
|
Term
| contraindications to breastfeeding - 9 |
|
Definition
| HIV, HSV on breast, untreated TB, varicella, radioactive iodine, MTX, lithium, bromocriptine, cyclophosphamide |
|
|
Term
| what med can you use if someone does not want to breastfeed |
|
Definition
|
|
Term
| what is the pumping schedule if baby is in NICU |
|
Definition
| start 6-12h post birth, pump 8-12x/d |
|
|
Term
| 3 options if low milk supply |
|
Definition
| hand expression of viscous hindmilk, metoclopramide, fenugreek |
|
|
Term
|
Definition
|
|
Term
| how long is metoclopramide used for low milk |
|
Definition
| 7-12d, never more than 12wk |
|
|
Term
| how much does metoclopramide improve milk supply |
|
Definition
|
|
Term
| major side effect metoclopramide |
|
Definition
|
|
Term
|
Definition
| trigonella foenim-graceum - phytoestrogen and diosgenin |
|
|
Term
| how well does fenugreek work for low milk |
|
Definition
|
|
Term
| side effects genugreek - 3 |
|
Definition
| nausea, diarrhea, asthma worsening |
|
|
Term
| how long does it take fenugreek to work |
|
Definition
|
|
Term
|
Definition
|
|
Term
| management of focal, non-cyclic mastalgia |
|
Definition
| likely due to muscle or lesion, get diagnostic mammogram |
|
|
Term
| management of cyclic non-focal mastalgia - 4 |
|
Definition
| likely due to luteal changes, supportive bra, NSAIDS #1, danzol FDA approved, tamoxifen non-FDA approved |
|
|
Term
| #1 treatment for mastalgia |
|
Definition
|
|
Term
| treatments that have no evidence for mastalgia - 6 |
|
Definition
| OCPS, vitamin E, B6, decreasing Na/caffeine/fats |
|
|
Term
| causes of bloody nipple discharge - 3 |
|
Definition
| intraductal papilloma #1, cancer/DCIS, ductal ectasia |
|
|
Term
| causes of brown nipple discharge - 2 |
|
Definition
| ductal ectasia, fibrocystic disease |
|
|
Term
| causes of green nipple discharge - 2 |
|
Definition
| ductal ectasia, fibrocystic disease |
|
|
Term
| causes of yellow nipple discharge - 1 |
|
Definition
|
|
Term
| causes of milky nipple discharge - 1 |
|
Definition
|
|
Term
| causes of clear nipple discharge - 1 |
|
Definition
|
|
Term
| chances of breast cancer if nipple discharge and mass |
|
Definition
|
|
Term
| chances of breast cancer if nipple discharge and no mass |
|
Definition
|
|
Term
| % nipple discharge that spontaneously resolves |
|
Definition
|
|
Term
| #1 cause of bloody nipple discharge |
|
Definition
| intraductal papilloma 60% |
|
|
Term
| #2 cause of bloody nipple discharge |
|
Definition
| cancer 5-15% (usually DCIS) |
|
|
Term
| concerning signs of nipple discharge - 7 |
|
Definition
| clear, yellow, UL, persistent, serosanginous, spontaneous, expressed from single duct |
|
|
Term
| first step in nipple discharge work up |
|
Definition
| exam and guiac, if nothing on exam do galactorrhea work up, if something on exam do diagnostic US and mammogram |
|
|
Term
| characteristics of nipple discharge where after mammogram youd just monitor routinely - 4 |
|
Definition
| white, green, not spontaneous, multiple ducts |
|
|
Term
| characteristics of nipple discharge where after mammogram youd either do frequent exams or biopsy - 4 |
|
Definition
| bloody, spontaneous, serous, single duct |
|
|
Term
| if concerning signs of nipple discharge and nothing on mammogram what is the risk of cancer, what could you do if still concerned |
|
Definition
|
|
Term
| if concerning signs of nipple discharge and nothing on mammogram to biopsy how often do you scree |
|
Definition
| imaging in 6mo, exam q6mo for 1-2y |
|
|
Term
| skin changes concerning of breast - 5 |
|
Definition
| thickening, erythema, dimpling, ulceration, induration, inflammation |
|
|
Term
| characteristics of a palpable mass that are concerning - 9 |
|
Definition
| skin changes, nipple retraction, bloody DC, non-tender, >70yo, axillary adenopathy, solid, immobile, indistinct borders |
|
|
Term
| characteristics of a palpable mass that are not concerning - 5 |
|
Definition
| no skin changes, smooth, mobile, well defined, <25yo |
|
|
Term
| if a palpable mass is not concerning what is the first step in management |
|
Definition
| observation 1-2mo, if not resolved do diagnostic mammogram |
|
|
Term
| management of non-concerning palpable mass, BIRADS 1-2 |
|
Definition
| observation 1-2y, biopsy if changes |
|
|
Term
| management of non-concerning palpable mass, simple cyst |
|
Definition
| routine follow up, therapeutic aspiration if desired |
|
|
Term
| management of non-concerning palpable mass,solid cyst |
|
Definition
| BIRADS 3 - US or dx mammogram q6-12mo for 1-2y, biopsy if changes. BIRADS 4 - tissue biopsy |
|
|
Term
| management of concerning palpable mass - BIRADS 1 |
|
Definition
|
|
Term
| management of non-concerning palpable mass - simple cyst |
|
Definition
|
|
Term
| management of non-concerning palpable mass - BIRADS 3 |
|
Definition
|
|
Term
| management of non-concerning palpable mass - solid cyst |
|
Definition
|
|
Term
| management of non-concerning palpable mass - non-simple cyst |
|
Definition
| aspiration vs tissue biopsy |
|
|
Term
| after finished working up a palpable breast mass, what is the long term follow up |
|
Definition
| exam q3-6mo for 1-2y, consider DX imaging q6-12mo for 1-2y |
|
|
Term
| benefits of US diagnosis for breast mass - 5 |
|
Definition
| <30yo, dense breasts, gives solid vs cystic, cab BX/FNA at time, best for occult masses |
|
|
Term
| benefits of mammogram - 2 |
|
Definition
| decreases stage 2+ breast cancer <50yo, decreases mortality associated with breast cancer with increasing age |
|
|
Term
|
Definition
| 10% recall, 61% FP, 10% FN >50yo, 20% FN <50%, 1:8 unneeded treatments, radiation exposure |
|
|
Term
| management of FNA results - 3 |
|
Definition
| clear - routine follow up, bloody - cytology and core biopsy, mass remains after aspiration - cytology and core biopsy, solid/no fluid - core biopsy |
|
|
Term
| 4 indications for breast MRI |
|
Definition
| dense tissue after identification on mammogram, if >20% lifetime risk of cancer, history of radiation 10-30yo, hereditary cancer syndrome |
|
|
Term
|
Definition
| decreased detection of insitu and <3mm lesions, increased FP/unneeded bx/recall over mammogram |
|
|
Term
| 6 things breast MRI is better for |
|
Definition
| better for hereditary cancer syndromes, silicone implants, known cancer, dense breasts, scarring, axillary mass of unknown primary |
|
|
Term
| risks of digital mammogram - 1 |
|
Definition
|
|
Term
| benefits of digital mammogram - 4 |
|
Definition
| better for <50yo, dense tissue, microcalcifications, overall superior to MRI, lower FP |
|
|
Term
| definition and risk of cancer - BIRADS 0 |
|
Definition
|
|
Term
| definition and risk of cancer - BIRADS 1 |
|
Definition
|
|
Term
| definition and risk of cancer - BIRADS 2 |
|
Definition
| benign normal changes, 0% |
|
|
Term
| definition and risk of cancer - BIRADS 3 |
|
Definition
| probably benign, close interval follow up, 2-95% cancer |
|
|
Term
| definition and risk of cancer - BIRADS 4 |
|
Definition
| suspicious for cancer, A - 2-10%, B - 10-50%, C - 50-95% |
|
|
Term
| definition and risk of cancer - BIRADS 5 |
|
Definition
|
|
Term
| definition and risk of cancer - BIRADS 6 |
|
Definition
|
|
Term
| criteria to be called BIRADS 5 - 3 |
|
Definition
| space occupying lesion in 2+ projections, 5+ clustered calcifications, skin distortion |
|
|
Term
| explain BIRADS 1 for dense breast, the % of the population that has it, and the % sensitivity of the test |
|
Definition
| all fat, 10% population, 88% sensitivity |
|
|
Term
| explain BIRADS 2 for dense breast, the % of the population that has it, and the % sensitivity of the test |
|
Definition
| scattered fibroglandular densities, 43% population, 82% sensitivity |
|
|
Term
| explain BIRADS 3 for dense breast, the % of the population that has it, and the % sensitivity of the test |
|
Definition
| dense heterogeneously, 39% population, 69% sensitivity |
|
|
Term
| explain BIRADS 4 for dense breast, the % of the population that has it, and the % sensitivity of the test |
|
Definition
| extremely dense, 8% population, 62% sensitivity |
|
|
Term
| when do you get a MRI for dense breast tissue |
|
Definition
| only in patients with risk factors |
|
|
Term
| risk of cancer with dense breast tissue |
|
Definition
|
|
Term
| non-proliferative breast lesions - 4 |
|
Definition
| fibrocystic changes, fibrocystic disease, chronic cystic mastitis, breast cysts |
|
|
Term
| proliferative breast lesions - 5 |
|
Definition
| ductal hyperplasia, intraductal papilloma, sclerosing adenosis, radial scars, fibroadenoma complex |
|
|
Term
| atypical hyperplasias - 2 |
|
Definition
|
|
Term
| average age of breast cysts |
|
Definition
|
|
Term
| risk of cancer with proliferative breast lesions |
|
Definition
|
|
Term
| management of atypical ductal or lobular hyperplasia |
|
Definition
| semiannual breast exam, yearly mammogram |
|
|
Term
| pagets of the breast is what % of breast cancer |
|
Definition
|
|
Term
| type of breast cancer associated with pagets |
|
Definition
| intraductal carcinoma, 80% have DCIS though |
|
|
Term
| signs of pagets of the breast - 7 |
|
Definition
| eczema, ulcers, clear/yellow discharge, crusting, itchy, burning, bloody |
|
|
Term
| parts of the gail model - 7 |
|
Definition
| age, menarche, age of first birth, 1st degree relatives with breast cancer, prior breast biopsies, atypical hyperplasias, race |
|
|
Term
| contraindications to gail model - 2 |
|
Definition
| high risk patient, BRCA in family history |
|
|
Term
| interpretation of GAIL model results |
|
Definition
| if >1.6% risk start on tamoxifen, consider mastectomy or BSO if lifespan likely >10y |
|
|
Term
|
Definition
|
|
Term
| #1 location of breast cancer |
|
Definition
|
|
Term
| smallest palpable breast mass |
|
Definition
|
|
Term
| lifetime risk of breast cancer |
|
Definition
|
|
Term
| average 5y survival for breast cancer |
|
Definition
|
|
Term
| percent of breast cancer that is ductal and lobular |
|
Definition
|
|
Term
| #1 relative risk of breast cancer |
|
Definition
|
|
Term
| #2 relative risk of breast cancer |
|
Definition
|
|
Term
| #3 relative risk of breast cancer |
|
Definition
| dense breast tissue >75% = 2-6 |
|
|
Term
| #4 relative risk of breast cancer |
|
Definition
|
|
Term
| #5 relative risk of breast cancer |
|
Definition
| first degree relative with breast cancer = 3 |
|
|
Term
| risks of breast cancer with relative risk 1-2 - 8 |
|
Definition
| first birth >30yo or nullip, menopause >55yo, history of breast biopsy, BMI >30, menarche <12yo, alcohol >2-5/d, unopposed estrogen, OCPs |
|
|
Term
| % of breast cancer that is self detected |
|
Definition
|
|
Term
| % false positive with clinical breast exam |
|
Definition
|
|
Term
| % clinical breast exam adds to detection of cancer with mammogram |
|
Definition
|
|
Term
| ACOG recommendation for clinical breast exam |
|
Definition
| q1-3y 25-39yo, annual at 40yo |
|
|
Term
| ACOG recommendation for mammogram |
|
Definition
| offer at 40yo, start at 50yo q1-2y, stop at 75yo or life expectancy <10y, continue past 75yo if desires |
|
|
Term
| recommendation for screening in BRCA, history of RT, or LCIS |
|
Definition
| mammogram and MRI alternating q6mo, start 10y before first family breast cancer diagnosis but no later than 25yo in BRCA, start 8-10y post RT but no earlier than 25yo, clinical exam q6-12mo |
|
|
Term
| average age of presentation DCIS vs LCIS |
|
Definition
|
|
Term
| clinical presentation DCIS vs LCIS |
|
Definition
| DCIS palpable mass, sometimes Y shaped, calcifications. LCIS is often an incidental finding. |
|
|
Term
| management of DCIS in low risk patient, risk of recurrence |
|
Definition
| lumpectomy 25% recur, followed by tamoxifen (controversial) |
|
|
Term
| management of DCIS in a high risk patient, risk of recurrence |
|
Definition
| lumpectomy + rads, 10% recurrence, followed by tamoxifen (controversial) |
|
|
Term
| why is tamoxifen for DCIS post treatment contriversial |
|
Definition
| it decreases ipsilateral recurrence a little, it decreases contralateral recurrence, but it does not change overall survival recurrence decreases from average 14 to 7% |
|
|
Term
| why isn't a simple mastectomy done for DCIS, recurrence |
|
Definition
| it can be if patient wants, recurrence is 2%, but mortality is the same even though recurrence is less |
|
|
Term
|
Definition
| increased screening mammogram/MRI q6mo alternating, clinical exam q6-12mo, optional prophylactic mastectomy +/- chemoprevention (in trials) |
|
|
Term
| characteristics of stage 1 breast cancer |
|
Definition
|
|
Term
| characteristics of stage 2 breast cancer |
|
Definition
| <5cm with positive nodes, >5cm without positive nodes |
|
|
Term
| characteristics of stage 3 breast cancer |
|
Definition
| extends to chest wall or skin, fixed nodes, >5cm with positive nodes |
|
|
Term
| characteristics of stage 4 breast cancer |
|
Definition
|
|
Term
| candidates for breast conserving therapy in breast cancer - 5 |
|
Definition
| none of these... multifocal disease, large tumor, hx chest PT, diffuse calcifications, positive margins |
|
|
Term
| what is breast conserving therapy |
|
Definition
| lumpectomy, LND level 1-2 vs SLN biopsy, RT |
|
|
Term
| who gets chemo after breast cancer surgery - 2 |
|
Definition
| anyone with a tumor >1cm or positive nodes |
|
|
Term
| who gets hormonal prophylaxis after breast cancer surgery |
|
Definition
| anyone who is ER/PR positive |
|
|
Term
|
Definition
| anti estrogenic on breast, estrogenic on bone and endometrium |
|
|
Term
| after breast cancer surgery how long do you give tamoxifen for |
|
Definition
| positive nodes 10y, negative nodes 5y |
|
|
Term
| when on tamoxifen what prevention do they need - 3 |
|
Definition
| EMBx for any AUB regardless of EMS, yearly eye exams, consider IUD to reduce polyps (but does not reduce hyperplasia) |
|
|
Term
| what SE in tamoxifen are WORSE than AIs - 3 |
|
Definition
| cataracts, VTE, endometrial hyperplasia |
|
|
Term
| what SE in AIs are WORSE than tamoxifen - 4 |
|
Definition
| muscle/joint pain, vaginal dryness/dysparunea, lowers BMD |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| SE tamoxifen not in the top 6 - 6 |
|
Definition
| VTE 5%, sexual dysfunction, ovarian cysts, vaginal dryness, endometrial hyperplasia |
|
|
Term
| risk of endometrial cancer on tamoxifen |
|
Definition
|
|
Term
| indication for toremifine |
|
Definition
| metastatic cancer in ER positive breast cancer |
|
|
Term
|
Definition
| stop conversion of androstendione to estrone and thus E2 in the adipose tissue |
|
|
Term
| indication for aromatase inhibitors |
|
Definition
| ER positive breast cancer PMP in replacement or after tamoxifen |
|
|
Term
|
Definition
| anastrazole, letrazole, exemestane |
|
|
Term
|
Definition
| instead of tamoxifen for 5y, after 2-3y of tamoxifen, after 2-5y of tamoxifen for 5y |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| hot flashes, vaginal dryness, muscle/joint pain, carpal tunnel, hair thinning, mood changes, decreased BMD, fracture (returns to normal risk after) |
|
|
Term
| #1 prognostic factor for breast cancer |
|
Definition
|
|
Term
| risks that axillary nodes may be positive - 6 |
|
Definition
| size, grade, location, LVSI, clusters of stromal invasion, microinvasion 5% |
|
|
Term
| % of breast masses that are in pregnancy and benign |
|
Definition
|
|
Term
| best way to diagnose breast masses in pregnancy |
|
Definition
|
|
Term
| if has breast cancer in pregnancy how does that change prognosis |
|
Definition
|
|
Term
| when do you deliver for breast cancer in pregnancy |
|
Definition
| you don't necessiarly, termination does not improve outcomes, but you should deliver 3wk after any chemo |
|
|
Term
| is mastectomy ok in pregnancy |
|
Definition
|
|
Term
|
Definition
| controversial due to radio-injection, so no |
|
|
Term
| complications of breast cancer chemo in pregnancy - 4 |
|
Definition
| IUGR, PTD, neutropenia of mom and baby |
|
|
Term
| SE of tratuzamab in pregnancy |
|
Definition
|
|
Term
| chemo often used in pregnancy in breast cancer - 4 |
|
Definition
| taxanes, vinorelbine, anthracycline, cyclosphosphamide |
|
|
Term
| when is chemo given in pregnancy for breast cancer |
|
Definition
|
|
Term
| if someone qualifies for chemoprophylaxis and declines, what is the survellience |
|
Definition
| exam q6-12mo, yearly mammogram |
|
|
Term
| chemoprophylaxis tamoxifen vs raloxifene - cancer prevention |
|
Definition
|
|
Term
| chemoprophylaxis tamoxifen vs raloxifene - VTE risk |
|
Definition
|
|
Term
| chemoprophylaxis tamoxifen vs raloxifene - endometrial hyperplasia |
|
Definition
|
|
Term
| chemoprophylaxis tamoxifen vs raloxifene - cataracts |
|
Definition
|
|
Term
| chemoprophylaxis tamoxifen vs raloxifene - age group |
|
Definition
| tamoxifen preferred pre-MP, raloxifene PMP |
|
|
Term
| chemoprophylaxis tamoxifen vs raloxifene - dose |
|
Definition
| tamoxifen 20mg x5y, raloxifene 60mg x5y |
|
|
Term
| rate of premature ovarian failure after breast cancer treatment |
|
Definition
|
|
Term
| #1 drug causing premature ovarian failure |
|
Definition
|
|
Term
| if ovarian function returns what is a good sign |
|
Definition
|
|
Term
| even if ovarian function returns after treatment what are the other issues with ovaries |
|
Definition
|
|
Term
| how much venlafaxine is best for balance of SE/hot flashes |
|
Definition
|
|
Term
| what drugs for HF decrease tamoxifen |
|
Definition
|
|
Term
| evidence for each in treatment of HF in breast cancer patients - buproprion, black cohosh, acupuncture, exercise, relaxation techniques |
|
Definition
| buproprion no data, black cohosh helps but little data, acupuncture no help, exercise helps, relaxation helps |
|
|
Term
| what 3 SSRIs have good evidence for HF |
|
Definition
| paroxetine, citalopram, escitalopram |
|
|
Term
| what 2 SSRIs have conflicting evidence for HF |
|
Definition
|
|
Term
| what forms are ok of vaginal estrogen in breast cancer patients |
|
Definition
| ring helps but no trials, suppository can interfere with AIs but limited data avoid them, cream helps |
|
|
Term
| when can you use testosterone for vaginal atrophy in breast cancer patients |
|
Definition
| you cant, it has a statistically non-significant but increased risk of breast cancer |
|
|
Term
| when can you use HRT for treatment of vaginal atrophy in breast cancer |
|
Definition
| if refractory to the other treatments for a short period of time |
|
|
Term
| cause of decreased sexual satisfaction after chemo |
|
Definition
| no desire 64%, dysparunea 38%, dryness 42% |
|
|
Term
| cause of decreased sexual satisfaction in breast cancer patients - 4 |
|
Definition
| body image, lack of sensation, inability to orgasm, chemo complications |
|
|
Term
| what is the one thing that helps with sexual satisfaction in breast cancer patients |
|
Definition
| breast conserving surgery |
|
|
Term
| what are good forms of contraception after breast cancer - 3 |
|
Definition
| condoms, copper IUD, sterilization |
|
|
Term
| is the mirena ok after breast cancer |
|
Definition
| trial says no increased cancer, but overall conflicting evidence, best to ask their oncologist |
|
|
Term
| is hormonal contraception ever ok after breast cancer |
|
Definition
| no, but technically after 5y cancer free it is a category 3 |
|
|
Term
| other than antidepressants how can you treat depression in breast cancer patients |
|
Definition
| treat their vasomotor symptoms, its associated with depression |
|
|
Term
| cause of osteoporosis in breast cancer patients - 3 |
|
Definition
| chemo, ovarian suppression, AIs |
|
|
Term
| survellience DEXA in breast cancer patients |
|
Definition
|
|
Term
| when to start bisphosphonates in breast cancer patients - 3 |
|
Definition
| T -1.5 to -2, >20% fx risk in 10y, >3% hip fx risk |
|
|
Term
| what bisphosphonate is best in breast cancer patients, why |
|
Definition
| zolduronic acid - helps kill tumor in bone |
|
|
Term
| how much does pregnancy increase risk of recurrence of breast cancer |
|
Definition
|
|
Term
| what can be used for ovulation induction after breast cancer |
|
Definition
|
|
Term
| what can help protect the ovaries, maybe, and help with future fertility in breast cancer patients |
|
Definition
| GNRH agonists during chemo |
|
|
