Name the Diagnosis
Workup/Managementt
Breastfeeding
BIRADS
Grab Bag
100
Breast pain that occurs 1 to 2 weeks prior to menses. The pain is commonly felt diffusely and bilaterally, with some radiation to the upper arm and axilla. It can be more severe in one breast than the other and it is relieved by the onset of menstrual flow.
What is: cyclical mastalgia
100
First step in the workup of a <30 year old patient with clinically suspicious palpable breast mass?
What is: US
100
True or false: patients taking daily medication for opioid use disorder should not breastfeed
What is: false
100
Next step in a patient < 30 years old with unilateral, serous, spontaneous nipple discharge and BIRADS 1-3 imaging findings?
What is: Duct excision
100
Three characteristics of nipple discharge that should prompt further workup
What is: Spontaneous, unilateral, from a single duct, clear, serous, or bloody
200
Bilateral breast pain firmness, swelling, occurring 3-5 days postpartum
What is: engorgement
200
First step in the workup of a >30 year old patient with clinically suspicious breast changes?
What is: mammogram
200
Two treatment modalities for plugged ducts
What is: Warm compress, massage, breastfeeding, lecithin
200
Define BI-RADS category 4 and next step for all category 4 findings
What is: Suspicious→ tissue diagnosis
200
Two sonographic features of of a simple breast cyst
What is: Anechoic, sharply circumscribed margins, posterior acoustic enhancement, refractive shadows
300
Most common proliferative breast mass in young women, typically small, well circumscribed, smooth/lobular painless mobile mass
What is: fibroadenoma
300
Two pharmacologic treatment options for mastalgia
What is: NSAIDs, danazol, tamoxifen, bromocriptine
300
Two SSRI’s that are preferred options when breastfeeding
What is: Fluoxetine, citalopram
300
Next step in a patient >30 years old with non-suspicious palpable findings with BI-RADS 1 imaging results?
What is: Monitor for 1-2 years with physical exam and diagnostic imaging
300
Two sonographic features of a complex cyst/solid mass and the next step in management of any cyst with solid components
Internal echos, ill defined margins, wall thickening. Next step-> core biopsy
400
Complex, ill-defined fluid collection that occurs in the setting of inflammation. Can occur as a result of excessive deep tissue massaging of plugged ducts
What is: phlegmon
400
Two antibiotics used for treatment of mastitis
What is: Dicloxacillin 500mg QID, Clindamycin 300mg QID, Augmentin 875mg BID
400
Three risk factors for mastitis
What is: Cleft lip/palate, cracked nipples, infant attachment problems, local milk stasis, missed feedings, nipple piercings, plastic breast pads, previous mastitis, poor maternal nutrition, tight bras, short infant frenulum, use of manual breast pump
400
Next step in a patient >30 years old with abnormal nipple discharge and BIRADS 4-5 imaging findings
What is: tissue biopsy
400
Three maternal benefits of breastfeeding
What is: Decreased risk of breast cancer, ovarian cancer, DM, HTN, MI
500
Collection of obstructed milk in a cyst-like cavity
What is: galactocele
500
Most common cause of abnormal nipple discharge
What is: Intraductal papilloma
500
Two “signs” of adequate milk supply
What is: Average feeding frequency of 8-12 feedings per day, steady weight gained by day 4-5, 6-8 wet diapers on a daily basis
500
Next step in a patient <30 years old with BIRADS 3 imaging results after a breast US and low clinical suspicion
What is: Physical exam +/- ultrasound/mammogram every 6-12 months for 1-2 years to assess stability
500
Three conditions infants with suboptimal breastfeeding are at increased risk of
What is: Otitis media, lower respiratory infection, Crohn’s disease, UC, GI infection, obesity, necrotizing enterocolitis, SIDS, leukemia, T1DM