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Setha: Reproductive Clinical Assessment > Bates/Lecture > Flashcards

Flashcards in Bates/Lecture Deck (39):
1

What breast mass is common between ages 15-25 during puberty and young adulthood?

Fibroadenoma

2

How does a fibroadenoma present?

Round, disc-like, or lobular usually single, but may be multiple mass that may be soft, but usually firm that is well delineated and very mobile, non-tender without retraction sign

3

What breast mass is common between ages 30-50 that repress after menopause except with estrogen therapy?

Cyst

4

How does a cyst present?

Single or multiple round mass that is soft to firm, usually elastic, well delineated, mobile, often tender, without retraction sign

5

What breast mass is seen between the ages of 30-90, but most common over the age of 50?

Breast cancer

6

How does breast cancer present?

Usually single mass with an irregular or stellate shape that is firm or hard, not clearly delineated from surrounding tissues, fixed to skin or underlying tissue, usually non-tender, retraction sign may be present

7

Fibrosis that is caused by shortening of the tissue that produces dimpling, changes in contour, and retraction deviation of the nipple on the breast

Retraction signs

8

What are some causes of retraction signs?

Breast cancer, fat necrosis, and memory duct ectasia

9

What position should the patient be in to look for skin dimpling?

Arms at rest, during special positioning, and on moving or compressing the breast

10

What are the retraction signs?

-Skin dimpling
-Abnormal contouring
-Nipple retraction/deviation
-Edema of the skin
-Pagets disease of the nipple

11

What produces edema of the skin?

lymphatic blockage

12

What sign is seen with edema of the skin?

peau d'orange sign: thickened skin with enlarged pores usually seen first in the lower portion of the breast or areola

13

What is seen with abnormal contours?

Any variation in the normal convexity of each breast compared one side with the other. Special positioning may be useful

14

What is a retracted nipple?

Flattened or pulled inward that may also be broadened and feels thickened

15

What can happen if nipple involvement is radially asymmetric?

It may deviate in a different direction from its normal counterpart, typically toward the underlying cancer

16

Uncommon form of breast cancer that starts as a scaly, eczema like lesion that may weep, crust, or erode with possible breast mass

Paget's disease of the nipple

17

What can Paget's disease present with?

invasive breast cancer or ductal carcinoma in situ

18

When to suspect Paget's disease?

persisting dermatitis of the nipple and areola

19

What is the lifetime risk of breast cancer?

1 in 8!

20

What is the most important risk factor with breast cancer/

AGE!

21

Other risk factors for breast cancer?

-family history
-breast tissue density
-biopsy showing atypical hyperplasia
-Unopposed estrogen exposure (e.g. early menarche, late menopause, no pregnancies)
-radiation to chest wall

22

What percentage of women with breast cancer have no identifiable risk factors?

>50%

23

What is important to know with a family history of breast CA?

Age of diagnosis

24

What screening is done for a young patient with increased risk factors for breast cancer?

Start screening early - usually 10 years prior to the age that the family member was diagnosed - MRI every other year with mammograms in off years

25

Diagnostic testing for a patient below 30 years old with nipple discharge/breast mass

Start with ultrasound only because younger breast tissue is more dense and harder to see things on mammogram

26

Diagnostic testing for a patient over 30 years old with nipple discharge/breast mass

Ultrasound and mammogram usually ordered

27

What age range do you start mammography?

40-50 years old - usually annually

28

Risks of mammograms

False positives, over diagnosis

29

When can you chose to stop giving patients mammograms for screening?

If life expectancy is less than 10 years

30

What gene mutations can you suspect with breast cancer?

BRCA1 & BRCA2

31

What can a positive family history for BRCA1 & BRCA2 include?

-1st degree relative w/ breast CA BEFORE age 50
-≥2 individuals in same lineage w/ breast CA
-1st degree relative w/ ovarian CA

32

Recommendations for CBE

20-40 years old, every 2-3 years
>40, annually

33

What are you looking for in CBE?

-Lump
-Pulled in nipple
-Dimpling
-Dripping
-Redness/rash
-Skin changes

34

What lymphatics should be palpated during CBE?

Infraclavicular, supraclavicular, and central deep axilla

35

How should the patient be positioned on the table for inspection of the breasts?

Patient seated

36

4 positions that the patient needs to be in during breast inspection

-Arms at sides
-Arms over head
-Hands pressed against hips
-Leaning forward

37

What position on the table should the patient be in during palpation?

Patient supine

38

Where are 60% of breast cancers found?

Upper outer quadrant

39

What characteristics do you need to describe if you find a breast mass/lump?

-location (by quadrant or clock, w/ centimeters from nipple)
-size
-shape
-consistency
-tenderness
-mobility