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Surgery M4 part 1 > Breast 1 > Flashcards

Breast 1 Flashcards

1
Q

What are the components of breast tissue?

A
  • glandular tissue consisting alveoli and ducts (ACINI) and lactiferous ducts
  • fibrofatty tissue - Cooper’s ligament
  • Axillary tail of Spencer
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2
Q

What is the attachment of Cooper’s ligament?

A

from Pectoralis Major to Skin

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3
Q

What is the only part of the female breast present deep to the deep fascia?

A

Axillary Tail of Spence

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4
Q

What is the medial blood supply of the breast?

A
  • internal thoracic artery from Subclavian

- anterior intercostals from internal thoracic

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5
Q

Which group of lymph nodes should be removed in case of breast cancer?

A
  • level 1 and 2 only
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6
Q

Why don’t we remove level 3?

A

to not obstruct the upper limb lymphatics

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7
Q

which hormone is responsible for fat deposition in breast? at what age

A

estrogen at telarche

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8
Q

which hormone is responsible for the development of the duct system in the mammary glands?

A

progesterone

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9
Q

What is prolactin’s effect on the breast? When is it secreted?

A

formation of acini and milk formation during pregnancy

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10
Q

Which hormone is responsible for milk ejection?

A

oxytocin

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11
Q

What is the most important and most commonly used method of breast investigation?

A

Mammogram

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12
Q

When is mammography used?

A

In older females due to a lower breast density resulting in a clearer view of a mass

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13
Q

What is the alternative method to use on younger females instead of the Mammogram?

A

breast ultrasound

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14
Q

What is the best screening method for carcinoma? and why?

A
  • Mammogram
  • it can detect micro calcifications before the appearance of a mass
  • it can differentiate between malignant (speculated) and benign (smooth) lesions
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15
Q

Which method of investigation can differentiate between cystic and solid lesions?

A

breast ultrasonography

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16
Q

What are the indications for breast MRI?

A
  • history of surgery inside the breast (scar tissue present)
  • detecting recurrence in a previous conservative breast surgery
  • only way to screen breast in case of silicon implants
  • presence of strong family history
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17
Q

What are the indications for breast MRI?

A
  • history of surgery inside the breast (scar tissue present)
  • detecting recurrence in a previous conservative breast surgery patient that removed a mass
  • only way to screen breast in case of silicon implants
  • presence of strong family history
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18
Q

When should we start the follow ups in case of a strong family history?

A

5 years prior to the development of your family member’s mass

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19
Q

Which method of investigation can differentiate between recurrence and fibrous tissue?

A

breast MRI

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20
Q

How many lactiferous ducts do we have in the female breast?

A

12 - 15 ducts

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21
Q

What is the indication of ductography?

A

When we find bleeding coming from 1 nipple from 1 duct

22
Q

what is the method of investigation that differentiates between intraductal papilloma and carcinoma?

A

ductography

23
Q

How do we suppress growth of a tumor with hormone receptors?

A

anti-estrogen

24
Q

What is the direction of the nipple?

A

Forward Lateral downward

25
Q

What is the effect of congenital nipple retraction and how is it treated?

A

predisposes to lactational breast abscess

  • massage and pull it
  • Ashfford’s operation
26
Q

How do we differentiate between acquired or congenital nipple retraction?

A

the congenital retraction is slit-like

if it’s dating since telarche its congenital if its recent its acquired

27
Q

What is Poland Syndrome?

A
  • amastia or amazia
  • absent sternal pectoralis major
  • absent 2nd to 5th rib
  • hand and vertebral anomalies
28
Q

What is the most common site of development of polymastia?

A

Axilla

29
Q

What is the cause of benign virginal hypertrophy? How is it treated?

A

Macromastia: abnormal estrogen receptor response

- reduction mammoplasty

30
Q

What may simulate malignancy in breast?

A

Traumatic breast diseases

  • breast hematoma due to old clotted hematoma becoming hard and macrocalcified
  • traumatic fat necrosis: minor repeated trauma causing rupture of fat cells leading to macrocalcifications
31
Q

What is the causative organism of acute lactational mastitis?

A

Staph. Aureus

32
Q

Wen are the 2 most common times for lactational mastitis?

A

first week after delivery and during first weaning

33
Q

What is the best method for localization of breast abscess?

A

Ultrasound

34
Q

How can we prevent acute lactational mastitis?

A 
DURING PREGNANCY
- good hygiene 
- nipple massage and frequent pulling
AFTER DELIVERY
- clean nipple after suckling 
- treatment of nipple fissuring 
- pump evacuation if milk engorgement occurs
35
Q

What is the first line of treatment in a small breast abscess?

A

aspiration and antibiotics

36
Q

What is the difference between an acute or chronic abscess?

A

chronic abscess

  • surrounded by extensive fibrosis resembling malignancy
  • leads to dimpling and nipple retraction
37
Q

What is mammary duct ectasia?

A

dilated inflamed lactiferous ducts

38
Q

What is the diagnosis of a breast secreting creamy discharge?

A

mammary duct ectasia

39
Q

What is the blood supply of the lateral aspect of the breast?

A
  • lateral thoracic artery from axillary artery

- post. intercostals from thoracic aorta

40
Q

What are the indications for each BIRADS score?

A

BIRADS 0: additional imagining
BIRADS 1: negative -> routine screening
BIRADS 2: benign -> routine screening
BIRADS 3: probably benign -> short interval follow up (6 months)
BIRADS 4: suspicious -> tissue diagnosis
BIRADS 5: highly suggestive of malignancy -> tissue diagnosis
BIRADS 6: biopsy proven malignancy -> surgical excision

41
Q

What does FNABC show?

A

histological signs of malignancy

42
Q

What does a tru cut biopsy show?

A

histological & pathological signs of tissues

43
Q

What’s the difference between amastia & amazia?

A

amastia is the absence of the breast tissue & nipple with aereola
amazia is the absence of the breast tissue only with presence of nipple

44
Q

What is athelia?

A

absence of nipple & aereola only

45
Q

What is polymastia?

A

presence of breast tissue along the milk-line

46
Q

What is polythelia?

A

extra nipples over milk line

47
Q

What are the predisposing factors of acute lactational mastitis?

A
  • milk engorgement
  • nipple fissuring
  • retracted nipple
  • bad hygiene
48
Q

What is the pathogenesis of acute lactational mastitis?

A

milk engorgement -> acute lactational mastitis -> breast abscess

49
Q

What is the difference between the clinical pictures of milk engorgement, lactational mastitis, & breast abscess?

A

MILK ENGORGEMENT LACTATIONAL MASTITIS BREAST ABSCESS
- mild dull aching pain - dull aching pain but more severe - throbbing pain
- mild fever - continuous fever - hectic fever
- enlarged & indurated - signs of inflammation - inflammation not responding to
breast without manifestations treatment of inflammation - +- fluctuation

50
Q

when should a mother with mastitis wean?

A
  • if there is an abscess due to lactational mastitis -> wean
  • if there is only milk engorgement -> continue breast feeding
  • if baby is close to weaning age -> wean
51
Q

what are the types of acute non-lactational mastitis?

A
  • MASTITIS NEONATORUM -> in 3rd day
  • MASTITIS OF PUBERTY -> tender enlargement of breast in boys & girls
  • PREMAMMARY ABSCESS -> infection of Montgomry sweat gland
  • RETROMAMMARY ABSCESS -> deep to pectoral fascia drained by Thomas incision

Surgery M4 part 1 (47 decks)

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