Breast and axilla Flashcards
(92 cards)
1
Q
What do you always check for in breast cancer screens?
A
Axillary lymph nodes
2
Q
What is tanner stage 1?
A
Elevation of only the papilla
3
Q
What is tanner stage 2?
A
Breast bud stage
Elevation of breast and papilla as a small mound
Enlargement of areola
4
Q
What is tanner stage 3?
A
Further enlargement of breast and areaola WITHOUT separation
5
Q
What is tanner stage 4?
A
Areola projected aboive level of breast as a secondary mound
6
Q
What is tanner stage 5?
A
Mature stage
Recession of areola mound to the general contour of the breast
Pojection of papilla only
7
Q
How long does it take to develop breasts?
A
4 years
8
Q
What are the 5 characterisitcs to look for during the breast examination?
A
Size Symmetry Shape Skin color Skin texture
9
Q
What is the best position for the patient to be in when palpating the breast?
A
Supine, with pillow beneath scapula
10
Q
What is the best method for palpating the breast?
A
vertical method
11
Q
Where do most malignancies in the breast occur?
A
Upper, outer quadrant
12
Q
What is the inframmary ridge?
A
Normal finding: reidge of compressed tissue along the lower edge of the breast
13
Q
When do you compress the nipple?
A
Only if there is discharge
14
Q
What are the five D’s for breast exam?
A
Discharge Depression or inversion Discoloration Dermatologic changes Deviation (compare opposite side)
15
Q
True or false: an “innie” nipple is always bad
A
False–only bad if changed
16
Q
What is the areola?
A
Pigment surrounding nipple
17
Q
What is colostrum?
A
a clear or milky fluid that is expressed from teh breast before milk production
18
Q
What is galactorrhea?
A
Lactation no associated with child bearing
19
Q
What is gynecomastia?
A
Abnormal large mammary glands in the male (sometimes may excrete milk)
20
Q
What is mastisits?
A
Inflammation of the breast
21
Q
What is mastodynia?
A
Pain in the breast
22
Q
When does breast development occur relative to the pubic hair development?
A
1 year prior to pubic hair
2 years prior to menarche
23
Q
What are the non-modifiable factors for breast CA?
A
Gender Age Genetic FHx PHx Race (whites more likely to have, blacks more likely to die) Dense breast tissue Previous chest radiation DES exposure Early menarche/menopause
24
Q
What are the modifiable factors for breast CA?
A
Postmenopausal obesity Exercise EtOH Hormone replacement Recent oral contraception breast feeding lowers risk
25
What are the three risk assessment tools?
Gail model
Claus model
BTCAPRO model
26
When are mammograms recommended?
above age 40, yearly
75+ should have discussion
27
When should women 20-39 have clinical breast exams?
1-3 years
28
When should women 40+ have clinical breast exams?
Yearly
29
When should women begin self-breast exam?
over 20 years
30
How often should high risk women have mammograms (or MRIs)?
yearly
31
When are venous changes normal?
Bilateral in obese or pregnant women
32
When are venous changes abnormal?
Unilateral
33
When you should not examine braests?
during menses (wait 5-7 days after)
34
What are the three biggest symptoms of breast disease?
Mass
pain
nipple discharge (color dependent bloody=CA)
35
What are the characteristics of breast carcinoma discharge (4)?
1. spontaneous
2. bloody
3. associated with mass
4. localized to a single duct in one breast
36
What are the characteristics of non-malignant breast discharge?
1. Discharge only with compression
2. multiple duct involvement
3. Frequently bilateral
37
nipple discharge that is clear, yellow, white, or dark green is characteristic of what type of breast issue (carcinoma or non-malignent)?
Either
38
What muscles form the floor of the breast (6)?
```
Pectoralis major &minor
Serratus anterior
Lats
Subscapularis
External oblique
Rectus abdominus
```
39
Where are the four places lymph can drain
Central axillary
Pectors
Subscapular
Lateral (along upper humerus)
40
Where do the pectoral lymph nodes receive drainage from?
Chest wall, breast
41
Where do the subscapular lymph nodes receive drainage from?
posterior chest wall, lateral border of the scap
42
Where do the lateral lymph nodes receive drainage from?
Upper arm
43
When is the best time (of the month) to perform a breast exam?
5-7 days after onset of menses
44
Where in the breast do most malignancies occur?
Upper, outer quadrant
45
What is the best method to use to palpate the breast: vertical (lawnmower), circular, or spoke?
Vertically
46
When should you compress the nipple?
Only if it has discharge
47
What is the common breast lesion for women ages 15-25?
Fibroadenomas
48
What is the common breast lesion for women ages 25-50?
Cysts
Fibrocystic changes
CA
49
What is the common breast lesion for women ages 50+?
CA until proven otherwise
50
What is the common breast lesion for women who are pregnant?
Lactating ademonma
51
What are the characterisitics of fibroadenomas? Are they mobile? Are they TTP?
Usually smooth, rubbery, round, mobile, no TTP
52
What are the characteristics of cysts?
usually soft, round, mobile
53
What are the characterisitcs of CA? Are they mobile?
Irregular, firm, may be mobile or fixed
54
What are the characteristics of fibrocystic changes?
nodular, ropelike
55
How many times more likely are women likely to get breast cancer than men?
100x more likely
56
What percent of breast cancers are heriditary?
5-10%
57
What is the most common genetic cause of breast CA?
BRCA1/2
58
What percent of invasive breast cancers were in women aged 55 or older?
2/3
59
One, first degree relative with breast CA increased your risk how much? How about for two primary relatives?
doubles risk, 5x for two
60
What is the racial disparity between white and african american women in terms of developing breast CA?
White more likely to develop
| Black more likely to die
61
Are women with dense breast tissue more or less likely to develop breast CA?
MOre
62
What is DES? How does it relate to breast CA?
Used in the 40's-70s to decrease miscarriage, but carinogenic to both mother and daughters
63
Women who have menopause (insert word here) or had menarche (here too) are more likely to develop breast CA.
Had menarche early, menopause later
64
Does breast feeding increase or decrease the risk for breast cancer?
Decreases
65
Does using hormone replacement therapies increase or decrease the risk for breast CA?
Increases
66
Define: areola
pigmented area surrounding the nipple
67
Define: colostrum
clear or mily fluid that is expressed from the breast before milk production
68
Define: duct ectasia
a benign condition of the subareolar ducts that can cause a nipple discharge
69
Define: fibroadenoma
a benign tumor of the breast
70
Define: fibrocystic disease
a benign condition that presents with fluid-filled cyst due to ductal enlargement that
is usually bilateral and multiple.
71
what is Galactorrhea
lactation not associated with childbearing
72
define Gynecomastia
abnormally large mammary glands in the male; sometimes may excrete milk
73
What are Intraductal papillomas?
benign tumors of the subareolar ducts that produce a nipple discharge
74
What is pain in the breast called?
Mastodynia:
75
what are tiny sebaceous glands that may appear on the areola called?
Montgomery follicles
76
What is Paget's disease
skin manifestations that are indicative of ductal carcinoma
77
What are skin changes of the breast due to edema caused by blockage of the lymph drainage
associated with inflammatory breast cancer called?
Peau d’orange
78
What is the tail of spence?
area where most malignancies of the breast tissue occurs.
79
What is the beginning of female pubertal breast development called?
Thelarche
80
Are fibrocystic changes of the breast usually unilateral or bilateral?
bilateral
81
What is the only type of mass that causes retraction of the breast?
CA
82
Which of the breast masses discussed varies with menses?
Fibrocystic breast changes
83
Is cancer usually unilaterally found, or bilaterally?
unilaterally
84
What type of shape are breast CAs?
Irregular or stellate
85
Does breast CA have well defined borders or poorly define borders? Are they fixed or mobile? Are they firm or soft
Poorly defined borders, fixed, hard
86
When are venous pattern changes in breasts concerning?
When they are unilateral
87
What happens to breasts at pregnancy (4)?
1. Fuller and more firm
2. areola darkens
3. nipple enlarges
4. Colostrum produced in the third trimester
88
You are seeing a new female patient that is concerned for breast CA. She is 23 years old, and presents with multiple, round masses in her right breast. The masses are firm, well delineated, mobile, and are non-tender. Retraction signs are absent. Based on lecture what is your diagnosis?
Fibroadenoma
89
You are seeing a new female patient with a concern for breast CA. She is a 37 yo female, who presents with, round, soft, and well delineated masses in her breasts bilaterally. The masses are mobile, and TTP. Retraction signs are absent. Based on lecture what is your diagnosis?
Cysts
90
You are seeing a well established 58 y.o. female patient who has a concern for breast CA. She presents with a single, poorly delineated, and irregular mass in her left breast that is firm to palpation. The mass is not moble, and retraction is present. Based on lecture what is your diagnosis?
May be CA
91
Infiltrating ductal presents as what (3 features)? What age group is most commonly affected?
Single, fixed, irregular mass
30-80 yo it is the most common
92
Are inflamatory tumors of the breast malignant or benign?
Malignant with poor prognosis
