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Clin Med 3 > Breast and Axillae - Lecture > Flashcards

Breast and Axillae - Lecture Flashcards

1
Q

What muscles form the floor of the breast (7)?

A 
pectoralis major 
pectoralis minor
serratus anterior
latissimus dorsi
subscapularis
external oblique
rectus abdominus
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2
Q

extends from connective tissue layer through the breast and attaches to the underlying muscle fascia, providing support for the breast

A

fibrous tissue: Coopers ligament or suspensory ligaments

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3
Q

lie along the chest wall; high in the axilla, midway between the anterior and posterior axillary folds

A

central nodes

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4
Q

anterior, lower border of pectoralis major; drains chest wall and much of the breast

A

pectoral nodes

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5
Q

posterior, lateral border of the scapula; drain posterior chest wall and a portion of the arm

A

subscapular nodes

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6
Q

along the upper humerus; drain most of the arm

A

lateral nodes

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7
Q

Briefly describe the path of lymph drainage in the breast

A

lymph drains from central axillary nodes to infraclavicular and supraclavicular nodes which then drains into axilla lymph nodes

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8
Q

When does onset of breast development occur?

A

approximately 1 year prior to onset of pubic hair development
2 years prior to menarche

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9
Q

How long does the process of breast development take?

A

usually 4 years

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10
Q

ridge of vestigial epithelium running from axilla to inguinal region which may house rudiments of breast tissue

A

milk line

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11
Q

What does modifiable risk mean?

A

factors that patient can change

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12
Q

What does non-modifiable risk mean?

A

factors that patient cannot change, such as genetics

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13
Q

What are some non-modifiable risks for breast cancer?

A

1) gender
2) age
3) genetic
4) family history
5) personal history
6) race
7) dense breast tissue
8) previous chest radiation
9) DES (diethylstilbestrol) exposure
10) menstrual periods
11) certain benign breast conditions

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14
Q

Which of the non-modifiable risks is the most important?

A

age

2 of 3 invasive breast cancer of women 55 or older

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15
Q

How much more likely are women to get breast cancer compared to male?

A

100 times more common in women

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16
Q

What percentage of breast cancer is hereditary?

A

5-10%

BRCA1 & BRCA2 are the most common (risk is as high as 80% to occur in younger women and affecting both breasts)

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17
Q

How is family history a non-modifiable risk?

A

first degree relative doubles risk, two first degree increases risk 5-fold

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18
Q

How is personal history a non-modifiable risk?

A

increase risk in getting new cancer in the other or same breast

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19
Q

Which race is more likely to develop breast cancer?

A

Whites are more likely to develop

African-Americans are more likely to die

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20
Q

What is DES (diethylstilbestrol)?

A

it was a drug used to treat miscarriages (1940s-1970s)

may increase risk of breast cancer in both the mothers and their daughters

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21
Q

What do menstrual periods be a risk factor for breast cancer?

A

menarch prior to age 12
menopause after age 55
these women are at higher risks

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22
Q

What benign breast condition can be a risk factor for breast cancer?

A

lobular carcinoma in situ

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23
Q

What are some modifiable risk factors for breast cancer?

A

1) postmenopausal obesity
2) exercise
3) alcohol
4) hormone replacement
5) recent oral contraceptive use
6) childbirth

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24
Q

What are some uncertain, controversial, or unproven risk factors for breast cancer?

A

1) diet and vitamin intake
2) antiperspirants
3) bras
4) induced abortion
5) breast implants
6) chemicals in environment
7) tobacco smoke
8) night work

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25
Q

What are some risk assessment tools used for breast cancer?

A

1) Gail model
2) Claus model
3) BTCAPRO model

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26
Q

Which breast cancer risk assessment tool assesses risk of BRCA1 and BRCA2?

A

BTCAPRO model

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27
Q

Which breast cancer risk assessment tool incorporates family history of both female and male relatives?

A

Claus model

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28
Q

Which breast cancer risk assessment tool gives 5 year and lifetime estimates for invasive breast cancer?

A

Gail model

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29
Q

What age group is fibroadenomas most likely occur in?

A

15-25, usually puberty and young adulthood, but up to 55

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30
Q

What shape are fibroadenomas?

A

round, disc-like, or lobular

31
Q

What kind of consistency do fibroadenomas have?

A

usually firm, rubbery

32
Q

What is the mobility of fibroadenomas?

A

very mobile

33
Q

Would patient experience tenderness with fibroadenomas?

A

usually nontender

34
Q

Will there be retraction signs for fibroadenomas?

A

no, it is absent

35
Q

What numbers could fibroadenomas occur in?

A

usually single but could be multiple

36
Q

What age group do fibrocystic changes occur in?

A

25-50

37
Q

What numbers could fibrocystic changes occur in?

A

single or multiple

38
Q

What shape to fibrocystic changes have?

A

round

39
Q

What is the consistency of fibrocystic changes?

A

soft to firm, usually elastic

40
Q

What is the mobility of fibrocystic changes?

A

mobile

41
Q

Are there retractions for fibrocystic changes?

A

no

42
Q

Will patient experience tenderness with fibrocystic changes?

A

yes, often tender

43
Q

What kind of delineation do fibrocystic changes have?

A

well delineated

44
Q

What age group do breast cancer usually occur in?

A

30-90, most common over age 50

45
Q

What numbers are cancer tissues present?

A

usually single, but my coexist with other nodules

46
Q

What shape do cancerous tissues have?

A

irregular or stellate

47
Q

What consistency do cancerous tissues have?

A

firm or hard

48
Q

What kind of delineation do cancerous tissues have?

A

not clearly delineated from surrounding tissues

49
Q

What is the mobility of cancerous tissues?

A

may be fixed to skin or underlying tissues

50
Q

Will patient experience tenderness with cancerous tissues?

A

no, usually nontender

51
Q

Will there be retraction signs present in cancerous tissues?

A

may be present

52
Q

A 23 year old female presents with bilateral palpable masses. Upon examination, the masses are found to be round, somewhat soft and mobile. There are no signs of retraction and. Patient indicate they are tender and varies with menses. What is the likely diagnosis?

A

fibrocystic changes

53
Q

A 16 year old female presents with multiple palpable masses, bilateral. Upon examination, both masses are round, firm, and very mobile. There are no signs of retraction and patient indicate they are not tender. Patient denies variation with menses. What is the likely diagnosis?

A

fibroadenomas

54
Q

A 52 year old postmenopausal female presents with a single palpable mass, located in the upper outer quadrant at two o’clock in the left breast. Upon examination, the mass is found to be irregular in shape, hard, and seems to be fixated. There are no signs of retraction and patient indicates is is nontender. The mass does not have defined borders. What is likely diagnosis?

A

cancer

55
Q

Are Montgomery tubercles normal findings?

A

yes, usually associated with pregnancy

56
Q

crusting and flaking could be a sign of…

A

Paget’s disease

57
Q

A patient has one breast with everted nipple while the other has inverted nipple, is this finding alarming?

A

yes

58
Q

What is the most common type of cancer? And which age group is this most prevalent in? What are other characteristics of this cancer?

A 
infiltrating ductal
30-80 years old
single mass
irregular or stellate, hard, stone-like
fixed
59
Q

What type of breast cancer is frequently involved with lymphatics and has poor prognosis?

A

inflammatory

60
Q

What type of breast cancer usually presents with eczematous patches on nipple, a rare form of breast cancer, can be associated with nipple redness and burning, and it is diagnosed by skin biopsy?

A

Paget’s disease

61
Q

When a patient presents with unilateral dilation in venous patterns, what could it be indicative of?

A

malignancy, however, bilateral can be seen in pregnancy or in obese women

62
Q

Is it normal for one breast to be larger than the other?

A

Yes, often the right is larger than the left

63
Q

How do you differentiate between Paget’s disease from contact dermatitis?

A

tissue biopsy

64
Q

Cystosarcoma phyllodes, fibroadenoma, and intraductal papilloma are all examples of…

A

benign tumors

65
Q

most common tumor under 25 years of age, small, movable and firm, no variation in size with menses or pregnancy

A

fibroadenoma

66
Q

tumor of lactiferous ducts, presents with nipple discharge

A

intraductal papilloma

67
Q

large bulky mass of cysts and connective tissue, rapidly growing

A

cystosarcoma phyllodes

68
Q

Is it a good idea to examine breasts during menstruation?

A

no, enlargement can occur 3-5 days prior to menstration. DO NOT examine breasts at this time. should be examined 5-7 days AFTER onset of menses

69
Q

What kind of changes would you see in the breasts of pregnant women?

A

fuller and more firm (can change two cup sizes)
areola darken
nipples enlarge and become erect
colostrum is secreted during the third trimester

70
Q

What are the 3 most important symptoms of breast disease?

A

1) presence of a mass
2) breast pain
3) nipple discharge (red can be cancerous while yellow can be inflammation)

71
Q

Is breast pain (mastalgia) commonly associated with breast cancer?

A

no, it is rarely associated with breast cancer, it is usually associated with fibrocystic changes in premenopausal women

72
Q

If nipple discharge is only with compression is it malignant?

A

no, it is most likely non-maglinant, usually involving multiple duct, and frequently bilateral

73
Q

Bilateral secretion (nipple discharge) without pregnancy is usually related to what?

A

hormones

if unilateral, then it is consider pathologic

74
Q

dilation of lactiferous duct, disorder of premenopausal age, can include nipple retraction, inversion, pain, and bloody discharge

A

duct ectasia

Clin Med 3 (11 decks)

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