Breast Disease

Question 1

When does breast tissue begin developing in utero?

what is the first step?

Answer 1

5-7 weeks gestation

1. bilateral thickening of ectoderm
2. involutes
3. glandular development is dependent on placental hormones

Question 2

what are the milk lines/mammary ridges?

Answer 2

often where supernumary nipples will develop [along this line]

Question 3

what is polymastia?

polythelia?

Answer 3

polymastia: extra tissue extending into the axillary region

polythelia: supernumary tissue from failure of mammary ridge to regress in utero

Question 4

What is athelia?

Amastia?

Answer 4

Athelia: absence of nipple [rare]

amastia: absence of 1 or both breasts–> could even involve absence of pec muscles

Question 5

What is neonatal gynecomastia?

what causes it?

Answer 5

neonatal breast enlargement

• seen in 65-90% of neonates
• cause: transfer of maternal & placental estrogen & progesterone
  
  • persists up to several months

Question 6

Thelarche…is?

Answer 6

breast puberty [basically]

Question 7

What are the 5 tanner stages of breast development in female?

(probably don’t have to know this but still…)

Answer 7

1. ŒPreadolescent nipple is elevated with no underlying glandular tissue or increased pigmentation of the areola
2. (~11 yo)- glandular tissue in the subareaola is obvious. Nipple and breast are single mound off of the breast wall
3. Ž(~12 yo) there is increase in the among of palpable glandular tissue with increased diameter and pigmentation of the areola breast and nipple in single plane.
4. (~13 yo) the areola further enlarges in a single plane, The nipple and areola form a separate mound above the level of the breast
5. (15 yo) there is a final development of a smooth contour with projection with nipple and areola

Question 8

tanner staging of female genitalia?

Answer 8

1. ŒPrepubertal; no pubic hair
2. Straight hair is extending along and between the labia
3. ŽPubic hair is increased in quantity, darker and present in the typical female triangle
4. Pubic hair is more dense, curled and adult in distribution but less abundant
5. Abundant, adult type pattern hair may extend onto the medial aspect of the thigh

Question 9

tanner staging male….

Answer 9

1. ŒPreubertal, no pubic hair, genitalia unchanged from early childhood
2. Light colored hair develops laterally and later becomes darker, penis and testes may be slightly larger, scrotal skin becomes more texturedŽ
3. Pubic hair is extended across the top of the penis; testes and scrotum are further enlarged; penis is larger especially in length
4. More abundant pubic hair with curling, genitalia resemble that of an adult, glans has become larger and broader
5. Quantity and pattern of pubic hair with hair present along the inner borders of the thighs. Testes and scrotum are adult in size.

Question 10

A 13-yo-female presents to the clinic with her mother. You document her Tanner stage based on the following exam findings:

BREASTS: the nipple and breast are developed in a separate mound above the level of the breast
GENITALIA: curled pubic hair is present

WHAT TANNER STAGE IS SHE IN?

Answer 10

Stage 4

Question 11

Which of the following is NOT a technique that can encourage breastfeeding mothers to successfully breastfeed on demand?

A. Flexible, opportunistic sleep schedules
B. Co-sleeping
C. “Baby-wearing”, wherein mother is carrying baby
D. Non-maternal helpers to assist the breastfeeding mother
E. Alternating use of formula feeds with breast feedings
F. Public acceptance of breastfeeding

Answer 11

E!!!

Question 12

How could milk cure warts?

Answer 12

a cream containing a compound of human breast milk [alpha-lactalbumin-oleic acid] appears to work for Txing stubborn warts

Question 13

24-yo-breast feeding female presents with sore, red breast and intermittent fevers…

what is it?

and how do you Tx?

Answer 13

mastitis: usually bacterial but need safe meds cuz still breast feeding

• Tx: DICLOXACILLIN!!!
  
  • lactmed is a good website…

Question 14

What are worrisome findings on clinical breast exam?

Answer 14

• Lump or contour change
• Skin tethering
• Nipple inversion
• Ulceration
• Nipple scaling
• Edema or peau d’orange (skin of an orange)

Question 15

What are some malignant features seen on mammogram?

Answer 15

microcalcifications [hard to see on mammo]

spiculated appearance [on mammo]

Question 16

Do women with breast implants still need mammograms?!!!

Answer 16

YESSSSSS!!!!!

Question 17

When should we start mammogram screenings regularly?

Answer 17

>50 yo

UNLESS Hx of breast cancer in the family

Question 18

What are fibroadenomas?

wh usually gets them?

Sx’s/Signs?

Answer 18

Fibroadenomata

• most common benign tumors of the female breast
• particularly in women aged 15 and 35 years
• Signs painless, discrete, rubbery, mobile mass. They arise from the lobular stroma. They enlarge to menopause and then tend to regress or involute.

Question 19

Increased risk for breast cancer?

Answer 19

• advanced age
• north american
• high perimenopausal IGF-1/E
• mother or sister w/ Hx of premenopausal breast cancer

Question 20

What is the avg risk of breast cancer in women?

Answer 20

12.15% lifetime risk

Question 21

21yo female with a non-tender, ovoid rubbery mass is found in the right upper medial breast. No other lesions felt on exam. No axillary adenopathy. No nipple discharge.

Answer 21

probably fibroadenoma

Question 22

What should be done to work up a suspicious breast mass?

Answer 22

• detected by palpation should be biopsied, regardless of (-) imaging findings
• detected by imaging should be biopsied, regardless of absent palpable findings
• Ultrasound is generally better for <30 yr old women than mammograms
• evaluation algorithms exist for young and older women who have palpable breast lump, breast pain, nipple discharge and abnormal imaging

Question 23

Who is ultrasound [for breast masses] recommended for?

Answer 23

better for <30 yo women than mammogram