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Women's Health - GYN > Breast Exam > Flashcards

Breast Exam Flashcards

(61 cards)

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1
Q

Adult female breast is modified ______ gland located within superficial fascia of chest wall.

A

sebaceous

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2
Q

Most glandular tissue of breast is located where? Significance?

A

upper outer quadrant

where most breast cancer occurs

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3
Q

Polythelia

A

extra nipple

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4
Q

polymastia

A

accessory breast

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5
Q

galactorrhea

A

milky bilateral nipple discharge

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6
Q

Describe a fibroadenoma. How is it dx’d?

A

benign solid mass that is fine, round and mobile (like a marble)

U/S then biopsy

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7
Q

cyst

A

mass that is usually soft to firm, round, mobile, often tender

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8
Q

What are fibrocystic changes in breast? Possible causes?

A

CYCLIC diffuse pain (usually right before a period)

nodular, rope-like lumps on breast exam

*benign, caffeine, tx with Vit E or OCs

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9
Q

Inverted nipple

A

depressed below the areolar surface

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10
Q

Gynecomastia

A

firm disc of glandular enlargement vs soft fatty enlargement of obesity (described in males)

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11
Q

Mastalgia

A

breast pain (cyclic, noncyclic, and extramammary)

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12
Q

Ductal ectasia

A

dilation of mammary duct beneath nipple that causes periductal fibrosis (duct wall thickening) and inflammation

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13
Q

Papillomas

A

benign lesion involving a single duct; associated with bloody nipple discharge

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14
Q

Mastitis

A

infection of the breast tissue

*common in nursing moms with fever, sudden onset-think CA in nonlactating women

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15
Q

Most common causes of bloody nipple discharge

A
  1. papilloma

2. carcinoma

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16
Q

Mastectomy

A

surgical removal of breast

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17
Q

How to quantitively assess breast development in adolescent?

A

Tanner’s sex maturity ratings

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18
Q

What positions should patient be put in to inspect breasts?

A
  1. arms at side
  2. arms overhead
  3. hands pressed against hips (tighten pectoralis)
    +/- leaning forward (esp if obese)
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19
Q

What are we looking for on breast exam palpation?

A

Consistency
Tenderness
Nodules (location, size, shape, etc.)

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20
Q

Findings in axillae that suggest malignant involvement

A

nodes larger or equaling 1 cm
nodes that are firm/hard
nodes matted together
fixed to skin or underlying tissue

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21
Q

How breast exam done for patient with mastectomy?

A

inspect scar and axilla for masses or unusual nodularity

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22
Q

Special technique to assess for spontaneous nipple discharge?

A

Press finger on radial areola to see if any discharge

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23
Q

How to write normal breast exam note in chart?

A

Breasts symmetric and without erythema or pigment skin changes, NTTP without masses, nipples without discharge, axilla without mass/adenopathy and NTTP

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24
Q

Recommendations for breast cancer screening

A

Annual mammogram starting at age 40

Regular self exams

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25
What patients require high risk screening (>20%)?
1st deg relative with breast cancer; start mammogram 10 yrs younger than the relative's age of dx, +/- MRI
26
If > 20% lifetime risk of breast cancer, then must do what screens?
mammogram and MRI
27
Risk factors in patient medical history for breast cancer
``` FHX previous radiation previous high risk lesions high alcohol use obesity immunosuppressant tx hormone replacement tx later first birth early onset menses ```
28
Benign vs malignant nipple discharge?
Benign: green or milky Malignant: clear/serous or bloody; spontaneous
29
Can cancer be ruled out with normal mammogram?
NO!!!
30
How is abnormal mammogram further eval'd?
Find lesion with U/S and eval as cystic vs solid If solid lesion or microcalcifications do steretotactic bx Make sure imaging and clinical findings match (concordance)
31
Always ________ a palpable mass on breast exam.
U/S
32
Signs/Sx's of breast cyst
gross palpable mass | severe, localized pain of sudden onset
33
Tx of breast cyst
> 2 cm: needle aspiration | consider excision of third recurrence
34
Benign solid tumors of breast that contain glandular and fibrous tissue. Do not increase breast cancer risk.
fibroadenomas
35
Large benign fibroadenoma that is very locally aggressive. Always excised.
Phyllodes Tumor
36
Non-lactational breast abscess signs
acute onset of pain and redness tender, palpable mass fever, malaise
37
Treatment of breast abscess
Drainage + abx therapy that covers staph aureus
38
What should be added to breast abscess tx if presence of subareolar abscess with retracted nipple?
Flagyl
39
Benign lesions that increase breast cancer risk
Atypical Ductal Hyperplasia Atypia associated with sclerosing adenosis Radial Scar Lobular Carcinoma In Situ * all require surgical excisional biopsy
40
Classic characteristics of cancerous lesion
single lesion hard non-mobile irregular borders
41
How to treat in situ cancer?
stage 0 | No chemo
42
Which type of invasive breast cancer not well seen on mammogram?
lobular cancer
43
Most common type of invasive cancer
ductal origin (80%); seen well on mammogram
44
Paget's Disease cause and treatment
Nipple lesion usually associated with ductal carcinoma in situ Standard treatment is mastectomy
45
Why is it a good thing if cancer is hormones positive for cell growth?
means that cancer will likely be treatable with estrogen and progesterone blockers
46
Lumpectomy vs Mastectomy
Lumpectomy - smaller lesions; single focus of disease - Adjuvant radiation Mastectomy - multifocal; larger burden of disease - Young age, family history - Usually no radiation
47
Sentinel Node biopsy of breast
dye injected into breast to follow lymphatic pathway and locate where cancer could reside May do axillary node dissection of first 3 nodes
48
How is cancer stages?
``` T = tumor size (stage 1-3) N = nodes (# and location) M = metastasis (stage 4, skin involvement) ```
49
Post-operative complications of mastectomy
skin problems if patient smokes staph infection seroma
50
Side effects of radiation
``` Skin erythema/pain Skin breakdown Damage to underlying lungs (pneumonitis, scarring) Tissue edema/contracture Secondary malignancy (angiosarcoma) ```
51
Two types of radiation
external beam | brachytherapy - ballon insert and drainage
52
Side effects of chemo
neutropenic fever, other infections neuropathy persistent fatigue "chemo brain"
53
28 year old female with a mass that has persisted for two cycles. The mass is painful. Family history of breast cancer in a maternal aunt at age 55. No imaging. What next? Likely dx?
Order U/S Fibroadenoma
54
65 year old with no family history of breast cancer. Currently on HRT. Last mammogram 2 years ago. Screening shows an 8mm density in the left breast. Ultrasound shows irregular 7mm mass that corresponds with mammogram. What next?
Biopsy
55
Long term follow up for lumpectomy with radiation therapy.
- Mammogram at 12, 18, 24 months then annual - Clinical exam q 6 months - Medical oncology follow up for at least 5 yrs
56
41 year old with palpable mass in breast x several weeks FHX: breast cancer in mother and two cousins premenopausally, ovarian cancer in maternal grandmother Mammogram and ultrasound: 2.5 cm highly suspicious mass, biopsy recommended Biopsy: poorly differentiated invasive ductal CA ER- PR- Her2 neu- MIB high What is her tx?
Neoadjuvant chemotherapy - chemo and systemic therapy before surgery Genetic testing based on strong FHX (ex. BRCA 2 mutation) Recommend bilateral mastectomies
57
Long term follow up of chemotherapy
Chest wall exams with imaging as indicated Oophrectomy = ovaries removed Pancreatic screening
58
Overweight woman with nipple discharge. Mammogram with scar from previous excisional biopsy for papilloma. Negative Ultrasound. Likely dx?
ductal excision shows papilloma
59
52 year old with acute onset of pain and erythema x days in her right breast. No known history of trauma. Had negative mammogram 1 month ago. Likely dx?
Breast abscess
60
Do we palpate anything while sitting?
axillae * do first on breast exam
61
peau d'orange finding on breast exam
"skin of an orange" classic looking skin overlying breast cancer

Women's Health - GYN (12 decks)

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