OB/GYN/GU

Question 1

What is the anatomical location of the breast? What structures does it overlie?

Answer 1

Superior to the chest wall overlying the fascia covering the pectoralis major and minor.

Question 2

What is the function of the female breast?

Answer 2

To produce and secrete milk

Question 3

How many lobes are found in the breast?

Answer 3

15-25 lobes

Question 4

Lobes connect to the nipple via what?

Answer 4

Lobes open into the nipple via lactiferous ducts.

Question 5

What divides the lobes into lobules?

Answer 5

Interlobar connective tissue

Question 6

What does the green arrow point at?

Answer 6

Terminal duct

Question 7

What does the blue arrow point to?

Answer 7

Interlobar connective tissue

Question 8

What do the red arrows point to?

Answer 8

Lobules

Question 9

This image is an example of what anatomical structure in the breast?

Answer 9

The Terminal Duct - Lobular Unit

Question 10

Are breast hormonally responsive?

Answer 10

Yes

Question 11

During pregnancy what changes occur in the breast?

Answer 11

Proliferation and enlargement of epithelial cells (breast lobule hyperplasia) –> bigger breasts to aid in milk secretion during lactation.

Question 12

What change occurs in the breast following menopause?

Answer 12

Atrophic changes.

Question 13

Puereral = ?

Answer 13

Puerperal = lactational

Question 14

What are the two types of mastitis?

Answer 14

Puerperal (lactational) and non-puerperal (non-lactational)

Question 15

What are signs and symptoms of mastitis?

Answer 15

Breast tenderness, redness, induration, occasionally abscess formation (which can feel like a mass).

Question 16

What is mastitis?

Answer 16

Breast inflammation

Question 17

What are some causes of Non Puerperal Mastitis?

Answer 17

(1) Duct ectasia
(2) Fat necrosis
(3) Granulomatous mastitis
(4) Inflammatory carcinoma

! May present as a breast mass (despite not being cancer)

Question 18

What are the differences between these two images?

Answer 18

Left is breast tissued during pregnancy –> larger lobules + ducts

Right is normal (unstimulated) breast tissue –> lobules and ducts much smaller

Question 19

What is lactational mastitis?

Answer 19

Occurs when there is a blockage of the lactiferous duct and there is leakage of milk into the surrounding tissue.

The cytokines in the milk may induce an inflammatory response (theory).

Question 20

What percentage of women who are breast feeding get lactational mastitis?

Answer 20

5-33%

Question 21

How many women who have lactational mastitis also form an abscess?

Answer 21

0.5%

Question 22

What are the common pathogens that cause a women to develop an abscess in the setting of lactational mastitis?

Answer 22

Staph and Strep (what’s on the mom’s skin and what’s in the baby’s mouth get in via fissures in the skin –> infx)

Question 23

What are the symptoms of lactational mastitis?

Answer 23

Pain, burning, redness, fever, swelling

Question 24

How would you diagnose lactational mastitis?

Answer 24

History and phyical exam. May do an ultrasound to rule out an abscess

Question 25

What is the treatment for lactational mastitis?

Answer 25

Antibiotics [penicillin & cephalosporin families]. Recommend frequent emptying of the breast (to keep things moving and prevent further obstruction).

Question 26

What does the star denote?

Answer 26

The star denotes an abscess in the breast tissue with normal tissue just below it.

Question 27

A mass that is tender or painful is a sign of it being benign or malignant?

Answer 27

Benign

Question 28

If the mass changes cylicly during menstural cycle is the mass likely benign or malignant?

Answer 28

Benign

Question 29

Nipple discharge, a history of breast cyst, or a history of trauma are signs that indicate a mass is likely benign or malignant?

Answer 29

Benign

Question 30

A mass + family history of breast cancer is more likely an indication of benign or malignnt?

Answer 30

Actually, can be either. However, FH of cancer is still a risk factor for cancer.

Question 31

On physical exam would indicate a mass is more likely benign?

Answer 31

Circumscription: **Well defined borders** Consistency: **Rubbery** Mobility: **Freely mobile**

Question 32

On physical exam, what would make a mass more likely to be malignant?

Answer 32

Circumscription: **Ill defined borders** Consistency: **Firm to rock hard** Mobility: **Attached to skin or chest wall**

Question 33

Duct ectasia is what kind of mastitis?

Answer 33

Non Puerperal Mastitis

Question 34

Who is the main population that has duct ectasia?

Answer 34

Multiparous postmenopausal women

Question 35

What is duct ectasia?

Answer 35

Inflammation with DILATATION of the subareolar ducts