4. Normal and Abnormal Breast Exam

Question 1

Breast tissue is hormonally sensitive and estrogen is responsible for growth of adipose tissue/lactiferous ducts, what is reponsible for stimulation of lobular growth and alveolar budding?

Answer 1

Progesterone

Question 2

Congenital anomalies are common, such as absence of a breast, accessory breast tissue along the milk line such as extra nipples (polythelia) and accessory breast such as polymastia which is usually located?

Answer 2

in the armpit

Question 3

Two MC complaints of breasts is pain and mass found, patient history is important. Risk factors for Breast cancer include older age, hx BC, high breast tissue density, first degree relatives, early menarche (age<12) and late cessation of menses (>55)… why?

Answer 3

Becuase these women have longer exposure to estrogens effects

Question 4

Other risk factors include never breastfed, long term OCP, postmenopausal obesity due to peripheral conversion of estrogen from fat, hx of endometrial/ovarian CA, alcohol, height, high socioeconomics and what heritage?

Answer 4

Ashkenazi Jewssss

Question 5

Make sure to evaluate both breasts on exam, including the axilla and chest wall, diagnostic tests include mammogram, US, MRI, FNA, and core biopsy… what ALWAYS gets a biopsy?

Answer 5

Palpable masses

Question 6

What diagnostic test is best in women 40 years and older due to fat replacing tissue, is able to detect lesions 2 years before theyre palpable, along with densities and calcifications?

Answer 6

Mammography

Question 7

Is the following screening or diagnostic?
no complaint/concerns, 4 images 2 craniocaudal and 2 mediolateral, can be done by standard radiograph versus digital enhancement?

Answer 7

Screening mammogram

Question 8

Is the following screening or diagnostic?
done in women with complaint or palpable mass or to adjunct an abnormal screening mammogram, contralateral breast should be imaged

Answer 8

Diagnostic mammogram

Question 9

ACOG screening guidelines for cancer suggest a mammo anually after age 40, clinical exam at ages 20-39, q 1-3 years, age 40+ : anually, and what about self breast exams?

Answer 9

Consider for high risk patients/ options / recommended (gray area)

Question 10

What diagnostic testing is used in evaluating inconclusive mammo findings, best for women less than 40 or with dense breast tissue, allowing to differentiate between cystic vs solid lesions?

Answer 10

US (also used to guide core needle bx)

Question 11

What imaging is useful adjunct to diagnostic mammography, used post cancer dx for further evaluation/staging, and in women at high risk for breast cnacer like BRCA?

Answer 11

MRI

Question 12

What testing is useful in determining solid vs cystic mass, done in offic with 24 gauge needle, clear fluid = no further eval, blood must be sent for cytology, if cyst reappears or does not resolve with this testing- need mammo/US and biopsy?

Answer 12

Fine Needle Aspiration Biopsy (FNA)

Question 13

After a FNA is performed, it is followed by what, which is a 14-16 gauge needle, used to get tissue from larger *solid masses for a dx, results in 3-6 samples 2cm in length?

Answer 13

Core Needle Biopsy

Question 14

Mastalgia or Breast pain (in B9 breast disease) can be cyclic, noncyclic or extramammary. Cyclic is usually due to menstruation and starts at luteal phase and ends after menses. Noncyclic is not associated with menstrual cycle and includes tumors, mastitis, and cysts, and can be associated with what 3 medications ?

Answer 14

Antidepressants
AntiHTN
OCPs

Question 15

Extramammary includes chest wall trauma, shingles and fibromyalgia. the only FDA approved treatment for mastalgia in B9 breast disease is what, which has many SE and doc never uses it?

Answer 15

Danazol

Question 16

Other medications for mastalgia tx include OCPs, SERMs, Depo Provera, but most of the time the physician says symptomatic relief occurs via wearing a properly fitting bra, weight reduction, exercise, decrease caffeine, and increasing?

Answer 16

Vitamin E intake (doesnt know why)

Question 17

Nipple discharge is usually benign, could be sign of endocrine DO or cancer, unilateral/bilateral, color consistency, spontaneous or expressed give all the clues

Answer 17

MEOW

Question 18

Non-spontaneous, non bloody, bilateral nipple discharge is most consistent with fibrocystic changes or ductal?

Answer 18

ectasia

Question 19

Milky discharge common with childbearing but may indicate hyperprolactinemia or hypothyroidism or medication related such as what two?

Answer 19

OCP and Psychotropics

Question 20

Bloody nipple discharge is CANCER till proven otherwise, but can be a benign intraductal papilloma, and is evaluted with breast ductography and requires?

Answer 20

ductal excision

Question 21

Breast mass malignancy chances increase with the following, greater than 2cm, immoble, poorly defined margins, firm, skin dimpling (Peau de orang), retraction, bloody discharge and ipsilateral?

Answer 21

lymphadenopathy

Question 22

There are three categories of benign breast masses: nonproliferative (MC), proliferative without atypia and proliferative with atypia, which is the most apt to become cancer?

Answer 22

Proliferative with atypia (8-10 risk)

Question 23

What benign breast mass type includes fibrocystic changes: on a spectrum, observed in 50-75% of women, lobules of breast dilate and form cysts which rupture and result in scarring and inflammation, adenosis (lobular growth w inc glands), and lactational adenomas (due to hormonal response)?

Answer 23

Non proliferative b9 breast masses

Question 24

The most common nonproliferative mass is what, which usually occurs in late teens/ early 20s, solid rubbery, mobile solitary tumor, usually 2-4cm but can get large, with some complex cellular lesions may increase risk of ca?

Answer 24

Fibroadenomas

Question 25

What nonproliferative b9 breast mass is a cystic dilation of duct filled with milky fluid, occurs near time of lactation, secondary infection may cause mastitis, and typically can be needle aspirated?

Answer 25

Galactocele

Question 26

All of the following are what kind of b9 mass… epithelial hyperplasia (lining duct), sclerosing adenosis - increased fibrosis w/in the breast lobules, and complex sclerosing lesions (radial scar) tubules trapped in a dense stroma surround by radiating arms of epithelium?

Answer 26

Proliferative WITHOUT atypia b9 breast masses

Question 27

Another proliferative without atypia b9 breast mass is what, which has intraductal growths typically seen in women 30-50 y/o, cause serous or serosanguinous discharge?

Answer 27

Papillomas

Question 28

Proliferative lesions with atypia are NOT b9, and occur when malignant cells replace normal epi lining the ducts or lobules, this is also known as?

Answer 28

Carcinoma in situ

Question 29

What is a Proliferative lesion with atypia, not a precursor to breast cancer but is a risk factor for developing breast cancer?

Answer 29

Lobular Carcnioma in situ LCIS

Question 30

What is a proliferative lesion with atypia that has ducts filled with atypical epi cells and women are at an increased for developing invasive disease or reoccurrence?

Answer 30

Ductal Carcinoma in situ DCIS

both are treated with excision and SERMs

Question 31

Breast cancer is the MC in women besides skin cancer, second leading cause of cancer related deaths in the US, there is a lifetime risk of developing breast ca of 1 in 8 and a lifetime risk of dying from it of?

Answer 31

1 in 28

Question 32

Risk factors for breast cancer include age >50, *caucasian women at greater risk, family history and genetics increase risk as well, women with 1st degree relative with breast cancer and what gene?

Answer 32

BRAC

1: 1/2 early onset breast ca and 90% ovarian cancers
(2: 35% early onset breast ca and less ovarian)

Question 33

Reproductive and menstrual history are important risk factors as well, along with radiation exposure, breast changes, overweight, alcohol- women who drink 2-4 dirnks per week have a 30% greater chance of dying from?

Answer 33

Breast cancer as opposed to nondrinkers

Question 34

What models usefullness decreased in second degree relatives with breast ca, falsely elevated in patients with multiple breast biopsies, and women considered high risk (5yr of >1.7%) should be conseled on prophylactic therapy?

Answer 34

Gail Model - Breast cancer risk

Question 35

Ductal carcinomas make up 80% of all breast cancers, MC in the 50s, spread to regional LNs, what carcinoma causes 5-15% of breast ca and is more likely to be multifocal and or BILATERAL?

Answer 35

Lobular Carcinoma

Question 36

What disease presents on the nipple as superficial dry skin lesion- 3% of breast cancers?

Answer 36

Pagets Disease

Question 37

What breast cancer makes up 1-4% and is characterized by swelling and reness of underlying skin and induration of surrounding tissues?

Answer 37

Inflammatory breast cancer

Question 38

Use receptor status in addition to staging to determine prognosis: estrogen, progesterone (positive finding)… what oncogene is a worse prognosis and is found in 20-30% of breast cancers?

Answer 38

Her2/neu

Question 39

Breast cancer is treated with surgery via lumpectomy with radiation or mastectomy, outcomes are equal, what therapy is used in all stages and reduces risk of reoccurence by 1/3 and reduces risk of death by 30%?

Answer 39

Adjuvant therapy

Question 40

Follow up post treatment for the first 2 years after diagnosis is every 3-6 months, anually after the first two years, most reocurrences occur within the first?

Answer 40

5 years after treatment