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ABDOMEN 4 > 4.1 Breast > Flashcards

4.1 Breast Flashcards

1
Q

Increase Breast Cancer Risks (3)

A
  1. Lifestyle behaviours (obese,inactive,alcohol)
  2. Hereditary factors
  3. Reproductive/hormonal factors (early menstruation, LMA with 1st pregnancy, late menopause, BCP, HRT)
    * exposed to estrogen longer
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2
Q

Indications for Breast ultrasound (7)

A

Dense breast tissue (more fibroglandular than fatty)
Mammogram uncertain
can be initial test under 30 years of age (due to radiation)
Biopsy
Breast implants
Male breast
Help plan radiation treatment

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3
Q

What is the gold standard for examining the breast?

A

Mammography

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4
Q

Advantages of using sonography for examining breasts?

A
  1. noninvasive
  2. Painless
  3. Non-ionizing
  4. Low cost
  5. Image chest wall
  6. Doppler
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5
Q

The mammary gland is a?

A

modified sweat gland

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6
Q

The mammary gland is composed of 3 different types of tissue:

A
  1. Fat tissue
  2. glandular tissue
  3. fibrous tissue
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7
Q

Th mammary gland is divided into 3 different layers or zones.

A
  1. Subcutaneous zone (Premammary)
  2. Mammary zone
  3. Retromammary zone
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8
Q

Where is the Subcutaneous zone (Premammary) located?

A

between skin and mammary fascia

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9
Q

What does the Subcutaneous zone (Premammary) consist of?

A

fat surrounded by connective tissue (CT)

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10
Q

Because the Subcutaneous zone (Premammary) consists of fat and CT this means No __ __ ___ develop here

A

True breast lesions

*but could spread here from mammary zone

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11
Q

What is the mammary fascia?

A

CT enveloping the mammary zone

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12
Q

What is the mammary fascia continuous with?

A

Cooper’s ligaments

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13
Q

What are Coopers ligaments?

A

They support and shape the breast

think coopers droopers

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14
Q

Mammary zone is the ____ layer

A

Functional

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15
Q

Mammary zone is composed of?

A

Fibroglandular tissue (breast parenchyma)

predominately located Upper outer quadrant(UOQ) and areolar region

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16
Q

Mammary zones contains ____ & ____

A

Lobes and lobules

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17
Q

Mammary zone have approx ___ lobes arranged ____. They contain which 3 things?

A

15-20 lobes; radilally
variable in size and contain
Ducts, stroma and acinus

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18
Q

Mammary zone contains_-__ _____per lobe and contains

A

20-40 LOBULES

Acini (milk producing glands)

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19
Q

Mammary zone Ducts are called?

A

Lactiferous ducts

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20
Q

What do the Lactiferous ducts do?

A

Drain acini, lobules, lobes

and converge towards the nipple to the lactiferous sinus

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21
Q

What is the functional unit of the breast

A

TDLU

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22
Q

What does the TDLU consist of?

A

Lobule and extra-lobular terminal duct (more common in duct)

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23
Q

Each TDLU is about __ to ___ in size.

A

1-2mm

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24
Q

THE SITE OF MOST MAJOR BREAST PATHOLOGY IS?

A

TDLU

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25
Q

WHAT IS THE TAIL OF SPENCE?

A

Mammary tissue extending into the axilla region

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26
Q

Retromammary zone is the ___ layer and is ___.

A

deepest; thin

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27
Q

Retromammary zone consists of

A

Fat

BV’s and lymphatics

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28
Q

The Nipple is a ____ ___ projecting from the center of the breast with multiple openings

A

Fibromuscular papilla

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29
Q

A normal variant of the nipple is?

A

inversion of the nipple

can also be seen with certain types of breast cancer, ask if recent change

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30
Q

The pigmented area around nipple is called the?

A

AREOLA

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31
Q

The bumpy appearance around the nipple is the?

A

sebaceous glands (oil producing)

32
Q

What are the 2 muscles related to the breast?

A
  1. Pectoralis Major

2. Pectoralis Minor

33
Q

Pectoralis Major lies?

A

posterior to retromammary zone

34
Q

Pectoralis Minor is covered by the?

A

Pectoralis Major muscle

35
Q

What are the 3 arteries of the breast?

A
  1. Lateral thoracic arteries
  2. Internal mammary arteries (havested)
  3. Intercostal arteries
36
Q

The venous drainage consists of both a ___ and ___ network?

A

deep and superficial network

37
Q

Lymph flows from the breast to the ?

A

axilla

38
Q

Lymph originates in the ____ and the ____

A

CT and lactiferous ducts

39
Q

FREQUENT INVASION OF THE LYMP SYSTEM Occurs with?

A

breast cancer.

Note: When find suspicious mass in breast always scan axilla looking for abnormal lymph nodes

40
Q

Physiology of the breast. What do they do?

A

Produce and secrete milk

Age and Stage of breast function influence amount of parenchyma and stroma

41
Q

What are the 4 HORMONES ASSOCIATED WITH THE BREAST?

A
  1. Estrogen
  2. Progesterone
  3. Prolactin
  4. Oxytocin
42
Q

What does Estrogen do?

A

Promotes growth of ductal tissue

43
Q

What does Progesterone do?

A

Stimulates development of lobular cells

44
Q

What does Prolactin do?

A

Stimulates milk production

45
Q

What does Oxytocin do?

A

Causes milk ejection from lactating breast

46
Q

PREPUBESCENT breast consists of?

A

Rudimentary ducts and tissue developing under nipple, little fat

47
Q

YOUNG ADULT breast consists of?

A 
Fibroglandular tissue (dense, hard to see with mammography, why US, 1st choice)
very minimal fat
48
Q

ADULT breast consists of?

A

Fibroglandular = fatty tissue

49
Q

PREGNANT /LACTATING breast consists of?

A

mostly glandular/prominent ducts

50
Q

OLDER breast consists of?

A

increase fat in breast, easier mammography

51
Q

MENOPAUSE breast consists of?

A

Parenchyma beneath nipple and UOQ, mostly fat

52
Q

POSTMENOPAUSE breast consists of?

A

Fatty tissue.

lobules and ducts atrophy

53
Q

What do we identify with breast US? (10)

A 
skin
nipple
Subcutaneous fat
parenchyma 
Lactiferous Ducts
Cooper's ligament
Retromammary layer
Muscles
Ribs
Nodes
54
Q

Sonographic appearance of Skin

A

2 thin echogenic lines
2-3mm
(with radiation, can see skin thickening)

55
Q

Sonographic appearance of Nipple

A 
Homogenous, medium level echoes
posterior shadowing ( hard to see pathology behind nipple)
56
Q

Sonographic appearance of Subcutaneous fat

A

Amount varies, does not extend posterior to nipple

Hypoechoic lobules, thin, echogenic strands, edge artifact.

57
Q

Sonographic appearance of breast parenchyma

A

Homogenous, echogenic compared to fat.

Interspersed hypoechoic zones (fat islant )

58
Q

Sonographic appearance of Lactiferous DUCTS + SIZE

A

Hypoechoic/anechoic tubular

enlarges towards nipple (up to 8mm)

59
Q

Sonographic appearance of Coopers ligament

A

Curved echogenic striations encasing hypoechoic fat lobules

60
Q

Sonographic appearance of Retromammary layer

A

Hypoechoic due to fat content and anterior to pectoralis muscle

61
Q

Sonographic appearance of Pectoralis muscle

A

Medium to low level echoes, striated

62
Q

Sonographic appearance of Lateral Ribs

A

Acoustic shadow

63
Q

Sonographic appearance of Medial cartilage

A

Hypoechoic

64
Q

Sonographic appearance of Lymph Nodes + size

A

In axilla and parenchyma
Oval, hypo, echogenic hilum
should be < 1cm AP

65
Q

What makes a lymph node suspicious

A

> 1cm , more round and no hilum

66
Q

Before starting exam

A

Hx-family,gravida,meds, surgeries, discharge
Review previous
Physical assessment - check for skin changes and scars
palpate mass

67
Q

What probe should you use for breast ultrasound?

A

12-18Mhz (highest possible)

68
Q

What do we want to penetrate to always?

A

Chest wall/pectoralis muscle

69
Q

What are the 2 methods/approaches we use to scan ?

A

Clock face or quadrant approach

orthogonal plames = 90 degree from each other

70
Q

quadrant approach

A

RUOQ( right upper outer)
RUIQ (right lower inner)
RLOQ (right lower outer)
RLIQ (right lower inner). same 4 left

71
Q

Clock face approach (more common)

A

9: 00-lateral in right, medial in left
3: 00- medial in right breast, lateral in left

72
Q

Describe Radial and antiradial planes

A

Radial- rays of sun
Anti radial - 90 degrees to this
lobules are orientated in radial manner

73
Q

Always scan axilla for nodes, why?

A

most likely place for breast cancer to metastasize

74
Q

When scanning scan posterior to nipple, place adjacent to nipple and angle?

A

retroareolar

75
Q

BIRADS stands for

A

Breast Imaging Reporting and Data System

76
Q

What is BIRADS

A

Reporting form documents breast lesions
method of risk categorization
Classify according to suspicion of breast cancer

77
Q

BIRADS rating

A 
1= sonographically normal
2=benign finding
3=probably benign - 6 month f/o
4a=low suspicion
4b=intermediate
4c=moderate suspicion
5=highly suggestive of malignancy. - 4/5=biopsy
6=known cancer

ABDOMEN 4 (10 decks)

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