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Y4 GI / Surgery > Breast > Flashcards

Breast Flashcards

1
Q

The breast sits on top of what muscle?

A

Pectoralis major

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2
Q

97% of lymphatic drainage from the breast goes where? 2% goes where?

A

97% axillary LN

2% internal mammary LN (central)

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3
Q

In what positions should you inspect the breasts?

A 
Arms by side
Arms raised
Hands on hips
Leaning forward 
Semi-recumbent
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4
Q

What are you looking for on inspection of the breasts?

A

Symmetry, size, shape, lamp, skin retraction, erythema, also, nipple retraction, dimpling, discharge

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5
Q

What position should the patient be lying in when you palpate their breasts?

A

Lying flat with hands behind head

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6
Q

When examining a breast lump, which side should you examine first?

A

Contralateral

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7
Q

What features should you note on examination of a breast lump?

A

Size, shape, fixity, consistency, fluctuant, pulsatile, temperature, tender

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8
Q

When examining a suspicious breast lump, after examining the breast, what should be examined further for completeness?

A

Listen to chest

Examine spine, abdo, neuro exam

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9
Q

Benign breast lump:

  • smooth or hard
  • well or poorly defined
  • fixed or moves easily
  • assoc skin changes
  • painful or painless
  • regular or irregular
A 
Smooth rubbery
Well defined
Moves 
No skin changes
Painful
Regular
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10
Q

During a breast lump history, what symptoms could you ask about in a systemic enquiry?

A

Weight loss, loss of appetite, bone pain, SOB, jaundice, abdo pain, fever, breast trauma

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11
Q

What is the commonest benign breast lesion?

A

Fibroadenoma

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12
Q

What is fibroadenoma also known as?

A

Breast mouse

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13
Q

What is the peak age range for fibroadenoma? Painful or painless? Mobile or fixed?

A

15-25yr
Painless
Mobile

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14
Q

Are all fibroadenomas biopsied?

A

Only if suspicious on imaging

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15
Q

“Rare benign fibroepithelial tumour with malignant potential, commonest in middle age, excised with clear margins” describes what

A

Phyllode’s tumour

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16
Q

What organism is commonest in breast abscesses?

A

S aureus

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17
Q

Fibrocystic breasts:

  • uni or bilateral?
  • painful or painless?
  • what age range?
A

Uni or bilateral
Painful or painless
Perimenopausal (subsides after menopause)

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18
Q

What is the best preventative measure for duct ectasia?

A

Smoking cessation

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19
Q

What is the mx of a breast abscess?

A

Aspirate US guided drainage + ABx

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20
Q

If a breast abscess lasts longer than 2wk what should you do?

A

Excisional biopsy to exclude inflammatory breast cancer

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21
Q

Halo appearance on mammogram =

A

Breast cyst

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22
Q

Duct ectasia

  • main RF
  • what age range?
  • presentation?
  • uni or bilateral?
  • painful or painless
A 
Smoking
40/50s
Bilateral
Creamy discharge / nipple retraction
Red tender lump
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23
Q

What is the management of duct ectasia?

A

ABx

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24
Q

“Wart like, within duct, PC watery/bloody discharge, not premalignant, Mx excise duct” describes what?

A

Duct papilloma

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25
Q

What is gynaecomastia?

A

Increase in breast tissue in males

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26
Q

What drugs can cause gynaecomastia?

A

Spironolactone, digoxin, cimetidine, cannabis

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27
Q

Testicular tumours can cause gynaecomastia - true or false

A

True

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28
Q

Which can cause gynaecomastia; cirrhosis or renal disease?

A

Both can

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29
Q

What drug can be used for the management of gynaecomastia?

A

Tamoxifen

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30
Q

What is the mechanism of tamoxifen?

A

Blocks the effects of oestrogen in breast tissue

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31
Q

What carries a higher breast Ca risk, a sister or a mum with a history of breast Ca?

A

Sister

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32
Q

What is occult disease?

A

Histologically proven malignant tumours whose primary site cannot be identified

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33
Q

Is Paget’s disease of the nipple invasive/ malignant?

A

Yes

34
Q

Breast cancer: which is 80%, which is 20% - lobular or ductal?

A

80% ductal

20% lobular

35
Q

Breast cancer is the commonest cancer in females in UK - true or false

A

True

36
Q

Paralysis of what nerve is responsible for winged scapula?

A

Long thoracic nerve

37
Q

What ages and how often are invited for breast cancer screening?

A

3 yearly

50 - 74

38
Q

What test is used for breast cancer screening?

A

Mammogram

US adjunct if uncertain

39
Q

From what age are BRCA positive women invited for breast cancer screening? What test is used for them?

A

From 30yr

MRI

40
Q

If in primary care you suspect breast cancer what do you prefer them for?

A

Triple assessment: examination + imaging + tissue biopsy
(imaging = mammo/US/MRI)
(one stop breast clinic)
(using 2 week wait)

41
Q

What type of biopsy is done for query breast cancer? Is it US guided?

A

Vacuum assisted core biopsy

All done under US guidance

42
Q

What classification system is used for breast cancer?

A

TNM

43
Q

Breast cancer grading is based on a degree of ______. There are X number grades.

A

Differentiation

3

44
Q

Where does breast cancer most commonly metastasise?

4 locations

A

Bone brain liver lung

45
Q

Mammogram / US / MRI- which uses ionising radiation?

A

Mammogram

46
Q

What does LCIS / DCIS stand for? What separates it from carcinoma?

A

Lobular carcinoma in situ
Ductal carcinoma in situ
Invasion of the basement membrane

47
Q

What is the main risk factor for breast cancer?

A

Estrogen exposure

48
Q

Which is a risk factor for breast cancer

  • early/late menarche
  • early/late menopause
  • OCP or POP
  • breastfeeding or not breastfeeding
  • early or later age of 1st pregnancy
  • nulliparity or multiparity
A
  • Early menarche
  • Late menopause
  • OCP (also HRT)
  • Not breastfeeding
  • Later age 1st pregnancy
  • Nulliparity

(think of it as all that fertile time not being protected by pregnancy hormones)

49
Q

In breast cancer triple assessment, what scan is done in those aged under / over 40 years?

A

Under 40: US + biopsy

Over 40: US + mammo + biopsy

50
Q

FNA cytology distinguishes malignant or premalignant - true or false

A

False

51
Q

Mammogram sensitivity increases / decreases with age

A

Increases

due to decreasing fat content

52
Q

What type of imaging is good for dense fat breasts?

A

US

53
Q

US is less sensitive in early cancer - true or false

A

True

54
Q

What tumour markers are tested for in breast Ca?

A

ER
PR
HER2

55
Q

Are all women with breast Ca checked for BRCA mutations?

A

I don’t know

56
Q

80% of breast cancer is positive for

-ER / PR / HER2

A

ER estrogen receptor

57
Q

ER is a good prognostic indicator - T or F

A

True

58
Q

HER2 is a good prognostic indicator - T or F

A

False - bad

59
Q

Mastectomy and breast conservation have the same long-term survival - T or F

A

True

60
Q

How many cm margin is left with breast conserving surgery?

A

1cm

61
Q

What is the function of radiotherapy in breast cancer?

A

To decrease local recurrence

62
Q

In breast cancer, who is offered radiotherapy?

A

Post WLE or high risk mastectomy

63
Q

What is the sentinel node?

A

First lymph-node that drains the tumour

64
Q

What is the most important prognostic indicator in breast cancer?

A

Axilla status

65
Q

What has worst cosmesis in breast construction - immediate or delayed?

A

Immediate

due to XRT

66
Q

Immediate and delayed breast construction have the same long-term survival outcomes - T or F

A

True

67
Q

In breast cancer Mx, who is given tamoxifen?

A

ER/PR positive pre-menopausal

68
Q

In breast cancer Mx, who is given aromatase inhibitors? Give an example of an aromatase inhibitor

A

ER/PR positive post-menopausal

69
Q

In breast cancer Mx, who is given Trastuzumab?

A

HER2+

Letrozole

70
Q

Define neoadjunct and adjunct

A

Neoadjunct before surgery

Adjunct after

71
Q

Is chemotherapy used for ER positive or negative breast Ca

A

ER negative

72
Q

Name 2 side effects of tamoxifen

A

Hot flush
Vaginal dryness
Weight gain

73
Q

Tamoxifen increases the risk of what cancer?

A

Endometrial cancer

74
Q

What do pacemakers, metal clips, claustrophobia and renal failure have in common?

A

MRI CI

75
Q

What do telangiectasia, pneumonitis, cardiac event and rib fracture have in common?

A

Radiotherapy SE

76
Q

Is BRCA 1 or 2 associated low or high grade cancers?

A

BRCA 1 high grade

BRCA 2 low grade

77
Q

What is the ER, HR and HER2 status of BRCA 1 cancers?

A

Triple negative

78
Q

What is the ER, HR and HER2 status of BRCA 2 cancers?

A

ER positive

79
Q

If sentinel node biopsy is positive - what is the next step?

A

Node clearance

80
Q

Is sentinel node biopsy done at the same time as breast conserving surgery or at a later date?

A

Same time

81
Q

Is radiotherapy given as after mastectomy?

A

Only after WLE or after mastectomy if high risk

Y4 GI / Surgery (11 decks)

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