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OB/GYN > Breast > Flashcards

Breast Flashcards

1
Q

Nerves of the breast

A

long thoracic n- serratus anterior, thoracodorsal n- latissumis dorsi, and intercostobrachial n- sensory to medial arm and axilla

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2
Q

vessels of breast

A

thoracodorsal a- latissumis dorsi, lateral thoracic, internal thoracic, internal mammary, intercostals, and thoracoacromial

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3
Q

lymphatics of breast

A

97% drain to ipsilateral axillary nodes, remaining to internal mammary nodes

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4
Q

Is primary axillary lymphadenopathy breast cancer?

A

No, usually is a lymphoma

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5
Q

in these breast disorders, surgical tx should be done AFTER development is complete

A

polands syndrome, polythelia

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6
Q

breast tenderness before each period. how to tx

A

cyclical mastalgia- properly fitting bra, vitamin E supp, and caffeine cessation. NSAIDS, tamoxifen 10 mg qd x 6 weeks

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7
Q

breast tenderness unrelated to menstrual cycle

A

mastodynia

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8
Q

important and common cause of cyclical mastalgia

A

fibrocystic change

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9
Q

panless, slow growing, well circumscribed, smooth, rubbery texture. common in young women and adolescents

A

fibroadenoma

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10
Q

cordlike palpable mass, painful. dx and tx

A

mondor’s disease- NSAIDS

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11
Q

smooth mass palpated in nursing female. dx and tx

A

might be galactocele- cystic tumor containing milk located in mammary glands. I and D

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12
Q

Complex breast cyst tx

A

aspirate, F/U with US every 6 months x 2 years. (FNA). if recurs, aspirate again. recurs, then excise. if bloody aspiration, then excise it

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13
Q

describe simple breast cyst

A

regular, thin walled, no internal echos/separations, no solid component

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14
Q

what kind of nipple discharge seeks attention

A

unilateral- get cytology, ductogram, US and biopsy

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15
Q

Nipple discharge. Diagnose how?

A

collect discharge for cytology. get prolactin level, esp. if galactorrhea. hx- color, clarity, bilateral, pregnancy/breastfeeding hx, spontaneous or only with pressure.

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16
Q

bloody nipple discharge

A

ductal ectasia, intraductal papilloma

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17
Q

most common cause of bloody nipple discharge from a single duct

A

intraductal papilloma

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18
Q

increase in the number of cells that line the terminal duct lobular unit

A

epithelial hyperplasia

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19
Q

the only benign breast condition that sig increases breast cancer risk

A

atypical hyperplasia

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20
Q

proliferative breast disease tx

A

tamoxifen if gail model risk more than 1.66, vitamin D and calcium

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21
Q

swiss cheese appearance of breats on mammogram, serous discharge, affects multiple ducts in both breasts

A

diffuse papillomatosis

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22
Q

stellate density on mammogram

A

radial scar

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23
Q

radial scar might be confused with..

A

BIRADS5

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24
Q

99% of male breast cancers related to…

A

BRCA 1 and 2, esp. BRCA 2

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25
what BRCA gene related to ovarian cancer
1- in 30-45%
26
surgical tx in ppl that are BRCA 1 positive- what is suggested?
get TAHcBSO
27
country with lowest incidence of breast cancer
Japan
28
risk of breast cancer
1 in 8 women (12%). 4-5% if no risk factors
29
Breast cancer screening decreases mortality by..
25%
30
Gail model
tool used to assess the risk of breast cancer
31
Gail model- risk for breast cancer greater than 1.66% indicates...
considerate use of tamoxifen to reduce risk
32
modified radical mastectomy
removal of one or more breasts as well as lymph nodes
33
subcutaneous mastectomy
nipple sparing
34
types of reconstruction
implant only, latissimus dorsi flap, TRAM flap, GAP flap, nipple reconstruction and tatooing
35
TRAM flap
transverse rectus abdominis flap
36
GAP flap
gluteal artery perforator
37
how is DCIS usually managed?
lumpectomy plus radiation
38
how is LCIS usually managed
excisional biopsy
39
most aggressive DCIS with increased recurrence rates
comedo DCIS
40
types of DCIS
solid, cribriform, comedo, and papillary
41
which is pre-malignant - DCIS or LCIS
DCIS
42
mass that is usually not palpable. presents as cluster of microcalcifications on mammogram
DCIS
43
Tx for DCIS
lumpectomy plus radiation plus sentinel node biopsy OR mastectomy- if tumor is multicentric, large, or if re-excision fails to get good margins
44
Premenopausal female presents with mass that is non palpable and not calcified. what tumor do you suspect?
LCIS
45
what do most patients that develop LCIS develop?
DUCTAL carcinoma
46
tx of LCIS
excisional biopsy, tamoxifen, nothing, bilateral subcutaneous mastectomy, no SLN
47
which type of invasive ductal carcinoma has worst prognosis?
scirrhotic
48
list types of invasive ductal carcinoma
MMETS- Medullary, Mucinous, Tubular, and Scirrhotic
49
tx for invasive ductal carcinoma
mastectomy +/-radiation and SLN biopsy OR lympectomy + radiation + SLN biopsy
50
ten percent of all breast cancers
invasive lobular carcinoma
51
85% of all breast cancers
invasive ductal carcinoma
52
what confers a worse prognosis in invasive LOBULAR carcinoma?
signet ring cells
53
peau d'orange lymphedema, erythema, and warmness in breast. clinician suspects mastitis, but abx therapy do not help. now what?
do incisional biopsy- indicates it is inflammatory breast cancer. need to treat right away- chemo and radiation prior to mastectomy because it is a T4 disease and very aggressive
54
what tumor resembles giant fibroadenoma?
cystosarcoma phyllodes
55
most common metastatic carcinomas of breast?
squamous and psudosarcomatous
56
tx for metastatic carcinoma
mastectomy
57
what prior hx to patients with paget's disease usually have?
DCIS or invasive ductal carcinoma
58
what type is male breast cancer usually?
ductal type
59
this cancer is assoc with steroid use, previous radiation, family hx, kliinefelters, and prolonged hyperestrogenic state
male breast cancer
60
tx for paget's disease and male breast cancer
MRM - modified radical mastectomy
61
tx for cystosarcoma phyllodes
wide local excision with negative margins, no SLN biopsy needed
62
patients presents with dark purple nodule or lesion on arm 5-10 years after surgery.
stewart treves syndrome-lymphangiosarcoma from chronic lymphedema following axillary lymph node dissection
63
pregnancy with mass- if cyst,
drain (and ultrasound)
64
pregnancy with solid mass-
core needle biopsy (and ultrasound)
65
if breast cancer-
MRM

OB/GYN (10 decks)

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