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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
Q

what BRCA gene related to ovarian cancer

A

1- in 30-45%

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26
Q

surgical tx in ppl that are BRCA 1 positive- what is suggested?

A

get TAHcBSO

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27
Q

country with lowest incidence of breast cancer

A

Japan

28
Q

risk of breast cancer

A

1 in 8 women (12%). 4-5% if no risk factors

29
Q

Breast cancer screening decreases mortality by..

A

25%

30
Q

Gail model

A

tool used to assess the risk of breast cancer

31
Q

Gail model- risk for breast cancer greater than 1.66% indicates…

A

considerate use of tamoxifen to reduce risk

32
Q

modified radical mastectomy

A

removal of one or more breasts as well as lymph nodes

33
Q

subcutaneous mastectomy

A

nipple sparing

34
Q

types of reconstruction

A

implant only, latissimus dorsi flap, TRAM flap, GAP flap, nipple reconstruction and tatooing

35
Q

TRAM flap

A

transverse rectus abdominis flap

36
Q

GAP flap

A

gluteal artery perforator

37
Q

how is DCIS usually managed?

A

lumpectomy plus radiation

38
Q

how is LCIS usually managed

A

excisional biopsy

39
Q

most aggressive DCIS with increased recurrence rates

A

comedo DCIS

40
Q

types of DCIS

A

solid, cribriform, comedo, and papillary

41
Q

which is pre-malignant - DCIS or LCIS

A

DCIS

42
Q

mass that is usually not palpable. presents as cluster of microcalcifications on mammogram

A

DCIS

43
Q

Tx for DCIS

A

lumpectomy plus radiation plus sentinel node biopsy OR mastectomy- if tumor is multicentric, large, or if re-excision fails to get good margins

44
Q

Premenopausal female presents with mass that is non palpable and not calcified. what tumor do you suspect?

A

LCIS

45
Q

what do most patients that develop LCIS develop?

A

DUCTAL carcinoma

46
Q

tx of LCIS

A

excisional biopsy, tamoxifen, nothing, bilateral subcutaneous mastectomy, no SLN

47
Q

which type of invasive ductal carcinoma has worst prognosis?

A

scirrhotic

48
Q

list types of invasive ductal carcinoma

A

MMETS- Medullary, Mucinous, Tubular, and Scirrhotic

49
Q

tx for invasive ductal carcinoma

A

mastectomy +/-radiation and SLN biopsy OR lympectomy + radiation + SLN biopsy

50
Q

ten percent of all breast cancers

A

invasive lobular carcinoma

51
Q

85% of all breast cancers

A

invasive ductal carcinoma

52
Q

what confers a worse prognosis in invasive LOBULAR carcinoma?

A

signet ring cells

53
Q

peau d’orange lymphedema, erythema, and warmness in breast. clinician suspects mastitis, but abx therapy do not help. now what?

A

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
Q

what tumor resembles giant fibroadenoma?

A

cystosarcoma phyllodes

55
Q

most common metastatic carcinomas of breast?

A

squamous and psudosarcomatous

56
Q

tx for metastatic carcinoma

A

mastectomy

57
Q

what prior hx to patients with paget’s disease usually have?

A

DCIS or invasive ductal carcinoma

58
Q

what type is male breast cancer usually?

A

ductal type

59
Q

this cancer is assoc with steroid use, previous radiation, family hx, kliinefelters, and prolonged hyperestrogenic state

A

male breast cancer

60
Q

tx for paget’s disease and male breast cancer

A

MRM - modified radical mastectomy

61
Q

tx for cystosarcoma phyllodes

A

wide local excision with negative margins, no SLN biopsy needed

62
Q

patients presents with dark purple nodule or lesion on arm 5-10 years after surgery.

A

stewart treves syndrome-lymphangiosarcoma from chronic lymphedema following axillary lymph node dissection

63
Q

pregnancy with mass- if cyst,

A

drain (and ultrasound)

64
Q

pregnancy with solid mass-

A

core needle biopsy (and ultrasound)

65
Q

if breast cancer-

A

MRM

OB/GYN (10 decks)

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