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Year 3 > Breast > Flashcards

Breast Flashcards

1
Q

What muscles do the breasts lie upon

A

pectoralis major
serratus anterior
external oblique

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2
Q

Breast nerve supply

A

intercostal nerves from T4-T6

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3
Q

Breast arterial supply

A

internal mammary (thoracic) artery
external mammary artery (laterally)
anterior intercostal arteries
thoraco-acromial artery

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4
Q

Breast venous drainage

A

superficial venous plexus to subclavian, axillary and intercostal veins

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5
Q

lymphatic drainage of breasts

A

70% axillary nodes
internal mammary chain
other lymphatic sites such as deep cervical and supraclavicular fossa (later in disease)

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6
Q

Preparation for lactation involves

A

Oestrogen: promotes duct development in high concentrations
progesterone: high levels stimulate formation of lobules
human placental lactogen: prepares mammary glands for lactation

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7
Q

Two hormones involved in stimulating lactation

A

prolactin: causes milk stimulation
oxytocin: causes contraction of the my-epithelial cells surrounding the mammary alveoli to result in milk ejection from the breast

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8
Q

What is the most common type of breast cancer

A

invasive ductal carcinoma

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9
Q

Typical changes seen in conjunction with invasive breast cancer

A
  1. Nuclear pleomorphism
  2. Coarse chromatin
  3. Angiogenesis
  4. Invasion of the basement membrane
  5. Dystrophic calcification (may be seen on mammography)
  6. Abnormal mitoses
  7. Vascular invasion
  8. Lymph node metastasis
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10
Q

What breast tumour is most commonly associated with a risk of metastasis to the contralateral breast

A

invasive lobular carcinoma

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11
Q

How does invasive lobular carcinoma of the breast present

A

mass is typically more diffuse than in ductal carcinoma
Less obvious on U/S and mammogram
Safest to perform an MRI (so there isn’t a risk of under-staging the lesion)
More likely to be multifocal and metastasise to the other breast

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12
Q

Most common causes of cancer in the UK

A
  1. Breast
  2. Lung
  3. Colorectal
  4. Prostate
  5. Bladder
  6. Non-Hodgkin’s lymphoma
  7. Melanoma
  8. Stomach
  9. Oesophagus
  10. Pancreas
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13
Q

Most common causes of death from cancer in the UK

A
  1. Lung
  2. Colorectal
  3. Breast
  4. Prostate
  5. Pancreas
  6. Oesophagus
  7. Stomach
  8. Bladder
  9. Non-Hodgkin’s lymphoma
  10. Ovarian
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14
Q

Classical demographic and presentation of primary hyperparathyroidism

A

elderly female with unquenchable thirst and inappropriately normal or raised parathyroid hormone level

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15
Q

Causes of hyperparathyroidism

A

80% solitary adenoma
15% hyperplasia
4% multiple adenoma
1% carcinoma

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16
Q

Symptomatic features of primary hyperparathyroidism

A

bones, stones, abdominal moans, and psychic groans

polydipsia, polyuria
depression
anorexia, nausea, constipation
peptic ulceration
pancreatitis
bone pain/fracture
renal stones
hypertension

17
Q

primary hyperparathyroidism associations

A

hypertension
multiple endocrine neoplasia: MEN I and II

18
Q

Investigations for primary hyperparathyroidism

A

raised calcium, low phosphate
PTH may be raised or (inappropriately, given the raised calcium) normal
technetium-MIBI subtraction scan
pepperpot skull is a characteristic X-ray finding of hyperparathyroidism

19
Q

Treatment for primary hyperparathyroidism

A

the definitive management is total parathyroidectomy
conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage
patients not suitable for surgery may be treated with cinacalcet, a calcimimetic
a calcimimetic ‘mimics’ the action of calcium on tissues by allosteric activation of the calcium-sensing receptor

20
Q

Selective oEstrogen Receptor Modulators (SERM)
Example
What is it
Adverse effects

A

Tamoxifen
acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor-positive breast cancer.

Adverse effects
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

21
Q

Aromatase inhibitors
example
what is it
adverse effects

A

Anastrozole and letrozole

reduces peripheral oestrogen synthesis. This is important as aromatisation accounts for the majority of oestrogen production in postmenopausal women and therefore anastrozole is used for ER +ve breast cancer in this group.

Adverse effects
osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia

Year 3 (14 decks)

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