Breast

Question 1

What is the blood supply to the breast?

Answer 1

Medially -** Internal thoracic (mammary) artery** which goes into perforating branches 2nd- 5th IC space

Laterally
- Posterior intercostal artery and it’s perforating branches
- Lateral thoracic (mammary) artery and it’s perforating branches
- Thoraco-acromial artery
- Anterior intercostal arteries 2-4 (branches of internal thoracic artery

Question 2

Which 3 groups of lymph nodes receive lymph from the breast?

Answer 2

Axillary, parasternal and posterior intercostal lymph nodes

Question 3

What nerves innervate the breast?

Answer 3

Anterior and lateral cutaneous branches of the 4-6th intercostal nerves

Question 4

What ligaments hold the breasts up?

Answer 4

Suspensory ligaments of cooper
They attach the dermis to the pectoralis fascia

Question 5

What muscles lie posterior to breasts?

Answer 5

Pectoralis major
Pectoralis minor
Serratus anterior
External oblique

Question 6

What does halo sign mean on mammography?

Answer 6

Breast cyst

Question 7

What drugs cause gynaecomastia?

Answer 7

D - digoxin
I - isoniazid
S - spironolactone
C - cemitidine
O - oestrogen

Metoclopramide
Methyldopa
Ethionamide
Chlorpromazine

Question 8

What is the most important prognostic indicator in breast cancer?

Answer 8

Nodal status

Question 9

Which type of breast cancer is characterised by a marked lymphocytic infiltrate?

Answer 9

Medullary breast cancer

Question 10

Cause of nipple discharge, inverted nipple and invovlement of multiple ducts?

Answer 10

Duct ectasia

Widening of the lactiferous ducts, blockage and build up
Menopausal women >50, smokers
Thick, green nipple discharge
Can be from single or multiple ducts

Question 11

What is the commonest cause of blood stained nipple discharge in younger women?

Answer 11

Intraductal papilloma

Question 12

Most likely cause of a19 year old male presents with bilateral gynaecomastia, poor vision and nipple discharge?

Answer 12

Prolactinoma

Proliferation of lactotrophic cells in anterior pituitary gland. Can cause compression of the optic chiasm resulting in bi temporal hemianopia

Question 13

What nerves are most likely to be damaged during axillary node clearnace?

Answer 13

Thoracodorsal nerve
Intercostalbrachial nerve

Question 14

Infiltration of the malignancy to what structures causes skin dimpling and nipple retraction?

Answer 14

Skin dimpling - Suspensory ligaments of cooper
Nipple retraction - Lactiferous ducts

Question 15

What type of breast ca is likely to show as linear, branching microcalcification with coarse granules on mammography?

Answer 15

Comedo DCIS

Question 16

Which type of breast tumour is most commonly associated with a risk of metastasis to the contralateral breast?

Answer 16

Invasive lobular carcinoma

Question 17

What breast condition is common in smokers and may present with recurrent infections?

Answer 17

Periductal mastitis

Question 18

What are the symptoms of periductal mastitis?

Answer 18

periareolar or sub areolar infections

Question 19

What is Mondors disease?

Answer 19

localised thrombophlebitis of a breast vein

Question 20

What is the most common type of wound closure following implantation after mastectomy?

Answer 20

Pedicled latissimus dorsi myocutaneous flap

Question 21

Which type of cancer forms as a result of chronic lymphoedema?

Answer 21

Lymphangiosarcoma

Question 22

What is the nerve supply to pectoralis major and minor?

Answer 22

Pec major - clavicular head is lateral pectoral nerve and sternocostal head is medial pectoral nerve.

Pec minor - medical pectoral nerve

Question 23

What is the nerve and blood supply to the latissimus dorsi?

Answer 23

Thoracodorsal artery - branch of subscapular artery

Thoracodorsal nerve - branch of posterior cord of brachial plexus

Question 24

What is the nerve and blood supply of the serratus anterior?

Answer 24

Long thoracic nerve (C5-7)

Lateral thoracic artery, the superior thoracic artery and the thoracodorsal artery

Question 25

What is the difference between nipple eczema and paget’s disease of the breast?

Answer 25

Most present with erythematous rashes.
Nipple eczema usually affects nipple only.
Paget’s disease spreads to areolar and periareaolar tissue. It is associated with undelying DCIS or invasive carcinoma. Diagnosis is made with punch biopsy.

Question 26

Which subtype of breast cancer is likely to have linear branching microcalcifications?

Answer 26

Comedo DCIS

Cribiform are multifocal

Question 27

Which biologic agent is useful for HER2 postitive breast cancer in young women?

Answer 27

Trastuzumab