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#DAY3_SURGERY > breast > Flashcards

breast Flashcards

1
Q

What is the location of the greatest volume of the breast

A

upper outer quadrant

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2
Q

Blood supply of breast

A
  1. internal mammary artery 2. posterior intercostal artery 3. branches of axillary artery
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3
Q

Venous drainage of breast

A
  1. Lateral thoracic and thoracoacromial to axillary 2. Internal thoracic
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4
Q

Possible route for breast cancer metastases to the vertebrae, skull, pelvic bones and CNS

A

Batson’s vertebral plexus

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5
Q

Most common site of axillary LN metastasis

A

Lateral/ axillary vein group - I

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6
Q

This hormone promotes ductal development of breast

A

estrogen

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7
Q

This hormone promotes lobular development of breast

A

progesterone

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8
Q

Treatment of breast abscess

A
  1. pre operative ultrasound 2. incision and drainage - with suppuration 3. local wound care - antibiotics and warm compress
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9
Q

This is a recurrent retroareolar infection and abscess of the breast

A

Zuska’s disease (recurrent periductal mastitis)

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10
Q

A benign self limited condition which is a variant of thrombophlebitis that involves the superficial veins of the anterior chest wall and breast

A

mondor disease

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11
Q

Treatment of mondor disease

A
  1. anti inflammatory medications 2. warm compress 3. restriction of motion 4. brassiere support
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12
Q

What is a size of a giant fibroadenoma

A

> 3 cm

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13
Q

Treatment of fibroadenoma

A
  1. cryoablation 2. surgical removal 3. observe
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14
Q

This occurs when the stroma of the breast involutes too quickly and the alveoli remains.

A

Breast Cyst

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15
Q

Management of breast cyst

A

Core needle biopsy

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16
Q

Definition of microcalcification

A
  1. < 0.5 mm 2. fine 3. linear 4. branching
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17
Q

It occurs in premenopausal women with serous or bloody nipple discharge

A

intraductal papilloma - Most common cause of bloody nipple discharge

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18
Q

What age to perform baseline mammography

A

35 y.o

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19
Q

What age to do annual mammogram

A

40 y.o

20
Q

What is the treatment if there is mutation in HER 2 gene

A

herceptin/trastuzumab

21
Q

Most common sign of breast CA

A

Mass

22
Q

Where is BRCA 1 located

A

chromosome 17q -develops invasive ductal carcinoma -poorly differentiated -hormone receptor negative

23
Q

Where is BRCA 2 located

A

Chromosome 13q -develops invasive ductal carcinoma -well differentiated -hormone receptor positive

24
Q

Most important prognostic correlate of disease free and overall survival of breast CA

A

axillary lymph node status

25
Q

Most common sites of metastases in breast CA

A
  1. bone 2. lung 3. pleura 4. soft tissue 5. liver
26
Q

Treatment of LCIS

A
  1. observation 2. chemoprevention with tamoxifen and bilateral total mastectomy 3. close follow up with PE and bilateral mammograms
27
Q

Treatment of DCIS

A
  1. >4 cm or >1 quadrant - mastectomy 2. low grade DCIS (cribriform or papillary subtype) and < 0.5 cm - lumpectomy
28
Q

What is the pathognomonic finding of Paget’s disease of nipple

A

PAGET CELLS - large, pale, vacuolated cells in the rete pegs of the epithelium

29
Q

Paget disease is positive for what marker? How can you differentiate it from Melanoma?

A

o (+) CEA – Paget disease o (+) S-100 – Melanoma

30
Q

It is a multifocal, multicentric and bilateral breast cancer with signet ring cells

A

INVASIVE LOBULAR CARCINOMA - Absence of e-cadherin as diagnostic biomarker - Small cells arranged in single file orientation (Indian file configuration) - Intracytoplasmic mucin that may displace the nucleus (Signet ring cell carcinoma)

31
Q

What test is used in nipple discharge

A

ductography

32
Q

Treatment of early invasive breast cancer (stage I, IIA, IIB)

A

Breast conservation surgery 1. lumpectomy 2. radiation therapy

33
Q

Contraindication to breast conservation surgery

A
  1. prior RT 2. unknown margin status 3. multicentric disease 4. scleroderma or SLE
34
Q

Treatent of advanced local regional breast cancer (IIIA, IIIB)

A
  1. surgery - MRM 2. adjuvant RT 3. chemotherapy - neoadjuvant
35
Q

5 year survival rate of breast cancer

A

I - 94% IIA - 85% IIB - 70% IIIA - 52% IIIB - 48% IV - 18%

36
Q

Differentiate the types of mastectomy

A
37
Q

What comprises a MRM

A
  1. removal of all breast tissue 2. nipple areola complex 3. level I and II LN 4. skin
38
Q

This surgery removes all breast tissue and skin, nipple areola complex, pectoralis major and minor, and level I, II, III LN

A

halstead radical mastectomy

39
Q

Most frequent complication of MRM

A

seroma

40
Q

treatment of pregnant breast CA

A

1st and 2nd trimester - MRM 3rd trimester - lumpeectomy with Axillary ND and RT after delivery

41
Q

Treatment of Phylloides tumor/cystosarcoma

A

Benign - total excision with 2 - 3 cm margin Malignant - total mastectomy WITHOUT` LN dissection

42
Q

It is a variant of infiltrating ductal carcinoma characterized by skin changes of brawny induration, erythema with a raised edge, and edema/ peau d orange

A

inflammatory breast cancer

43
Q

what causes the appearane of inflammatory breast cancer

A

dermal lymphatic invasion

44
Q

This surgery is the removal of all breast tissue, nipple areola complex, skin

A

total (simple) mastectomy

45
Q

This presents as a chronic, erythematous, eczematoid rash or ulcer and is associated with DCIS and invasive cancer of the breast

A

Paget’s disease

46
Q

Treatment of Paget’s disease

A
  1. lumpectomy 2. mastectomy 3. MRM depends on the extent of involvement and presence of invasive cancer
47
Q

This drug is quoted as medical adrenalectomy

A

anastrazole - inhibit production of adrenal steroid and conversion of androgen to estrogen in the adrenal gland and peripherally

#DAY3_SURGERY (16 decks)

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