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SURG > BREAST > Flashcards

BREAST Flashcards

1
Q

Blood supply of breast

A

Internal mammary and lateral thoracic aa

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2
Q

Intercostobrachial n comes off which nerve?

A

2nd intercostal. Provides sensation to medial arm

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3
Q

Medial pectoral n supplies

A

both pec minor and major

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4
Q

Lateral pectoral nerve supplies

A

pec minor ONLY

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5
Q

Poland syndrome

A

Amastia
Hypo plastic shoulder
No pecs

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6
Q

Mondor’s disease

A

Thrombophlebitis of superficial vein of breast

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7
Q

Tx of Mondor’s disease

A

NSAID

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8
Q

Rx of Mastodynia

A

Danazol, OCP

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9
Q

How many of DCIS recurrences are invasive?

A

50%

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10
Q

Cure rate of DCIS

A

94-100%

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11
Q

Surgical tx of DCIS

A

Excision and radiotherapy OR mastectomy. Axillary dissection NOT required as only 1% have positive nodes.

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12
Q

Risks of Tamoxifen

A 
1-2% DVT, PE
Cataracts
Uterine adenocarcinoma, sarcoma
Decreases risk of osteoporosis
NO CHANGE in incidence of heart disease
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13
Q

Tamoxifen on survival rate of breast CA

A

Tamoxifen has NOT been shown to increase survival, only decrease rate of recurrence (DCIS and ipsilateral/contralateral invasive breast CA).

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14
Q

Van Nuys classification

A 
May ID pts who can benefit from lumpectomy alone.
Low grade
W/O necrosis
Margin > 1 cm
Lesion <1.5 cm
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15
Q

Difference between LCIS and Atypical Lobular Hyperplasia (ALH)

A

LCIS has >50% lobular involvement and ALH <50%

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16
Q

Increased risk in patients with LCIS

A

7-10x increased risk of invasive CA in either breast

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17
Q

% of malignancies in Phyllodes tumor

A

10%

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18
Q

How does Phyllodes tumor spread?

A

Hematogenously, if at all.

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19
Q

Surgical tx of Phyllodes

A

Wide local excision, mastectomy not necessary! No ALND (doesn’t spread through LN)

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20
Q

1 cause of bloody nipple discharge

A

Intraductal papilloma – > NO RISK OF CA

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21
Q

Comedo breast CA

A

Likely multi centric. Poor prognosis. :(

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22
Q

What is a radial scar and what do you do about it?

A

Stellate arrangement of ductal structures with sclerotic background and central fibro-elastic core. Associated with carcinoma anywhere in the scar – do not stereotactically biopsy as that has increased chance of sampling error. Instead, you should do an excision biopsy

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23
Q

T1 breast cancer size

A

<2 cm

24
Q

T2 breast cancer size

A

2.1 - 5 cm

25
Q

T3 breast cancer size

A

> 5 cm

26
Q

N1 in breast cancer

A

+ axillary nodes

27
Q

N2 in breast cancer

A

matted/fixed nodes

28
Q

N3 in breast cancer

A

internal mammary nodes

29
Q

Stage I breast CA

A

T1 (90-95% 5 year survival)

30
Q

Stage II breast CA

A

T2N1 or T3N0 (50-80% 5 year survival)

31
Q

Stage III breast CA

A

T4 or N3 (30-50% 5 year survival)

32
Q

In pre-menopausal women with breast CA, who gets chemo?

A

ER/PR-
T>1 cm
Any N, including micro (SN+)

33
Q

In post menopausal women with breast CA, who gets chemo?

A

ER/PR- and T >2 cm

>4 nodes OR matted nodes (regardless of ER/PR, whether positive OR negative!)

34
Q

Who gets axillary radiation in breast CA?

A

+ supraclavicular node
Matted nodes (extra capsular extension)
>4 nodes

35
Q

Li-Fraumeni syndrome is a mutation of?

A

p53

36
Q

How often do patients with Mondor disease have an underlying breast CA

A

6.3%

37
Q

Most common etiology of Mondor

A

Idiopathic

Others: previous trauma, surgery, or biopsy, an underlying connective tissue disorder, breast cancer

38
Q

Raloxifine can be administered to who?

A

POST menopausal women.

39
Q

What is pseudogynecomastia (lipomastia)

A

Fat deposition WITHOUT glandular proliferation. Think the very obese male.

40
Q

Benign breast disease associated with increased risk of malginancy

A

Atypical ductal hyperplasia and atypical lobular hyperplasia (4x). If family history is +, risk increases to 9x.

41
Q

Cowmen’s syndrome (PTEN mutations) associated with cancers where?

A

Hamartomatous and/or cancerous lesions in Skin, Mucous membranes, breast, thyroid, endometrium, colon, and brain.

42
Q

What should you do FIRST in the diagnostic workup of suspected Paget’s disease?

A

Full thickness nipple areolar skin biopsy. Dx is best made with confirmation of Paget cells involving epidermis of nipple by histology.

43
Q

In the absence of radiographic findings, pathologic unilateral bloody nipple discharge should be managed with…

A

Terminal duct excision.

44
Q

Breast RF for chest wall recurrence post-mastectomy

A

Presence of axillary node mets

45
Q

What breast CA is difficult to detect on mammography

A

LCIS.

46
Q

Indicators for chemo prior to breast CA surgery

A

Arm edema
Skin ulceration
Edema of skin of breast
Tumor fixation to serrates anterior

47
Q

Recommendations for screening in known/suspected BRCA mutation

A

Annual MRI starting at age 25 and then annual mammogram and breast MRI beginning at age 30
Annual ovarian cancer screening (including transvaginal ovarian ultrasounds, CA-125, pelvic exams beginning at age years or 5-10 years before the earliest age of first diagnosis of ovarian cancer in the family)
Biannual clinical breast exam beginning at age 25
Monthly breast self-exams/breast awareness starting at age 18

48
Q

Which systemic agent improves survival in men with ER+ breast CA?

A

Tamoxifen

49
Q

Hormone med with androgenic properties highly effective for alleviation of breast pain

A

Danazol

50
Q

2 endocrine disorders that cause galactorrhea

A

HYPOthyroidism and hyperprolactinemia

51
Q

Class of drug notorious for inducing galactorrhea, amenorrhea

A

TYPICAL antipsychotic

52
Q

Benign breast disease resulting in nipple retraction and thick yellow/green or bloody discharge

A

Duct ectasia

53
Q

Small normal bumps on areola

A

Montgomery’s tubercle

54
Q

Risk of developing local recurrence after mastectomy in women with DCIS

A

1%

55
Q

Mammography findings of fat necrosis

A

Architectural distortion
Microcalcs
Spiculated masses

If it demonstrates mixed soft tissue density with calcified rim, dx of fat necrosis is confirmed

56
Q

Why do cigarette smokers in particular get recurrent breast abscesses

A

Cigarette smokers have decreased blood levels of beta-carotene, which in turn affects the ability of vitamin A to protect against squamous metaplasia. Vitamin A is essential for the differentiation and preservation of normal mucosal epithelium. Deficiency of vitamin A produces a keratinizing squamous metaplasia that can lead to intermittent duct obstruction and recurrent infection.

SURG (17 decks)

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