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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

24
Q

T2 breast cancer size

A

2.1 - 5 cm

25
T3 breast cancer size
>5 cm
26
N1 in breast cancer
+ axillary nodes
27
N2 in breast cancer
matted/fixed nodes
28
N3 in breast cancer
internal mammary nodes
29
Stage I breast CA
T1 (90-95% 5 year survival)
30
Stage II breast CA
T2N1 or T3N0 (50-80% 5 year survival)
31
Stage III breast CA
T4 or N3 (30-50% 5 year survival)
32
In pre-menopausal women with breast CA, who gets chemo?
ER/PR- T>1 cm Any N, including micro (SN+)
33
In post menopausal women with breast CA, who gets chemo?
ER/PR- and T >2 cm | >4 nodes OR matted nodes (regardless of ER/PR, whether positive OR negative!)
34
Who gets axillary radiation in breast CA?
+ supraclavicular node Matted nodes (extra capsular extension) >4 nodes
35
Li-Fraumeni syndrome is a mutation of?
p53
36
How often do patients with Mondor disease have an underlying breast CA
6.3%
37
Most common etiology of Mondor
Idiopathic | Others: previous trauma, surgery, or biopsy, an underlying connective tissue disorder, breast cancer
38
Raloxifine can be administered to who?
POST menopausal women.
39
What is pseudogynecomastia (lipomastia)
Fat deposition WITHOUT glandular proliferation. Think the very obese male.
40
Benign breast disease associated with increased risk of malginancy
Atypical ductal hyperplasia and atypical lobular hyperplasia (4x). If family history is +, risk increases to 9x.
41
Cowmen's syndrome (PTEN mutations) associated with cancers where?
Hamartomatous and/or cancerous lesions in Skin, Mucous membranes, breast, thyroid, endometrium, colon, and brain.
42
What should you do FIRST in the diagnostic workup of suspected Paget's disease?
Full thickness nipple areolar skin biopsy. Dx is best made with confirmation of Paget cells involving epidermis of nipple by histology.
43
In the absence of radiographic findings, pathologic unilateral bloody nipple discharge should be managed with...
Terminal duct excision.
44
Breast RF for chest wall recurrence post-mastectomy
Presence of axillary node mets
45
What breast CA is difficult to detect on mammography
LCIS.
46
Indicators for chemo prior to breast CA surgery
Arm edema Skin ulceration Edema of skin of breast Tumor fixation to serrates anterior
47
Recommendations for screening in known/suspected BRCA mutation
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
Which systemic agent improves survival in men with ER+ breast CA?
Tamoxifen
49
Hormone med with androgenic properties highly effective for alleviation of breast pain
Danazol
50
2 endocrine disorders that cause galactorrhea
HYPOthyroidism and hyperprolactinemia
51
Class of drug notorious for inducing galactorrhea, amenorrhea
TYPICAL antipsychotic
52
Benign breast disease resulting in nipple retraction and thick yellow/green or bloody discharge
Duct ectasia
53
Small normal bumps on areola
Montgomery's tubercle
54
Risk of developing local recurrence after mastectomy in women with DCIS
1%
55
Mammography findings of fat necrosis
Architectural distortion Microcalcs Spiculated masses If it demonstrates mixed soft tissue density with calcified rim, dx of fat necrosis is confirmed
56
Why do cigarette smokers in particular get recurrent breast abscesses
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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