Breast

Question 1

Breast is formed from

Answer 1

Ectoderm milk streak forms

Question 2

What hormone is responsible for forming a Double layer of columnar cells -> makes up the duct

Answer 2

Estrogen is responsible for form which component of the breast

Question 3

What hormone is responsible for lobular development

Answer 3

Progesterone is responsible for forming which component of the breast

Question 4

What hormone synergizes estrogen and progesterone

Answer 4

Prolactin: synergizes what hormones

Question 5

Increases in what hormone cause breast swelling and growth of glandular tissue

Answer 5

Estrogen: increases causes what physiolgic effect on the breast

Question 6

Increases in what hormone causes glandular maturation while withdrawl causes menses

Answer 6

Progesterone increases causes … while with drawl leads to

Question 7

What hormones causes ovum release

Answer 7

FSH and LH surge causes what

Question 8

Serratus anterior (winged scapule defect) caused by injury to what nerve

Answer 8

Long thoracic nerve innervates what muscles and injury to it leads to what defect

Question 9

Latissumus dorsi is inervated by what nerve and injury to said nerve leads to what defect

Answer 9

Thoracodorsal nerve innervates …, injury leads to weak arm movements/adduction/pull ups

Question 10

Pectoralis Major and Minor are innervated by this nerve where as pectoralis major is only innervated by

Answer 10

medial pectoral nerve innervates» while the lateral pectoral nerve is responsible for

Question 11

Most commonly injured nerve with MRM and ALND is … and is responsible for…

Answer 11

intercostobrachial nerve responsible for sensation to medial arm and axilla is injured during these 2 surgeries

Question 12

Blood supply to the breast comes from

Answer 12

internal thoracic artery, intercostal arteries, throcoacromial artery and lateral thoracic artery supply what structure

Question 13

This valveless vein plexus is responsible for direct hematogenous metastasis of breast cancer to spine

Answer 13

Characteristics and issues with Batsons plexus

Question 14

Lymphatic drainage of breast 97% goes to..where as 2% goes to..

Answer 14

Axillary nodes account for what percentage of breast drainage compared to internal mammary nodes

Question 15

What is the primary axillary adenopathy

Answer 15

lymphoma is considered when you have this on …exam

Question 16

IF found, Supra clavicular nodes do what to your staging

Answer 16

N3 disease is automatic if you find nodes in this locationn

Question 17

Most common cause of breast abscess is (staph)…where as the organism and risk factors include

Answer 17

Found in lactating mothers, slit nipple and pt that smoke

Question 18

Treatment of a breast abscess is, while abscesses >3cm have a high propensity to fail this management. while failure i management at this length of time should make you concerned for necrotic breast cancer

Answer 18

percutaneous drainage is treatment of choice for this…If it fails to resolve in 2 weeks will need excisional biopsy including skin to rule out

Question 19

Infectious mastitis is most commonly associated with … and is causes by staph auresu s

Answer 19

Breast feeding

Question 20

Galactocele is..and treated by…

Answer 20

breast cyst filled with milk, treated with aspiration vs I&D

Question 21

Galactorrhea is caused by an increase in this hormone or these drugs

Answer 21

prolactin, OCP, TCA, phenothiazines, metoclopramide, alpha methyl dopa* can cause this in women (or men)

Question 22

Gynecomastia is associated with

Answer 22

spironlactone, marijuna can cause this condition that most often regresses

Question 23

Neonatal breast enlargments is caused by…and most often results in

Answer 23

pathology caused by circulating maternal estrogen and most often regresses

Question 24

Mastodynia is … and treated with

Answer 24

pain in the breast, benign most often in setting normal breast exam and imaging. treatment is with danazol, ocps, nsaids, can be cyclical

Question 25

Mondors Disease is… treated with nsaids

Answer 25

Superficial venous thrombophlebitis of breast (most commonly associated with trauma), cordlike can be painful treatment is…

Question 26

Types of Fibrocystic Disease

Answer 26

Fibromatosis, sclerosing adenosis, apocrine metaplasia, duct adenosis, epithelial hyperplasia, ductal hyperplasi

Question 27

Symptoms of Fibrocystic disease

Answer 27

breast pain, nipple discharge (brown / yellow), lumpy breast tissue that changes with hormonal cycle

Question 28

most common cause and treatment of bloody nipple discharge

Answer 28

intradutal papilloma usually close to the nipple, work up with ductogramm needle localization followed by subareolar exicsion

Question 29

spiculated mass with central sclerosis surrounded by entrappted normal ducts and lobules peripherally

Answer 29

Radial scar

Question 30

Abundant proliferation of stromal epithelial contents

Answer 30

Fibroadenoma

Question 31

Fat disruption, lipid laden macrophages, chronic inflammation

Answer 31

Fat Necrosis

Question 32

increased central cellularity with lobules and intact myopithelial contents

Answer 32

sclerosing adenosis

Question 33

complex, branching fronds, lined with epithelial cells that are cuboidal or columnar

Answer 33

intraductal papilloma

Question 34

Fibroadenomas are surgical treated at what size and most often present with what symptoms

Answer 34

> 3cm , painless, slow growing , well circumscribed. Popcorn lesions on mammography

Question 35

Indication for observation of breast mass

Answer 35

Pt is less then 40, mass is clinically benign on exam, imaging consistent with fibroadenoma and FNA/Core needle are concordiant

Question 36

Serous breast discharge concerning for

Answer 36

malignancy vs green/yellow, brown discharge (consistent with benign disease.

Question 37

Histological evidence of DCIS

Answer 37

Malignant, cells of ductal epithelium without invasion of basement of membrane - comedo pattern most aggressive subtype - cluster of calcifications on mammography

Question 38

Treatment of non high grade DCIS

Answer 38

Lumpectomy and XRT (need 2mm margins) Do not need SLNB, possible tamoxifen, raloxifen

Question 39

Treatment of high grade DCIS

Answer 39

(comedo type, multicentric and multifocal ) if a large tumor not amenable to lumpectomy or if not able to good margins, simple mastectomy also need SLNBx.