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Clinical Med > Breast and axilla > Flashcards

Breast and axilla Flashcards

1
Q

What do you always check for in breast cancer screens?

A

Axillary lymph nodes

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2
Q

What is tanner stage 1?

A

Elevation of only the papilla

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3
Q

What is tanner stage 2?

A

Breast bud stage

Elevation of breast and papilla as a small mound
Enlargement of areola

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4
Q

What is tanner stage 3?

A

Further enlargement of breast and areaola WITHOUT separation

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5
Q

What is tanner stage 4?

A

Areola projected aboive level of breast as a secondary mound

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6
Q

What is tanner stage 5?

A

Mature stage
Recession of areola mound to the general contour of the breast

Pojection of papilla only

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7
Q

How long does it take to develop breasts?

A

4 years

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8
Q

What are the 5 characterisitcs to look for during the breast examination?

A 
Size
Symmetry
Shape
Skin color
Skin texture
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9
Q

What is the best position for the patient to be in when palpating the breast?

A

Supine, with pillow beneath scapula

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10
Q

What is the best method for palpating the breast?

A

vertical method

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11
Q

Where do most malignancies in the breast occur?

A

Upper, outer quadrant

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12
Q

What is the inframmary ridge?

A

Normal finding: reidge of compressed tissue along the lower edge of the breast

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13
Q

When do you compress the nipple?

A

Only if there is discharge

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14
Q

What are the five D’s for breast exam?

A 
Discharge
Depression or inversion
Discoloration
Dermatologic changes
Deviation (compare opposite side)
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15
Q

True or false: an “innie” nipple is always bad

A

False–only bad if changed

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16
Q

What is the areola?

A

Pigment surrounding nipple

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17
Q

What is colostrum?

A

a clear or milky fluid that is expressed from teh breast before milk production

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18
Q

What is galactorrhea?

A

Lactation no associated with child bearing

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19
Q

What is gynecomastia?

A

Abnormal large mammary glands in the male (sometimes may excrete milk)

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20
Q

What is mastisits?

A

Inflammation of the breast

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21
Q

What is mastodynia?

A

Pain in the breast

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22
Q

When does breast development occur relative to the pubic hair development?

A

1 year prior to pubic hair

2 years prior to menarche

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23
Q

What are the non-modifiable factors for breast CA?

A 
Gender
Age
Genetic
FHx
PHx
Race (whites more likely to have, blacks more likely to die)
Dense breast tissue
Previous chest radiation
DES exposure
Early menarche/menopause
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24
Q

What are the modifiable factors for breast CA?

A 
Postmenopausal obesity
Exercise
EtOH
Hormone replacement
Recent oral contraception
breast feeding lowers risk
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25
Q

What are the three risk assessment tools?

A

Gail model
Claus model
BTCAPRO model

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26
Q

When are mammograms recommended?

A

above age 40, yearly

75+ should have discussion

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27
Q

When should women 20-39 have clinical breast exams?

A

1-3 years

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28
Q

When should women 40+ have clinical breast exams?

A

Yearly

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29
Q

When should women begin self-breast exam?

A

over 20 years

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30
Q

How often should high risk women have mammograms (or MRIs)?

A

yearly

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31
Q

When are venous changes normal?

A

Bilateral in obese or pregnant women

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32
Q

When are venous changes abnormal?

A

Unilateral

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33
Q

When you should not examine braests?

A

during menses (wait 5-7 days after)

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34
Q

What are the three biggest symptoms of breast disease?

A

Mass
pain
nipple discharge (color dependent bloody=CA)

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35
Q

What are the characteristics of breast carcinoma discharge (4)?

A
  1. spontaneous
  2. bloody
  3. associated with mass
  4. localized to a single duct in one breast
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36
Q

What are the characteristics of non-malignant breast discharge?

A
  1. Discharge only with compression
  2. multiple duct involvement
  3. Frequently bilateral
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37
Q

nipple discharge that is clear, yellow, white, or dark green is characteristic of what type of breast issue (carcinoma or non-malignent)?

A

Either

38
Q

What muscles form the floor of the breast (6)?

A 
Pectoralis major &minor
Serratus anterior
Lats
Subscapularis
External oblique
Rectus abdominus
39
Q

Where are the four places lymph can drain

A

Central axillary
Pectors
Subscapular
Lateral (along upper humerus)

40
Q

Where do the pectoral lymph nodes receive drainage from?

A

Chest wall, breast

41
Q

Where do the subscapular lymph nodes receive drainage from?

A

posterior chest wall, lateral border of the scap

42
Q

Where do the lateral lymph nodes receive drainage from?

A

Upper arm

43
Q

When is the best time (of the month) to perform a breast exam?

A

5-7 days after onset of menses

44
Q

Where in the breast do most malignancies occur?

A

Upper, outer quadrant

45
Q

What is the best method to use to palpate the breast: vertical (lawnmower), circular, or spoke?

A

Vertically

46
Q

When should you compress the nipple?

A

Only if it has discharge

47
Q

What is the common breast lesion for women ages 15-25?

A

Fibroadenomas

48
Q

What is the common breast lesion for women ages 25-50?

A

Cysts

Fibrocystic changes

CA

49
Q

What is the common breast lesion for women ages 50+?

A

CA until proven otherwise

50
Q

What is the common breast lesion for women who are pregnant?

A

Lactating ademonma

51
Q

What are the characterisitics of fibroadenomas? Are they mobile? Are they TTP?

A

Usually smooth, rubbery, round, mobile, no TTP

52
Q

What are the characteristics of cysts?

A

usually soft, round, mobile

53
Q

What are the characterisitcs of CA? Are they mobile?

A

Irregular, firm, may be mobile or fixed

54
Q

What are the characteristics of fibrocystic changes?

A

nodular, ropelike

55
Q

How many times more likely are women likely to get breast cancer than men?

A

100x more likely

56
Q

What percent of breast cancers are heriditary?

A

5-10%

57
Q

What is the most common genetic cause of breast CA?

A

BRCA1/2

58
Q

What percent of invasive breast cancers were in women aged 55 or older?

A

2/3

59
Q

One, first degree relative with breast CA increased your risk how much? How about for two primary relatives?

A

doubles risk, 5x for two

60
Q

What is the racial disparity between white and african american women in terms of developing breast CA?

A

White more likely to develop

Black more likely to die

61
Q

Are women with dense breast tissue more or less likely to develop breast CA?

A

MOre

62
Q

What is DES? How does it relate to breast CA?

A

Used in the 40’s-70s to decrease miscarriage, but carinogenic to both mother and daughters

63
Q

Women who have menopause (insert word here) or had menarche (here too) are more likely to develop breast CA.

A

Had menarche early, menopause later

64
Q

Does breast feeding increase or decrease the risk for breast cancer?

A

Decreases

65
Q

Does using hormone replacement therapies increase or decrease the risk for breast CA?

A

Increases

66
Q

Define: areola

A

pigmented area surrounding the nipple

67
Q

Define: colostrum

A

clear or mily fluid that is expressed from the breast before milk production

68
Q

Define: duct ectasia

A

a benign condition of the subareolar ducts that can cause a nipple discharge

69
Q

Define: fibroadenoma

A

a benign tumor of the breast

70
Q

Define: fibrocystic disease

A

a benign condition that presents with fluid-filled cyst due to ductal enlargement that
is usually bilateral and multiple.

71
Q

what is Galactorrhea

A

lactation not associated with childbearing

72
Q

define Gynecomastia

A

abnormally large mammary glands in the male; sometimes may excrete milk

73
Q

What are Intraductal papillomas?

A

benign tumors of the subareolar ducts that produce a nipple discharge

74
Q

What is pain in the breast called?

A

Mastodynia:

75
Q

what are tiny sebaceous glands that may appear on the areola called?

A

Montgomery follicles

76
Q

What is Paget’s disease

A

skin manifestations that are indicative of ductal carcinoma

77
Q

What are skin changes of the breast due to edema caused by blockage of the lymph drainage
associated with inflammatory breast cancer called?

A

Peau d’orange

78
Q

What is the tail of spence?

A

area where most malignancies of the breast tissue occurs.

79
Q

What is the beginning of female pubertal breast development called?

A

Thelarche

80
Q

Are fibrocystic changes of the breast usually unilateral or bilateral?

A

bilateral

81
Q

What is the only type of mass that causes retraction of the breast?

A

CA

82
Q

Which of the breast masses discussed varies with menses?

A

Fibrocystic breast changes

83
Q

Is cancer usually unilaterally found, or bilaterally?

A

unilaterally

84
Q

What type of shape are breast CAs?

A

Irregular or stellate

85
Q

Does breast CA have well defined borders or poorly define borders? Are they fixed or mobile? Are they firm or soft

A

Poorly defined borders, fixed, hard

86
Q

When are venous pattern changes in breasts concerning?

A

When they are unilateral

87
Q

What happens to breasts at pregnancy (4)?

A
  1. Fuller and more firm
  2. areola darkens
  3. nipple enlarges
  4. Colostrum produced in the third trimester
88
Q

You are seeing a new female patient that is concerned for breast CA. She is 23 years old, and presents with multiple, round masses in her right breast. The masses are firm, well delineated, mobile, and are non-tender. Retraction signs are absent. Based on lecture what is your diagnosis?

A

Fibroadenoma

89
Q

You are seeing a new female patient with a concern for breast CA. She is a 37 yo female, who presents with, round, soft, and well delineated masses in her breasts bilaterally. The masses are mobile, and TTP. Retraction signs are absent. Based on lecture what is your diagnosis?

A

Cysts

90
Q

You are seeing a well established 58 y.o. female patient who has a concern for breast CA. She presents with a single, poorly delineated, and irregular mass in her left breast that is firm to palpation. The mass is not moble, and retraction is present. Based on lecture what is your diagnosis?

A

May be CA

91
Q

Infiltrating ductal presents as what (3 features)? What age group is most commonly affected?

A

Single, fixed, irregular mass

30-80 yo it is the most common

92
Q

Are inflamatory tumors of the breast malignant or benign?

A

Malignant with poor prognosis

Clinical Med (30 decks)

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