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Learning to love Clinical Medicine > Breast and axillae > Flashcards

Breast and axillae Flashcards

1
Q

Colostrum

A

clear or milky fluid from breast before mild production

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2
Q

Cooper ligament

A

subcutaneous fibrous tissue that provides support to the breast

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3
Q

Duct ectasia

A

benign condition of the subareolar ducts that can cause nipple discharge

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4
Q

Fibroadenoma

A

benign tumor of the breast

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5
Q

Fibrocystic disease

A

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

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6
Q

Galactorrhea

A

lactation not associated with childbearing

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7
Q

Intraductal papillomas

A

benign tumors of the subareolar ducts that produce a nipple discharge

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8
Q

Mastodynia

A

breast pain

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9
Q

Montgomery follicles

A

tiny sebaceous glands on areola

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10
Q

Paget disease

A

skin manifestations indicative of ductal carcinoma

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11
Q

Peau d’orange

A

breast skin changes due to edema caused by lymph drainage blockage, associated with breast cancer

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12
Q

Tail of Spence

A

area where most malignancies of the breast tissue occurs

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13
Q

Thelarche

A

beginning of female pubertal breast development

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14
Q

Muscles forming floor of the breast

A

Pec major and minor, Serratus anterior, Lat dorsi, subscapularis, external oblique, rectus abdominus

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15
Q

Lymphatics of breast

A

drain toward axilla, from central axillary nodes to infraclavicular and supraclavicular nodes, common places for metastases: axillae

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16
Q

***Tanner I

A

prepubertal, elevation of only papilla

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17
Q

***Tanner II

A

breast bud stage, elevation of breast and papilla as small mound, enlargement of diameter of areola

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18
Q

***Tanner III

A

further enlargement of breast areola with no separation of contours

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19
Q

***Tanner IV

A

areola projected above level of breast as secondary mound

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20
Q

***Tanner V

A

recession of areola mound to general contour of breast, projection of papilla only

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21
Q

Milk line

A

vestigial epithelium from axilla to inguinal region; some women have accessory breasts or nipples, most commonly in axilla

22
Q

Breast inspection

A 
Size  best 5-7 days after  menses onset
Symmetry
Alignment
Nipple characteristics
Shape/type (convex, pendulous, conical)
Skin color and texture
23
Q

Inframammary ridge

A

normal, transverse ridge of compressed tissue along lower edge of breast, common in pendulous breasts

24
Q

***Five “D”s for Nipples

A 
Discharge
Depression or Inversion
Discoloration
Dermatologic changes
Deviation - compared to opposite
25
Three broad groups of risk factors for breast cancer
modifiable, non-modifiable, uncertain/controversial/unproven
26
***Non-modifiable breast cancer risk factors
- gender (100x more female) - age (most important - 2/3 occur @55yo+) - genetic (5-10%, BRCA1/2) - fmhx (1st degree doubles risk, 2 first degree 5x risk) - pmhx - race (white more likely to develop, Af. Am. more likely to die) - dense breast tissue (higher risk) - previous chest radiation - Diethylstilbestrol exposure - menstrual periods (before 12 menarche, after 55 menopause) - benign breast conditions such as lobular carcinoma in situ
27
***Modifiable breast cancer risk factors
- post menopausal obesity - exercise - alcohol (2-5 daily increases risk) - hormone replacement (combined HRT increases risk, reversible, not ET therapy alone) - recent oral contraceptive use (reversible) - childbirth (breast feeding lowers risk, nullparity increases risk)
28
***Uncertain/controversial/unproven breast cancer risk factors
- diets and vitamins - antiperspirants - bras - induced abortion - breast implants (make harder to examine, no higher risk) - chemicals in environment - tobacco smoke - night work
29
Three breast cancer risk assessment tools
- Gail Model (5 year and lifetime estimates) - Claus Model (high risk women, uses fmhx of males and females) - BTCAPRO Model (high risk women, uses BRCA 1/2)
30
AGOG 2012 recommendations for early detection
- 40yo+ annual mammogram - CBE (1-3 yrs for young women, annual for 40+) - BSE - high risk women: MRI and mammogram yearly - moderate risk women: consider MRI with PCP
31
***Fibroadenoma characteristics
- Fibroadenoma: smooth, round, very mobile, nontender, well delineated, no retraction, 15-25yo - usually bilateral, no variation with menses
32
***Fibrocystic characteristics
- Fibrocystic changes: nodular, ropelike, 25-50 - usually bilateral, multiple or single, mobile, soft to firm/elastic (spongy) - no retraction, well defined borders - variation with menses
33
***Breast Cyst characteristics
- Cysts: soft to form, round, mobile, often tender, well delineated, no retraction, 25-50yo
34
***Breast CA characteristics
- Cancer: irregular/stellate, firm/stone-like, mobile or fixed, not clearly delineated, usually nontender, maybe retraction, 25-50+ - no variation with menses, unilateral, single but may coexist
35
Montgomery tubercles
normal
36
Paget's disease
- retraction or deviation => think cancer - inversion vs. eversion - unilateral or bilateral
37
Assymetric breasts likely means...
Think cancer
38
Retraction and dimpling likely means...
Recent unilateral inversion of previously everted nipple => malignancy
39
Peau d'orange
Skin edema around nipple at first | Associated with cancer
40
Three types of malignant tumors **and age groups**
1. Infiltrating ductal - 30-80yo, single mass - irregular/stellate, hard/stone - fixed - most common type 2. Inflammatory - lymphatic involvement frequent - poor prognosis 3. Paget's disease - eczematous nipples - rare form - nipple redness/burning - skin biopsy to dx
41
Normal variations of breasts
- size: often one is larger - contact dermatitis: differentiate from paget's with skin biopsy - dermal cyst of nipple
42
Benign tumors
- cystosarcoma phyllodes: large bulky mass of cysts & CT, rapidly growing - fibroadenoma: most common tumor <25yo, small/movable/firm/no change with menses - intraductal papilloma: tumor of lactiferous ducts, nipple discharge
43
Menstruation and breasts
- do not examine breasts during menstruation - breasts enlarge 3-5 days prior to menses - increased nodularity and fluid buildup - BEST to inspect breasts 5-7 days after onset
44
***Pregnancy and breasts
- fuller/more firm - darker areola, enlarged/erect nipples - colostrum during third trimester, which switches to milk only after birth (24hrs)
45
Most important symptoms o fbreast disease
1. mass 2. breast pain 3. nipple discharge - bloody=cancer - yellow/green=infection - white=colostrum
46
Breast mass stats
90% benign | 60% discovered by SBE
47
Breast mass hx questions
1. When first notice? 2. Change during period? 3. Physiologic nodularity? 4. Tender? 5. Previous mass? 6. SKin changes? 7. Recent injury? 8. Nipple discharge or retraction? 9. Pregnant, nursing, post-partum? 10. FMHX?
48
Mastalgia questions and facts
1. When did you first feel pain? 2. Describe. 3. Unilateral/bilateral 4. Changes in menses? 5. Change with cycles? 6. Changes in breasts? - mass, d/c, retraction 7. INjury? Common causes: engorgement during luteal stage of cycle, pregnancy, hematoma, cysts, mastitis, abscess, galatocele, nipple disorder Facts: rarely associated with breast cancer
49
Nipple d/c questions
1. expressed or spontaneous? 2. color? 3. unilateral/bilateral? 4. first notice? 5. menstrual cycle related? 6. LMP? 7. NIpple retraction, mass, tenderness? 8. medications - oral contras? 9. if post-partum...any prob w/ delivery? 10. FMHX?
50
Nipple discharge facts
1. breast carcinoma - spontaneous, bloody - mass associated, single duct in one breast 2. non-malignant - only with compression - multiple ducts, bilateral Either: fluid can be yellow/clear/white/dark green Most common cause of cancerous d/c is intraductal papilloma --> ductal ectasia
51
Common causes of nipple d/c
intraductal papilloma, fibrocystic disease, sclerosing adenosis less common: chronic cystic mastitis, ductal ectasia, galactocele, papillary cystadenoma, keratosis of nipple, fat necrosis, acute mastitis/abscess

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