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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
Q

Three broad groups of risk factors for breast cancer

A

modifiable, non-modifiable, uncertain/controversial/unproven

26
Q

***Non-modifiable breast cancer risk factors

A
  • 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
Q

***Modifiable breast cancer risk factors

A
  • 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
Q

***Uncertain/controversial/unproven breast cancer risk factors

A
  • diets and vitamins
  • antiperspirants
  • bras
  • induced abortion
  • breast implants (make harder to examine, no higher risk)
  • chemicals in environment
  • tobacco smoke
  • night work
29
Q

Three breast cancer risk assessment tools

A
  • 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
Q

AGOG 2012 recommendations for early detection

A
  • 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
Q

***Fibroadenoma characteristics

A
  • Fibroadenoma: smooth, round, very mobile, nontender, well delineated, no retraction, 15-25yo
  • usually bilateral, no variation with menses
32
Q

***Fibrocystic characteristics

A
  • 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
Q

***Breast Cyst characteristics

A
  • Cysts: soft to form, round, mobile, often tender, well delineated, no retraction, 25-50yo
34
Q

***Breast CA characteristics

A
  • 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
Q

Montgomery tubercles

A

normal

36
Q

Paget’s disease

A
  • retraction or deviation => think cancer
  • inversion vs. eversion
  • unilateral or bilateral
37
Q

Assymetric breasts likely means…

A

Think cancer

38
Q

Retraction and dimpling likely means…

A

Recent unilateral inversion of previously everted nipple => malignancy

39
Q

Peau d’orange

A

Skin edema around nipple at first

Associated with cancer

40
Q

Three types of malignant tumors and age groups

A
  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
Q

Normal variations of breasts

A
  • size: often one is larger
  • contact dermatitis: differentiate from paget’s with skin biopsy
  • dermal cyst of nipple
42
Q

Benign tumors

A
  • 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
Q

Menstruation and breasts

A
  • 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
Q

***Pregnancy and breasts

A
  • fuller/more firm
  • darker areola, enlarged/erect nipples
  • colostrum during third trimester, which switches to milk only after birth (24hrs)
45
Q

Most important symptoms o fbreast disease

A
  1. mass
  2. breast pain
  3. nipple discharge
    - bloody=cancer
    - yellow/green=infection
    - white=colostrum
46
Q

Breast mass stats

A

90% benign

60% discovered by SBE

47
Q

Breast mass hx questions

A
  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
Q

Mastalgia questions and facts

A
  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
Q

Nipple d/c questions

A
  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
Q

Nipple discharge facts

A
  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
Q

Common causes of nipple d/c

A

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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