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ICM 1 Block 3 > Breast Diseases > Flashcards

Breast Diseases Flashcards

1
Q

what are the 3 tissue components of the breast?

A
  1. Glandular tissue - secretory tubuloalveolar glands and ducts
  2. Fibrous connective tissue - structural support
  3. Adipose tissue
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2
Q

what is the physiology behind lactation?

A

Nipple sucking by infant will cause release of

  • oxytocin = posterior pituitary (milk letdown)
  • prolactin = anterior pituitary (milk production)
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3
Q

what is physiological nodularity?

when does it increase?

A

when you touch the normal adult breast, it may be soft, but it often feels granular, nodular, or lumpy. This is in someparts of the breast

increases pre-menstrually

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4
Q

what is the milk line?

this can be confused for what?

A

Extra nipples along the “milk line”

often mistaken for a common mole

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5
Q

where does lymph commonly drain to in the breast?

A

axillary lymph node

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6
Q

what are the four divisions of the axillary lymphatics of the breast?

what part of the breast does it drain?

A

pectoral - drains the anterior chest wall

lateral - most of the arm

subscapular - posterior chest wall

central -

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7
Q

where do the central nodes of the axillary lymph nodes are palpable?

A

between the anterior and posterior axillary folds

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8
Q

how do you describe the male breat?

A

small areola and nipple

little ductal branching and lobe development

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9
Q

in the breast for females what do you examine?

A

you inspect and palpate

check: axilla

special technique: examination of mastectomy or breast augmentation

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10
Q

what are the common symptoms of the breast?

A
  • Breast lump or mass - ask how long? size? where is it? size change with menstruation? painful?
  • Breast pain or discomfort - ask oldcarts
  • Nipple discharge
  • Skin changes
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11
Q

what are the Palpable Masses of the Breast?

A

fibroadenoma

cyst

fibrocystic changes

cancer

lactating adenoma

mastitis

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12
Q

in palpation, what do you check for in a fibroadenoma?

in palpation, what do you check for in a cyst?

in palpation, what do you check for in a fibrocystic changes?

in palpation, what do you check for in a cancer?

A

Usually firm, round, mobile, non tender

soft to firm, round, mobile; often tender

Nodular, ropelike

Irregular, stellate, firm, not clearly delineated from surrounding tissue

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13
Q

nipple discharge that appears only after squeezing the nipple is called?

nipple discharge that appears spontaneous, milky, bilateral?

nipple discharge that is spontaneous, persistent, nonlactational, bloody, unilateral?

nipple discharge that is purulent?

A

physiologic

galactorrhea

papilloma or breast cancer

breast abcess

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14
Q

skin change in the breast that presents as skin retraction can be?

skin change in the breast that presents as edema of the skin?

what other skin changes do you look for?

A

cancer, mammary duct ectacia and fat necrosis

peau d’orange, is caused by local lymphatic blockage due to tumor. - late sign of breast cancer

  • Nipple retraction and deviation
  • Paget’s disease of nipple
  • Redness: Sign of mastitis
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15
Q

what is this?

A

Paget’s

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16
Q

what is this?

A

peau d’orange

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17
Q

what is this?

A

mastitis

18
Q

what is this?

A

breast abscess

19
Q

what is galactorrhea?

A

Spontaneous flow of milk from the breast - Unassociated with childbirth or nursing.

20
Q

what can cause galactorrhea?

A
  • Hyperprolactenemia - prolactinoma of the anterior pituitary
  • Thyroid conditions with increased TSH
  • Excessive Nipple stimulation
21
Q

what is Gynecomastia?

what can it be an indicator of?

A

Benign enlargement of breast tissue in males associated with benign pubertal changes

testicular cancer or a side effect of drugs or genetic disorders (Klinefelter syndrome)

22
Q

how can drugs cause gynecomastia?

what drugs can cause gynecomastia?

A
  • increasing estrogen levels
  • increasing prolactin levels
  • blocking androgen receptors
  1. Ketaconazole
  2. cimetidine
  3. antiandrogens
  4. spiranolactone
23
Q

is senile gynecomastia normal?

A

yes

24
Q

what is mastitis?

what are the types of mastitis?

A

Inflammation of the breast, common during lactation

Puerperal mastitis: inflammation of the breast in connection with

  • pregnancy,
  • breastfeeding or weaning

Nonpuerperal mastitis: Unrelated to pregnancy or lactation (Duct ectasia)

25
Q

what can cause mastitis?

what is the most common cause?

A

Stasis of milk, trauma, infection, tight clothing

Staphylococcus aureus

26
Q

what is the clinical presentation of mastitis?

A

Fever, Purulent nipple discharge and Abscess formation in worst cases.

27
Q

what is Mammary duct ectasia?

what will you look for?

A

It is a disorder of peri- or post-menopausal age where there is blocking of lactiferous ducts.

nipple retraction, inversion, pain, nipple discharge = “greenish discharge”

28
Q

what is Fibrocystic breast changes?

A

are considered normal changes of the breast where Symptoms (tenderness) tend to peak immediately before each menstrual period and decrease afterwards

29
Q

how do you differentiate fibroadenoma from a fibrocystic change?

A

fibrocystic changes usually present with a lumpy breast

fibroadenoma usually presents with a dominant mass.

30
Q

what is Fibroadenoma?

what is another name for it?

A

Noncancerous tumor, composed of fibrous and glandular tissue that is estrogen sensitive

breast mouse

31
Q

what is Fat necrosis?

A

rare lesion of breast, clinically important because it produces a mass which is almost indistinguishable from carcinomas even with imaging studies.

32
Q

what is Intraductal papilloma?

what are the types?

A

benign non-palpable papillary growth in the lactiferous duct that causes bloody discharge

central = Near the nipple, solitary, develops in the period nearing menopause

peripheral = Away from nipple, Multiple, found in younger women. High risk of cancer.

33
Q

what is Paget’s disease of the breast?

look for what?

A

A malignant condition that outwardly may have the appearance of eczema with skin changes involving the nipple of the breast.

Eczema like rash, skin of nipple and areola becomes red, itchy, scaly. Straw colored or bloody discharge.

34
Q

what are the Clinical features of breast cancer?

A

Painless mass in the breast

  • Usually single
  • Irregular shape
  • located in the upper outer quadrant.
  • Firm or hard in consistency
  • Not well delineated from surrounding tissue
  • Immobile: Fixation to the chest wall

axillary lymphadenopathy

hepatomegaly

bone pain

35
Q

most important Risk factors for breast cancer are… (exam Q)

A
  • Female
  • Age (65+ versus <65 years)
  • genetic mutations of BRCA1 and/or BRCA2
  • first-degree relatives with breast
  • cancer diagnosed at an early age
  • Personal history of breast cancer
  • Late age at first full-term pregnancy (>30 years)
  • Early menarche (<12 years)
  • Late menopause (>55 years)
  • No full-term pregnancies
  • Never breastfed a child
  • Recent oral contraceptive use
  • Recent and long-term use of hormone replacement therapy
  • Obesity (postmenopausal)
36
Q

prognosis is dependent on what?

A

size

staging of cancer

Her neu (erb 2)

37
Q

breast cancer is pharmologically treated with what if HER2 positive?

this drug acts as what?

A

leuprolide

a GnRH agonist

38
Q

chemopreventive drugs for breast cancer are…

these drugs are high risk for who?

A

estrogen receptor modulators = tamoxifen and raloxifene

for breast cancer and women undergone hysterectomy

39
Q

what screening can be done for breast cancer?

A

mammography

BRACA-1 or -2 screen

breast examination

MRI if they have BRACA -1/2 mutation or relative or hist of radiation exposure at age 10-30

40
Q
A

ICM 1 Block 3 (1 decks)

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