Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

WOMEN'S HEALTH > BREAST DISORDERS > Flashcards

BREAST DISORDERS Flashcards

1
Q

Adult female breast is actually a modified _____________, located within the superficial fascia of the chest wall.

A

sebaceous gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • the breast is histologically primarily composed of
A

⦁ lobules or glands
⦁ milk ducts
⦁ connective tissues
⦁ fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Younger breasts are predominately ____________

The glands are replaced by _____ with aging. This process accelerates with menopause.

A

glandular tissue.

fat

The differences in palpable consistency and in radiographic density between the glands and fat are key components of breast cancer detection programs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

connect breast tissue, holds breast tissue up

A

Cooper’s ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Each breast = 15 - 25 lobules, with a disproportionate amount of the glandular or lobular tissue present in the ___________ quadrants of each breast.

A

upper outer quadrants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

COMPLICATIONS THAT CAN OCCUR

  • CT
  • fat
  • duct system
A

o Connective tissue
⦁ fibrocystic changes
⦁ fibroadenomas

o Fat tissue
⦁ necrosis from trauma
⦁ lipomas

o Duct system
⦁ may become dilated
⦁ may contain papillary neoplasms
⦁ may undergo malignant transformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Breast tissue is very sensitive to ___________, especially the glandular cells.

A

hormonal changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

breast exams are recommended at what timeline of the menstrual cycle

A

1 week following menstruation

  • During each menstrual cycle, breast tissue tends to swell from changes in the body’s levels of estrogen and progesterone
  • The milk glands and ducts enlarge, and in turn, the breasts retain water
  • During menstruation, breasts may temporarily feel swollen, painful, tender, or lumpy

menstruation = not the best time to evaluate the breasts; bring them back for exam during a time when they’re not tender/swollen/lumpy - recommend a week following menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

most common malignancy in women

A

breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

risk factors for breast cancer

A 
⦁	age
⦁	family hx
⦁	race
⦁	genetics
⦁	early menarche
⦁	late menopause
⦁	increased exposure to estrogen
⦁	use of estrogen therapy
⦁	nulligravid state
⦁	first pregnancy after age 35
⦁	fibrocystic conditions
⦁	cancer in one breast
⦁	endometrial cancer
⦁	not breastfeeding
⦁	hx of epithelial hyperplasia with atypia
⦁	exposure to ionizing radiation or other carcinogens
⦁	certain dietary factors (fat, alcohol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

most significant risk factor for breast cancer after gender

A

age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

age & breast cancer

A
  • Age is the most significant risk factor after gender
  • Breast cancer is rare in women < 25 years, about 2% occur before age 30
  • Incidence increases with age, with a plateau in women aged 50-55 years.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

family hx & breast cancer

A
  • 1st degree relative significantly increases risk (sister, mother)
  • Two or more relatives with breast or ovarian cancer
  • Breast cancer occurring in an affected relative younger than 50 years
  • Relatives with both breast cancer and ovarian cancer
  • One or more relatives with 2 cancers (breast and ovarian cancer or two independent breast cancers)
  • Male relatives with breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

race & breast cancer

A
  • Caucasian more likely, although incidence in black women is increasing.
  • Individuals of Ashkenazi Jewish descent have a 2-times greater risk.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

_________ MENARCHE & _________MENOPAUSE

are risk factors for breast cancer

A

EARLY MENARCHE

LATE MENOPAUSE

= increased estrogen exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

increased exposure to estrogen risk factor

A

obesity (fat cells release estrogen)

persistent anovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

BRCA 1 & BRCA 2 are ________ ________ genes

A

tumor suppressor genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

BRCA 1 & BRCA 2 GENES: their role

A
  • these are tumor suppressor genes; they prevent cells from growing/dividing too rapidly or in an uncontrolled way
  • these genes inhibit the growth of cells that line the milk ducts in the breast
  • these genes are directly involved in the repair of damaged DNA

When these genes are mutated:
⦁ disrupts protein production, resulting in an abnormally small, nonfunctional version of the BRCA2 protein.
⦁ change one of the protein building blocks (amino acids) used to make the BRCA proteins.
⦁ defective BRCA protein is unable to help fix damaged DNA.
⦁ Results in the build up of mutations.
⦁ Causes cells to divide in an uncontrolled way and form a tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In addition to breast cancer, harmful BRCA 1 mutations may also increase a woman’s risk of the following cancers, in addition to breast cancer

A

⦁ cervical
⦁ uterine
⦁ pancreatic
⦁ colon

“C CUP” = cervical, colon, uterine, pancreatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In addition to breast cancer, harmful BRCA 2 mutations may also increase a woman’s risk of the following cancers, in addition to breast cancer

A

⦁ pancreatic
⦁ stomach
⦁ gallbladder & bile duct
⦁ melanoma

BRCA2 = think GI & melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MALE BRCA1 & BRCA 2 MUTATIONS

A
  • men with harmful BRCA1 mutations also have an increased risk of breast cancer, and also possibly pancreatic, testicular, and prostate cancer
  • male breast cancer, pancreatic cancer, and prostate cancer = more strongly associated with BRCA 2 mutations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  • male breast cancer, pancreatic cancer, and prostate cancer = more strongly associated with _________ mutations
A

BRCA 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

location - most breast cancers located in _______________ quadrant

A

outer upper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

presentation of breast cancer mass

A
  • solitary nodule
  • non-tender
  • firm / hard
  • ill defined margins
  • not mobile
  • skin nipple retractions
  • axillary lymphadenopathy

**a good number of breast masses are found by mammogram with no palpable mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

breast care guidelines from ACS

A

women aged 40-44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so

women aged 45-54 = annual mammograms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

women aged _______ should get annual mammograms

A

45-54

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

breast cancer screening guidelines for 55+

A

Women aged 55 years and older should switch to mammograms every 2 years, or have the choice to continue yearly screening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Some women – because of their family history, a genetic tendency, or certain other factors – should be screened with _____ along with mammograms. (The number of women who fall into this category is very small.)

A

MRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Z-method for breast cancer & quadrant

A

Outer upper > nipple > inner upper > outer lower > inner lower

% risk for breast cancer decreased down the Z line, except for the nipple.

Outer upper quadrant = highest % chance, then nipple, then back to Z formation

1cm = pea; 2cm = peanut; 4cm = walnut; 5cm = keylime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

most frequent lesion of the breast**

A

Fibrocystic change

31
Q

fibrocystic change = represents an exaggerated physiologic response to a _____________________

A

changing hormonal environment

32
Q
  • a painful mass which often exacerbates or increases in size during premenstrual phase
A

fibrocystic change

33
Q
  • exacerbated by alcohol
A

fibrocystic change

34
Q

FIBROCYSTIC CHANGE

A
  • used to be referred to as fibrocystic condition
  • represents an exaggerated physiologic response to a changing hormonal environment

MOST FREQUENT LESION OF THE BREAST

⦁ most women experience some degree of fibrocystic change

  • common in women aged 30-50
  • rare in postmenopausal women who are NOT taking HRT
  • a painful mass which often exacerbates or increases in size during premenstrual phase
  • exacerbated by alcohol
35
Q

signs/symptoms of fibrocystic changes

A
  • often multiple, usually bilateral masses**
  • rapid fluctuation in size = common
  • painful & tender**
  • pain occurs or increases during premenstrual phase of the cycle
  • size also increases during premenstrual phase of the cycle
36
Q

pain & size increase during ________________ of the cycle

A

premenstrual phase

which is why you don’t do breast exams before or during menstrual cycle - do 1 week after

37
Q

SPECIFIC DIAGNOSTICS & TREATMENT FOR FIBROCYSTIC CHANGES

A
  • reexamine the pt at intervals - a cyst that doesn’t resolve over several months may need to be excised
  • reassure pt that discomfort is not a sign of cancer
  • symptoms usually improve with the cyclical decrease in hormone stimulation
  • OCPs offer no benefit
  • use support bra
  • vitamin E supplements
  • avoid chocolate, alcohol, caffeinated beverages
  • teach and encourage monthly BSE
  • may need to be biopsied
38
Q

Fibroadenomas occur most frequently in

A

young women

usually within 20 years after puberty

39
Q

fibroadenomas tend to occur at an earlier age in

A

black women

40
Q

Benign neoplasm made from an overgrowth of glandular and fibrous breast tissue

A

fibroadenoma

41
Q

CLINICAL PRESENTATION OF FIBROADENOMAS

A
  • round or ovoid
  • non-tender**
  • smooth margins
  • rubbery
  • discrete - only 1 present*
  • relatively movable
  • can be 1-5cm in diameter
42
Q

DIAGNOSTICS & TREATMENT FOR FIBROADENOMA

A
  • ultrasound can distinguish cysts - fibroadenomas show up well on ultrasound
  • can do FNB to confirm cytology

Since fibradenomas are benign, treatment will vary depending on the diagnosis

  • if it is small, painless, remains the same size, and biopsy shows no problems, then further treatment is not needed, but should continue to do follow-up ultrasounds
  • if it is large (> 3cm), painful, growing, or biopsy shows atypical cells = remove it
43
Q

It is recommended that fibroadenomas be removed in women

A

> 40

44
Q

If fibroadenoma is rapidly growing need to rule out

A

phyllodes tumor

45
Q

⦁ Phyllodes tumor doesn’t metastasize through lymph nodes..it goes directly to the

A

lungs

46
Q

phyllodes tumors can be __________ or _______

A

benign or malignant

47
Q

Two key differences between fibroadenomas and phyllodes tumors

A

1) phyllodes tumors tend to grow more quickly
2) phyllodes tumors develop about 10 years later in life — in the 40s as opposed to the 30s.
- These differences can help doctors distinguish phyllodes tumors from fibroadenomas

48
Q

imaging: - a patient’s _____ determines the preferred imaging method

A

age

49
Q

when is an ultrasound preferred for imaging?

A
  • is preferred if a palpable mass is found
  • is preferred if patient is < 30
  • is preferred if patient is pregnant
  • Ultrasounds can differentiate cystic from a solid palpable mass - this is important because cysts are usually not treated, but a solid lump must be biopsied to rule out cancer
  • US is also used for guidance for needle localization is a mass is not palpable, but is found on a mammogram
50
Q

when to do mammography

A
  • if the patient has a palpable mass
  • is > 30-35
  • is not pregnant
  • sensitivity is much more reduced in younger / denser breasts, therefore mammography is considered inappropriate in patients < 35

Usually follow up with ultrasounds if determination between cystic & solid mass is needed

51
Q

when to refer

A
  • refer to surgeon for further investigation

- Biopsy - if the diagnosis depends ultimately upon examination of tissue/cells from biopsy

52
Q

types of biopsies

A

⦁ FNA
⦁ core needle aspiration
⦁ excisional biopsy

53
Q

only definitive diagnosis of breast cancer

A

excisional biopsy

54
Q

MASTITIS SYMPTOMS

A

fever (101 +)
malaise - ill feeling
breast tenderness , warm to the touch
- swelling of the breast
- pain or burning sensation continuously or while breast-feeding
- skin redness, often in a wedge-shaped pattern

55
Q

most common bug of mastitis

A

staph aureus

56
Q

most commonly affected group for mastitis

A

newly breastfeeding women (first baby)

57
Q

presentation of mastitis

A
  • unilateral
  • most frequently begins within 3 months after delivery
  • may start out as a sore or fissured nipple
  • may have a lump if starting to form an abscess
58
Q

abx treatment for mastitis

A

dicloxacillin or cephalosporin (Keflex) x 5-7 days

59
Q

TREATMENT FOR MASTITIS

A
  • staph aureus = culprit
  • Antibiotics for PCN-resistant staph = Dicloxacillin or Cephalosporin (Keflex) x 5-7 days
  • regular emptying of the breast by nursing followed by expression of any remaining milk by hand or which mechanical suction device
  • warm compresses to the breast
  • failure to respond within 3 days with ABX = should prompt consideration of MRSA
  • pt may need to be admitted for IV therapy
  • any delay in treatment could result in breast abscess
60
Q

MASTITIS PREVENTION

A
  • breastfeed equally from both breasts
  • empty breasts completely to prevent engorgement & blocked ducts
  • use good breastfeeding techniques to prevent sore, cracked nipples
  • avoid dehydration - drink plenty of fluids
  • practice careful hygiene = handwashing, clean nipples, keep baby clean
61
Q

breast abscess

A
  • area of redness, tenderness & induration on breast during nursing or otherwise
  • most likely culprit = Staph Aureus
  • the early stages of infection can be treated while nursing from that breast, but if the infection is not controlled within 24 hrs, an abscess may form
  • Treatment = surgical drainage & nursing is discontinued; pt likely admitted for IV therapy & I&D
62
Q

MOST COMMON CAUSE OF SPONTANEOUS NIPPLE DISCHARGE FROM A SINGLE DUCT

A

intraductal papilloma

63
Q

benign growth in single milk duct

A

intraductal papilloma

64
Q

INTRADUCTAL PAPILLOMA

A
  • tiny wart-like growth in breast tissue that sometimes punctures a duct
  • little benign tumors that grow inside milk ducts and can cause benign nipple discharge
  • most commonly occurs in women aged 35-55
  • causes & risk factors = unknown
  • MOST COMMON CAUSE OF SPONTANEOUS NIPPLE DISCHARGE FROM A SINGLE DUCT
    ⦁ discharge can be serous, bloody or cloudy
  • mass may not be palpable; unilateral. serous or serosanguinous dripping from single duct
65
Q

= 1 lump, usually near a nipple, causes nipple discharge

A

solitary intraductal papilloma

66
Q

groups of lumps, farther away from the nipple. Usually don’t cause discharge, and can’t be felt

A

multiple papillomas

67
Q

very small groups of cells inside the ducts. a type of hyperplasia, and are more scattered than multiple papillomas

A

papillomatosis

68
Q

other tests for intraductal papilloma

A
  • breast biopsy to rule out cancer
  • examination of discharge to see if cells are cancerous
  • x-ray with contrast is injected into the affected duct (ductogram)
69
Q

treatment of intraductal papilloma

A
  • the involved duct is surgically removed, and the cells are checked for cancer
70
Q

CAUSES OF NIPPLE DISCHARGE

A 
⦁	Papilloma
⦁	premenopausal women - spontaneous
⦁	prolactinoma
⦁	oral contraceptive agents
⦁	abscess
⦁	medications (anti-psychotics)
⦁	hypothyroidism
  • check prolactin levels, check for pituitary tumor, check TSH / T3/T4
71
Q

SUSPICIOUS VS NOT SUSPICIOUS NIPPLE DISCHARGE

A

O SUSPICIOUS NIPPLE DISCHARGE

  • 1 breast
  • 1 duct
  • associated with a lump
  • leaks out on its own
  • occurs most days of the month
  • discharge is watery or bloody (red, brown or black)
  • a lot of discharge

O NOT SUSPICIOUS DISCHARGE

  • both breasts
  • several ducts
  • squeezing brings it on
  • occasional
  • different colors (green, yellow, white)
  • a little
72
Q

evaluation of breast tenderness

A 
Breast examination checking for:
⦁	areas of tenderness
⦁	mass
⦁	trauma (bruising)
⦁	nipple discharge
US/Mammogram, if necessary
73
Q

breast tenderness is

A
  • May be unilateral or bilateral
  • usually not related to trauma to the breast
  • usually related to fibrocystic changes
  • may be associated with breast cancer
  • may be related to dietary habits (caffeine, chocolate, salt)
74
Q

treatment of breast tenderness

A
  • NSAIDS
  • eliminate caffeine, chocolate, salt
  • monthly SBE
  • RTC if symptoms don’t resolve within 1-2 months

WOMEN'S HEALTH (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions