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Misc. Notes Year 3 > Breast Doc > Flashcards

Breast Doc Flashcards

1
Q

Which ribs does breast tissue extend from

A

Ribs 2-6

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2
Q

Where does breast tissue sit in relation to the pec major

A

Sits on top of the deep fascia that covers pec major and serratus anterior

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3
Q

What is the retromammary space

A

The space between the fascia (covering pec major) and breast tissue

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4
Q

What are the three main arteries supplying the breast tissue

A

Internal mammary
Posterior intercostal
Lateral thoracic

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5
Q

Give an outline of the path that most lymph takes from the breast

A

Majority of lymphatic will drain to ipsilateral axillary node then to supra-clavicular nodes then to thoracic duct

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6
Q

Apart from the ipsilateral axillary nodes, what 3 other groups of nodes receive lymph from the breast tissue

A

Parasternal
Abdominal
Nodes of contralateral breast

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7
Q

What is the basic functional secretory unit of breast tissue

A

Terminal Duct Lobular Unit (TDLU) –> site of milk production

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8
Q

What is the largest of the ducts, which connect the nipple and acini, called

A

Lactiferous duct

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9
Q

What happens to the lactiferous ducts just before they reach the nipple

A

Expansion of ducts called the lactiferous sinus –> storage site for milk

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10
Q

What special epithelium is lines the ducts and what is its function

A

Myoepithelium –> contracts in response to oxytocin

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11
Q

The nipple is the only place in the body where sebaceous glands do what

A

Open up directly to the skin

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12
Q

What kind of epithelium is the nipple composed of

A

highly pigmented keratinised epithelium

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13
Q

What is the difference in tissue composition of the breasts in young adults and older adults

A

Young –> higher proportion of glandular tissue compared to adipose tissue
Older –> loss of glandular tissue and replacement with adipose tissue

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14
Q

What happens to the breast tissue in pregnancy

A

The glandular tissue proliferates in response to oestrogen and progesterone

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15
Q

What makes up the triple assessment that is offered to all women who attend the breast clinic

A

Clinical: history and examination
Radiological: mammography +/- ultrasound
Cyto-pathology: cytology or biopsy

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16
Q

During breast examination, which three arm positions should you get the patient to hold

A

Resting on thighs
Above head
Hands on hips

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17
Q

What is the general rule of thumb on when to use ultrasound or mammography to visualise breast tissue

A

> 40 y/o –> Mammography

<40 y/o –> Ultrasound

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18
Q

On a mammogram, what colour is fat and what colour is glandular tissue

A

Fat –> grey

Glandular tissue –> white

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19
Q

A popcorn shaped calcification on mammogram suggests what pathology

A

Fibroadenoma

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20
Q

A rod shaped calcification on mammogram suggests what pathology

A

Duct ectasia

21
Q

Which benign breast disease is associated with a seatbelt injury and what drug can be associated with it as well

A

Fat necrosis

Warfarin therapy

22
Q

How is fat necrosis managed

A

Analgesia

can spontaneously resolve

23
Q

Which benign breast disease is strongly associated with smoking and how does it present

A

Duct ectasia

Pain and nipple discharge

24
Q

How is duct ectasia managed

A

Duct excision

25
Q

What pathology presents as multiple lumps within breast and cyclical mastalgia

A

Fibrocystic change

26
Q

Blue domed cysts filled with pale fluid is suggestive of which disease

A

Fibrocystic change

27
Q

Which breast disease will present as a painless, firm and mobile mass and what classic appearance will it have on ultrasound

A

Fibroadenoma

Breast mouse on USS

28
Q

Young women of which ethnicity are prone to fibroadenomas and how is it treated

A

Afro-caribbean

Excise if unsure

29
Q

What is Mondor’s disease

A

Thrombophlebitis of the subcutaneous veins of the chest well and breast

30
Q

Which two benign breast conditions can be described as biphasic

A

Phyllodes tumour

Fibroadenoma

31
Q

When is the peak incidence for breast cancer

A

60-70

32
Q

Describe the breast cancer screening program

A

50-70

Mammogram every 3 years

33
Q

What is the most common type of breast cancer

A

Carcinoma

34
Q

What are the two most common pre-cursors for breast carcinoma

A

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS)

35
Q

What are the three receptors that a breast cancer can express

A

Estrogen
Progesterone
HER 2

36
Q

What is the best combination of receptor expression of a breast cancer, in terms of prognosis

A

ER positive
PR positive
HER 2 negative

37
Q

What is the worst combination of receptor expression of a breast cancer, in terms of prognosis

A

Triple negative

38
Q

Which three lifestyle factors are risks for breast cancer

A

Obesity
Alcohol
Smoking

39
Q

Which form of contraception increases your risk of breast cancer

A

COCP

40
Q

What is Paget’s Disease of the Nipple

A

High grade DCIS extending along ducts to reach the epidermis of the nipple

41
Q

What is the most common finding on mammogram which is almost pathognomonic for DCIS

A

Micro-calcification

42
Q

Where does DCIS typically arise from

A

Arises in TDLU

43
Q

What are the two types of Lobular in situ neoplasia and what is the difference between them

A

Atypical Lobular Hyperplasia (ALH) <50% of lobule involved

Lobular Carcinoma in situ (LCIS) >50% of lobule involved

44
Q

What are the two surgical options available for someone with breast cancer

A

Wide Local Excision + radiotherapy

Radical mastectomy + radiotherapy

45
Q

In general how small must the breast cancer be in order to be excised by Wide Local Excision instead of mastectomy

A

<4cm

46
Q

Tumours can be shrank prior to surgery using drugs; what is this process called

A

Neo-Adjuvant chemotherapy

47
Q

Which anti-oestrogen therapies can be given for an ER positive tumour

A

Tamoxifen
Aromatase inhibitors(Letrozole)
GnRH antagonists - (Goserilin)

48
Q

What is the main risk of using tamoxifen and how does this risk arise

A

Endometrial cancer

tamoxifen acts as an anti-oestrogen agent in breast tissue but like an oestrogen in the uterus

49
Q

What kind of drug is Trastuzamab and how can it be used in breast cancer therapy

A

Monoclonal antibody against HER2 (use in HER 2 + tumours)

Also called herceptin

Misc. Notes Year 3 (25 decks)

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