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Women's Health - GYN > Breast Exam > Flashcards

Breast Exam Flashcards

1
Q

Adult female breast is modified ______ gland located within superficial fascia of chest wall.

A

sebaceous

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2
Q

Most glandular tissue of breast is located where? Significance?

A

upper outer quadrant

where most breast cancer occurs

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3
Q

Polythelia

A

extra nipple

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4
Q

polymastia

A

accessory breast

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5
Q

galactorrhea

A

milky bilateral nipple discharge

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6
Q

Describe a fibroadenoma. How is it dx’d?

A

benign solid mass that is fine, round and mobile (like a marble)

U/S then biopsy

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7
Q

cyst

A

mass that is usually soft to firm, round, mobile, often tender

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8
Q

What are fibrocystic changes in breast? Possible causes?

A

CYCLIC diffuse pain (usually right before a period)

nodular, rope-like lumps on breast exam

*benign, caffeine, tx with Vit E or OCs

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9
Q

Inverted nipple

A

depressed below the areolar surface

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10
Q

Gynecomastia

A

firm disc of glandular enlargement vs soft fatty enlargement of obesity (described in males)

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11
Q

Mastalgia

A

breast pain (cyclic, noncyclic, and extramammary)

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12
Q

Ductal ectasia

A

dilation of mammary duct beneath nipple that causes periductal fibrosis (duct wall thickening) and inflammation

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13
Q

Papillomas

A

benign lesion involving a single duct; associated with bloody nipple discharge

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14
Q

Mastitis

A

infection of the breast tissue

*common in nursing moms with fever, sudden onset-think CA in nonlactating women

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15
Q

Most common causes of bloody nipple discharge

A
  1. papilloma

2. carcinoma

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16
Q

Mastectomy

A

surgical removal of breast

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17
Q

How to quantitively assess breast development in adolescent?

A

Tanner’s sex maturity ratings

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18
Q

What positions should patient be put in to inspect breasts?

A
  1. arms at side
  2. arms overhead
  3. hands pressed against hips (tighten pectoralis)
    +/- leaning forward (esp if obese)
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19
Q

What are we looking for on breast exam palpation?

A

Consistency
Tenderness
Nodules (location, size, shape, etc.)

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20
Q

Findings in axillae that suggest malignant involvement

A

nodes larger or equaling 1 cm
nodes that are firm/hard
nodes matted together
fixed to skin or underlying tissue

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21
Q

How breast exam done for patient with mastectomy?

A

inspect scar and axilla for masses or unusual nodularity

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22
Q

Special technique to assess for spontaneous nipple discharge?

A

Press finger on radial areola to see if any discharge

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23
Q

How to write normal breast exam note in chart?

A

Breasts symmetric and without erythema or pigment skin changes, NTTP without masses, nipples without discharge, axilla without mass/adenopathy and NTTP

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24
Q

Recommendations for breast cancer screening

A

Annual mammogram starting at age 40

Regular self exams

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25
Q

What patients require high risk screening (>20%)?

A

1st deg relative with breast cancer; start mammogram 10 yrs younger than the relative’s age of dx, +/- MRI

26
Q

If > 20% lifetime risk of breast cancer, then must do what screens?

A

mammogram and MRI

27
Q

Risk factors in patient medical history for breast cancer

A 
FHX
previous radiation
previous high risk lesions
high alcohol use
obesity
immunosuppressant tx
hormone replacement tx
later first birth
early onset menses
28
Q

Benign vs malignant nipple discharge?

A

Benign: green or milky

Malignant: clear/serous or bloody; spontaneous

29
Q

Can cancer be ruled out with normal mammogram?

A

NO!!!

30
Q

How is abnormal mammogram further eval’d?

A

Find lesion with U/S and eval as cystic vs solid

If solid lesion or microcalcifications do steretotactic bx

Make sure imaging and clinical findings match (concordance)

31
Q

Always ________ a palpable mass on breast exam.

A

U/S

32
Q

Signs/Sx’s of breast cyst

A

gross palpable mass

severe, localized pain of sudden onset

33
Q

Tx of breast cyst

A

> 2 cm: needle aspiration

consider excision of third recurrence

34
Q

Benign solid tumors of breast that contain glandular and fibrous tissue. Do not increase breast cancer risk.

A

fibroadenomas

35
Q

Large benign fibroadenoma that is very locally aggressive. Always excised.

A

Phyllodes Tumor

36
Q

Non-lactational breast abscess signs

A

acute onset of pain and redness
tender, palpable mass
fever, malaise

37
Q

Treatment of breast abscess

A

Drainage + abx therapy that covers staph aureus

38
Q

What should be added to breast abscess tx if presence of subareolar abscess with retracted nipple?

A

Flagyl

39
Q

Benign lesions that increase breast cancer risk

A

Atypical Ductal Hyperplasia
Atypia associated with sclerosing adenosis
Radial Scar
Lobular Carcinoma In Situ

  • all require surgical excisional biopsy
40
Q

Classic characteristics of cancerous lesion

A

single lesion
hard
non-mobile
irregular borders

41
Q

How to treat in situ cancer?

A

stage 0

No chemo

42
Q

Which type of invasive breast cancer not well seen on mammogram?

A

lobular cancer

43
Q

Most common type of invasive cancer

A

ductal origin (80%); seen well on mammogram

44
Q

Paget’s Disease cause and treatment

A

Nipple lesion usually associated with ductal carcinoma in situ

Standard treatment is mastectomy

45
Q

Why is it a good thing if cancer is hormones positive for cell growth?

A

means that cancer will likely be treatable with estrogen and progesterone blockers

46
Q

Lumpectomy vs Mastectomy

A

Lumpectomy

  • smaller lesions; single focus of disease
  • Adjuvant radiation

Mastectomy

  • multifocal; larger burden of disease
  • Young age, family history
  • Usually no radiation
47
Q

Sentinel Node biopsy of breast

A

dye injected into breast to follow lymphatic pathway and locate where cancer could reside

May do axillary node dissection of first 3 nodes

48
Q

How is cancer stages?

A 
T = tumor size (stage 1-3)
N = nodes (# and location)
M = metastasis (stage 4, skin involvement)
49
Q

Post-operative complications of mastectomy

A

skin problems if patient smokes
staph infection
seroma

50
Q

Side effects of radiation

A 
Skin erythema/pain
Skin breakdown
Damage to underlying lungs (pneumonitis, scarring)
Tissue edema/contracture
Secondary malignancy (angiosarcoma)
51
Q

Two types of radiation

A

external beam

brachytherapy - ballon insert and drainage

52
Q

Side effects of chemo

A

neutropenic fever, other infections
neuropathy
persistent fatigue
“chemo brain”

53
Q

28 year old female with a mass that has persisted for two cycles. The mass is painful. Family history of breast cancer in a maternal aunt at age 55. No imaging.

What next? Likely dx?

A

Order U/S

Fibroadenoma

54
Q

65 year old with no family history of breast cancer. Currently on HRT. Last mammogram 2 years ago. Screening shows an 8mm density in the left breast. Ultrasound shows irregular 7mm mass that corresponds with mammogram.

What next?

A

Biopsy

55
Q

Long term follow up for lumpectomy with radiation therapy.

A
  • Mammogram at 12, 18, 24 months then annual
  • Clinical exam q 6 months
  • Medical oncology follow up for at least 5 yrs
56
Q

41 year old with palpable mass in breast x several weeks

FHX: breast cancer in mother and two cousins premenopausally, ovarian cancer in maternal grandmother

Mammogram and ultrasound: 2.5 cm highly suspicious mass, biopsy recommended

Biopsy: poorly differentiated invasive ductal CA
ER- PR- Her2 neu- MIB high

What is her tx?

A

Neoadjuvant chemotherapy - chemo and systemic therapy before surgery

Genetic testing based on strong FHX (ex. BRCA 2 mutation)

Recommend bilateral mastectomies

57
Q

Long term follow up of chemotherapy

A

Chest wall exams with imaging as indicated
Oophrectomy = ovaries removed
Pancreatic screening

58
Q

Overweight woman with nipple discharge. Mammogram with scar from previous excisional biopsy for papilloma. Negative Ultrasound.

Likely dx?

A

ductal excision shows papilloma

59
Q

52 year old with acute onset of pain and erythema x days in her right breast. No known history of trauma. Had negative mammogram 1 month ago.

Likely dx?

A

Breast abscess

60
Q

Do we palpate anything while sitting?

A

axillae

  • do first on breast exam
61
Q

peau d’orange finding on breast exam

A

“skin of an orange”

classic looking skin overlying breast cancer

Women's Health - GYN (12 decks)

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