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Breast Exam cards Flashcards

1
Q

Common symptoms of breast diseases?

A

lumps, skin changes, nipple inversion, nipple discharge, pain and acute inflammation

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2
Q

commonest site of nipple development?

A

4th intercostal space midclavicular line

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3
Q

nipple consists of?

A

erectile tissue covered with pigmented skin (which also covers the areola)

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4
Q

size of the breast (in normal circumstance) is determined by?

A

the amount of fat and storm surrounding the glandular tissue

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5
Q

size of the breast during lactation is determined by?

A

enlargement of glandular tissue

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6
Q

what are the common symptoms seen in the breasts in premenstrual phase?

A

swelling and tenderness (due to fluid retention) and prominence of glandular elements of the breast

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7
Q

when is it best to examine breasts of lactating women?

A

after breast-feeding or milk expression (because they are swollen and engorged with milk)

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8
Q

hands on thighs

A

pectoral muscles relaxed

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9
Q

hands on hips

A

pectoral muscles contracted

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10
Q

arms raised above the head

A

pectorals + skin over breasts stretched (good for finding fixation)

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11
Q

leaning forward

A

breast pendulous

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12
Q

order of breast palpation

A

outside towards the nipple

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13
Q

4 quads of the breast

A

upper, lower and inner, outer

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14
Q

which group of nodes receives most lymph drainage from the breast?

A

axillary nodes

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15
Q

axillary nodes are supplied by

A

Sappey’s plexus (network of lymphatics in the areolar).
If they are the sentinel lymph nodes, easy treatment cause subareolar route is the most straightforward to infiltrate. [NB medial most difficult to infiltrate, so poor prognosis]

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16
Q

which lymph node pathway if blocked, can cause the contralateral breast to enlarge?

A

internal mammary pathway (originates from lateral and medial halves of the breast)

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17
Q

if tumour fixed to chest wall?

A

fixed when pectoral muscle is relaxed.

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18
Q

if tumour tethered to fascia, but not pectoral muscle ?

A

mobile when pectoral muscle is relaxed, but adherent when muscle is tensed

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19
Q

how is carcinoma of the breast classified?

A

TNM system

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20
Q

characteristic features of carcinoma of the breast

A
  • solid masses
  • irregular outline
  • painless but firm or hard
  • contrast in consistency with surrounding breast tissue
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21
Q

what is a fibrocystic change of the breast ?

A

irregular modularity of the breast.

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22
Q

commonest site for fibrocystic change of the breast?

A

upper outer quadrant ; esp common in young women

23
Q

characteristic features of fibrocystic changes

A
  • tissue is rubbery
  • varies in size with hormonal cycle; largest premenstrually
  • changes usually bilateral
24
Q

what is a fibroadenoma

A

benign breast tumour.

due to overgrowth of elements from terminal duct lobules

25
characteristic features of fibroadenoma
- smooth - mobile - discrete - rubbery - not painful - common in young women (<35y)
26
breast cysts?
- fluid filled masses derived from fluid accumulation in terminal duct lobules. - may be single or multiple - subject to hormonal stimulation.
27
commonest cause of breast lump in a women ages 35-50yrs?
breast cyst
28
characteristic features of breast cysts>
- dependent on intracystic pressure - may be smooth lumps - soft, fluctuant/impalapble when pressure is low - hard and painful when pressure os high - may be associated with malignancy
29
how to exclude malignancy associated with breast cysts?
any blood-stained cyst aspirate, with there being a residual mass in the cyst following aspiration or which reoccurs after several aspirations should be EXCISED to exclude malignancy
30
what are the 2 types of breast abscesses?
- lactational | - non lactational
31
lactational abscess characteristics ?
- occur in women who are breastfeeding | - usually peripheral
32
Non-lactational abscess characteristics?
- an extension of periductal mastitis (inflammation and infection of ducts below the nipple) - classical distribution at edge of nipple ± nipple inversion - usually in young female smokers
33
non-lactating abscess can discharge through?
fistula (abnormal connection) between inflamed duct and skin, classically at the areolocutaneous border
34
infiltration of dermis by tumour in the breast presents as?
skin being fixed over the tumour - indrawing of skin.
35
in dimpling due to retraction of skin ?
skin remains mobile over the tumour
36
tumour tethered to chest wall only
fixed when pectoral contracted, mobile when relaxed
37
tumour infiltrated the chest wall
fixed when pectoral is both contracted and relaxed
38
what is peau d'orange appearance of skin of the breast ?
= skin of an orange. when skin is attached at the hair follicles but swollen in between, resulting from lymphedema of the breast - most commonly due to obstruction of intrammamary lymphatics with a tumour
39
what is Paget's disease of the breast?
type of cancer of the breast. | arrises due to invasion of epidermis by cells from an underlying intraductal carcinoma (ductal carcinoma in situ)
40
which carcinoma can mimic eczema of the breast
Paget's disease of the breast
41
when eczema is confined to a nipple on the breast, what needs to be investigated for?
Paget's disease of the breast
42
benign nipple inversion causes
periductal inflammation and fibrosis (both shorten nipple ducts causing the inversion)
43
benign nipple inversion characteristics
symmetrical, slit-like inversion
44
malignant disease causing nipple inversion characteristics
asymmetrical, distorting, pulling nipple away from central position ± bloody discharge
45
dd of nipple discharge
- duct ectasia (lactiferous duct blocked; greenish discharge) - intraductal papilloma - intraductal carcinoma
46
galactorrhea?
- milky discharge from multiple ducts in both breasts - Is a feature of hyperprolactinaemia - usually associated with Montgomery tubercle hyperplasia (sebaceous glands in areolar region presenting as small bumps)
47
causes of hyperprolactinaemia?
- physiological --> pregnancy, postpartum - drugs --> DA antagonists, DA depleting agents - pituitary tumours - hypothalamic and stalk lesions - primary hypothyroidism - renal failure
48
dd of gynaecomastia :
- in 50% prepubertal boys due to high oestrogen levels - drugs (oestrogen in treatment of prostatic cancer, spironolactone and cimetidine) - cirrhosis of liver - in conditions with increased oestrogen production (interstitial tumours of testis, some adrenal tumours, thyrotoxicosis) - in conditions with decreased androgen production, (hypergonadotrophic hypogonadism, Klinefelter's syndrome, orchitis)
49
classical characteristics of breast cancer on mammography?
irregular opacity with spiculated edges, often associated with irregular micro calcification.
50
in which age group is mammography more sensitive?
more sensitive in breasts of older women (higher fat content), in whom it can detect a lesion before clinically palpable, compared to younger women' (more opaque) NB with increasing age, the glandular tissue is replaced with fatty tissue
51
which is the commonest malignancy in women?
carcinoma of the breast
52
presenting symptoms of breast cancer?
- painless lump/thickening - nipple discharge - nipple inversion/in-drawing - distortion - Paget's disease - Axillary nodes
53
presenting signs of breast cancer?
- painless lump (irregular, hard, fixed) - skin tethering - indrawn nipple
54
if lymph nodes in supraclavicular fossa are enlarged, what does this indicate about the breast cancer?
breast cancer is classed as metastatic and is surgically incurable.

Phase 2B (6 decks)

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