Brainscape's Knowledge GenomeTM

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


See full index

The Thorax > Breast Surgery > Flashcards

Breast Surgery Flashcards

1
Q

Embryological origin of the epithelial lining of the ducts and acini

A

Ectoderm

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

Embryological origin of the supporting tissue (stroma)

A

Mesenchyme

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

When is the mammary ridge developed

A

5 weeks

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

Where are the milk lines situated

A

Stretch from axilla to the groin

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

At what age is the breast bud formed

A

10

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

When does nipple development occur

A

12

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

Which ribs does the breast span

A

2nd to 6th

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

Which muscles does the breast cover

A
  • Medial 2/3rd = Pec major

- Lateral 1/3rd = Serratus anterior

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

Outline the structure of the breast

A
  • Composed of 15-20 lobules
  • Lobules drain into lactiferous ducts
  • Lactiferous ducts drain into lactiferous sinuses which store milk
  • Lactiferous ducts feed excretory sinuses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What type of epithelium lines the lobule ducts

A

Columnar/cuboidal epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of epithelium lines the excretory ducts

A

Squamous epithelium

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

What connects the breast to the deep fascia of the chest wall

A

Suspensory ligaments of Cooper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which rib space does the nipple align with

A

4th

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the blood supply to the lateral breast

A

Lateral thoracic and Thoracoacromial arteries (branches of the axillary artery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outline the blood supply to the medial breast

A

Perforating branches of intercostal spaces 1-4 (branches of the IMA)

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

Outline the venous drainage of the lateral breast

A

Thoracoacromial vein -> lateral thoracic vein -> axillary vein

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

Outline the venous drainage of the medial breast

A

Internal thoracic vein -> subclavian vein

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

Via which route does breast cancer spread to the thoracic vertebrae and ribs

A

Haematogenous via posterior intercostal veins that communicate with the vertebral venous plexus

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

Describe the cutaneous innervation of the breast

A

Cutaneous branches of intercostal nerves T4-6

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

Outline the lymphatic drainage of the breast

A
  • 75-97% via axillary nodes

- 25% to internal mammary nodes through 2nd-4th intercostal spaces

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

Outline the connection between right and left breast lymphatics

A

There is anastomosis across the midline and down the abdominal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How are Axillary lymph nodes classified in axillary node clearance

A
  • Level 1 = lateral to pec minor
  • Level 2 = posterior to pec minor
  • Level 3 = medial to pec minor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which structures drain into the anterior (pectoral) nodes

A

Anterior upper trunk and breast

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

Which structures drain into the posterior (subscapular) nodes

A

Posterior upper trunk and axillary tail

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

Which structures drain into the apical (subclavicular) nodes

A
  • Upper limb
  • Anterior upper trunk and breast
  • Posterior upper trunk and axillary tail
  • Lateral, anterior, and posterior lymph nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What stimulates the growth and development of breast tissue during puberty

A

Oestrogens

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

Outline the changes that occur in the breast tissue during the menstrual cycle

A
  • Follicular Phase = Oestrogen secreted from the Graafian follicle causes mammary duct proliferation and increase in stromal tissue
  • Luteal Phase = rise in progesterone causes dilatation of the mammary ducts
  • Menstruation = involution of breast tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What changes to the breast are seen during pregnancy

A
  • Placental oestrogen causes proliferation and branching of the lobules and ductal system
  • Further fat and stromal tissue are laid down
  • Breast weight can double
  • Nipple and areolar become more pigmented
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does lactation occur

A

When prolactin release is no longer inhibited by oestrogen

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

What is released from the breast during the first 2-4 days post-partum

A

Colostrum - high in protein and IgA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What causes milk ejection

A

Oxytocin - released in response to suckling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What happens to the breast tissue during menopause

A

Regression of breast tissue and replacement with fat and fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What imaging modality is used in the triple assessment

A
  • <35 = USS

- >35 = Mammography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What imaging modality is preferable in those with implants presenting with a lump

A
  • <35 = USS

- >35 = Mammography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What imaging modality is preferred for assessing issues with breast implants

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What imaging modality is preferred for screening young patients with a family history of breast Ca

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does C1 mean on cytology assessment

A

Insufficient cells for diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What letter denotes core biopsy in the triple assessment

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does B5a indicate

A

DCIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What does B5b indicate

A

Invasive carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the gold standard method of histological assessment

A

Core biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When is punch biopsy indicated

A

For suspicious skin lesion on breast or areola

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Describe the cyclical variation in fibrocystic breast disease

A

Symptoms peak at the end of the luteal phase (just before menstruation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Outline the histological changes seen in fibrocystic breast disease

A
  • Stromal fibrosis adenosis (increase in glandular tissue)
  • Cyst formation
  • Papillomatosis
  • Epithelial hyperplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Symptoms of fibrocystic breast disease

A
  • Nodular breast tissue (cobblestone texture)
  • Discrete tender lumps
  • Cyclical breast pain
  • Breast cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Management of fibrocystic breast disease

A
  • Reassurance
  • Analgesia
  • Aspiration of cysts
  • COCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Clinical features of breast cysts

A
  • Palpable 1-5mm in diameter
  • Often multiple
  • Appear rapidly and diminish after menstruation
  • Smooth and may be fluctuant
  • Often tender
  • May be blue-ish in colour
  • Halo sign on USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Management of breast cysts

A
  • Aspirate
  • If clear fluid = discard
  • If blood-stained = biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

From where do fibroadenomas develop

A

Whole lobule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Clinical features of fibroadenoma

A
  • Mobile, firm breast lump
  • 1-5cm
  • 7% bilateral
  • 7% recurrent after excision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What constitutes a ‘giant’ fibroadenoma

A

> 5cm

52
Q

Describe the structure of a fibroadenoma

A

Growth of glandular and cystic tissue within a network of fibrous stroma, enclosed by capsule

53
Q

Why must core biopsy be performed in fibroadenoma

A

Cannot be distinguished from Phyllodes tumour on cytology alone

54
Q

Outline the indications for surgical excision of fibroadenoma

A
  • > 3cm
  • Patient request
  • Diagnostic difficulties
55
Q

Management of Phyllodes tumour

A

Wide local excision (axillary surgery is NOT indicated)

56
Q

Clinical features of Fat necrosis

A
  • Lump
  • Skin dimpling and retraction
  • Associated with trauma
57
Q

How does fat necrosis appear on mammography

A

Focal calcification and scarring

58
Q

Outline the management of fat necrosis

A
  • Must be imaged and biopsied

- Can be excised if diagnostic uncertainty

59
Q

Clinical features of sclerosing adenosis (radial scars)

A
  • Breast lump or pain
  • Mammographic changes mimic carcinoma
  • Distortion of distal lobular unit, without hyperplasia
60
Q

How do blocked Montgomery’s tubercles present

A

Periareolar lump (caused by blockage of the sebaceous glands of the areolar)

61
Q

Clinical features of Mondor’s disease

A
  • Thrombophlebitis of subcutaneous vein

- Presents as tender skin dimpling with palpable indurate cord

62
Q

Treatment of Mondor’s disease

A

NSAIDs

63
Q

Management of Galactocele

A

Aspirated to dryness

64
Q

Clinical features of Paget’s disease of the nipple

A
  • Scaly, non-itchy nipple lesion
  • May be point of bleeding, discharge is rare
  • Can spread to areola
65
Q

Paget’s Vs Eczema differences

A
  • Paget’s is typicaly unilateral
  • Eczema does NOT affect the nipple
  • Paget’s spares areola
66
Q

Investigating Paget’s disease

A
  • Bilateral mammograms
  • Punch biopsy
  • Biopsy of underlying lesion
67
Q

Clinical features of mammary duct ectasia

A
  • Older women
  • Smokers
  • Green nipple discharge
  • Occasional nipple retraction
68
Q

How may troublesome duct ectasia be managed

A

Hadfield’s procedure (total duct excision)

69
Q

Clinical features of duct papilloma

A
  • Usually within 2-3cm of nipple
  • Benign polyp of ductal epithelium
  • Blood-stained discharge
70
Q

List the abnormal features of nipple discharge

A
  • Single duct
  • Frankly blood-stained
  • RBCs on cytology
  • Papilloma on USS
71
Q

How should cases of nipple discharge with concerning features be managed

A

Microdochectomy (diagnostic procedure)

72
Q

What is the most common cause of blood-stained discharge in younger women

A

Intraductal papilloma

73
Q

Most common cause of mastitis neonatorum

A
  • Staph aureus

- E. coli

74
Q

Most common cause of lactational/puerperal mastitis

A

Staph aureus

75
Q

How should mastitis neonatorum be managed

A

Antibiotics (rarely needs drainage)

76
Q

How should lactational/puerperal mastitis be managed

A
  • Antibiotics
  • Continue breast feeding
  • Simple analgesia/cold compress
77
Q

How should lactational abscesses be managed

A
  • Aspiration under USS
  • Saline and LA irrigation
  • Repeat every 2-3 days
78
Q

Clinical features of periareolar mastitis

A
  • 90% smokers
  • Periareolar inflammation
  • Yellow discharge
  • Nipple retraction
79
Q

Outline the management of periareolar mastitis

A
  1. Antibiotics
  2. Needle aspiration
  3. Subareolar duct excision if recurrent (risks mammary duct fistula)
80
Q

Lifetime risk of breast cancer

A

1 in 8

81
Q

List the typical pathological changes seen in conjunction with invasive breast cancer

A
  1. Nuclear pleomorphism
  2. Coarse chromatin
  3. Angiogenesis
  4. Invasion of the basement membrane
  5. Dystrophic calcification
  6. Abnormal mitosis
  7. Vascular invasion
  8. Lymph node metastasis
82
Q

What is comedo necrosis and what does it indicate

A
  • Large cells with pleomorphic nuclei and luminal necrosis

- DCIS

83
Q

Outline the management of DCIS

A
  • WLE if <4cm
  • Mastectomy if >4cm
  • Consider adjuvant radiotherapy if high grade or large
84
Q

Lobular carcinoma in situ is a marker of risk for what

A
  • 30% risk of synchronous breast cancer if radiological abnormality
  • Metachronous breast cancer if no radiological abnormality
85
Q

Histological features of invasive lobular carcinoma

A
  • Indian file pattern

- Bullseye pattern

86
Q

Management of inflammatory breast cancer

A
  1. Primary chemotherapy

2. Mastectomy with axillary clearance

87
Q

What tumour features are amenable to wide local excision

A
  • Solitary lesion
  • Peripheral tumour
  • Small lesion in large breast
  • DCIS <4cm
  • Patient choice
88
Q

What tumour features are amenable to mastectomy

A
  • Multifocal tumour
  • DCIS >4cm
  • Patient choice
  • Patient who cannot receive adjuvant radiotherapy
  • Local recurrence after previous breast conserving surgery
89
Q

What treatment must follow breast-conserving surgery

A

Adjuvant radiotherapy

90
Q

What are the necessary resection margins in breast-conserving surgery

A
  • 1mm for invasive disease
  • 2mm for DCIS
    (A cuff of 1cm surrounding tissue is aimed for on excision)
91
Q

List the common complications of simple mastectomy

A
  • Haematoma
  • Seroma
  • Psychological trauma
  • Disease recurrence
92
Q

What nerve is at risk during sentinel node biopsy

A

Intercostobrachial nerve (causing numbness of the inner arm)

93
Q

List the intraoperative hazards in axillary node clearance

A
  • Axillary vein
  • Thoracodorsal trunk
  • Long thoracic nerve
  • Thoracoacromial artery (in level 3 dissection)
94
Q

What type of genes are BRCA genes

A

DNA-mistmatch repair genes

95
Q

On which chromosome is BRCA 1 found

A

Long-arm of chromosome 17

96
Q

Which cancers is BRCA 1 associated with

A
  • Female breast cancer
  • Ovarian cancer
  • Prostate cancer
  • Colon cancer
97
Q

What is the lifetime incidence of developing breast cancer in a BRCA -1 carrier

A

70%

98
Q

What are the typical features of breast cancers in those with BRCA-1 mutation

A
  • High-grade
  • Usually ER and PR negative
  • Well-circumscribed or round appearance
99
Q

On which chromosome is BRCA 2 found

A

Long-arm of chromosome 13

100
Q

Which cancers is BRCA 2 associated with

A
  • Male and female breast cancer

- Ovarian cancer

101
Q

What are the typical features of breast cancers in those with BRCA-2 mutation

A
  • Less well defined

- More commonly lobular

102
Q

What is the lifetime risk of developing breast cancer in a BRCA-2 carrier

A

55%

103
Q

What are the adaptations to the breast screening programme for those with moderate and severe genetic risk of breast cancer

A
  • Annual examination and mammogram from 35
    (Earlier if known family cases <35)
  • Those with dense breast tissue or <35 will have MRI
104
Q

How does breast cancer risk correlate with oestrogen exposure

A

Raised incidence with greater lifetime oestrogen exposure

105
Q

What score is used to predict prognosis in breast cancer

A

Nottingham prognostic index

106
Q

Outline the components of the Nottingham prognostic index

A

(0.2 x tumour size (cm)) + tumour grade + lymph node status

107
Q

What is the single most important prognostic factor

A

Lymph node status

108
Q

How many sentinel nodes are there

A

1-7

109
Q

How are the sentinel nodes identified

A

By combination of 2 techniques:

  1. Technetium-99 detected by gamma probe
  2. Blue patent V dye
110
Q

What score quantifies the number of ER-positive cells

A

Allred score

111
Q

What system is used to stage breast cancer

A

Bloom-Richardson model

112
Q

Who are invited to breast screening and how often

A

All women aged 50-70 (+/- 3 years) every 3 years

113
Q

Outline the basic hormonal adjuvant options for ER+ve breast cancer treatement

A
  • Premenopausal = Tamoxifen

- Post-menopausal = Aromatase inhibtor e.g. Letrozole

114
Q

How long should Tamoxifen be given and why is this limited

A
  • 5 years

- Evidence of increased risk of endometrial cancer when given for longer

115
Q

What is the function of aromatase

A

Converts circulating androgens to oestrogen in the peripheral fatty tussues

116
Q

In whom is chest wall radiotherapy given

A
  • Grade 3 cancers that are multifocal or near to skin/muscle
  • Larger cancers >4cm
  • Presence of lymphovascular invasion
  • 3 or more positive nodes
117
Q

What is the clinic follow-up duration in breast cancer patients

A

2 years

118
Q

What is the typical site of autologous tissue used on oncoplastic breast reconstruction

A

Pedicled extended latissimus dorsi flap

119
Q

What is the capsular contracture rate for implant-based reconstructions

A

75%

120
Q

What is the most frequent site of breast metastases

A

Bones

121
Q

What drugs can cause Gynaecomastia

A
  • ACE-i
  • Calcium channel blockers
  • Spironolactone
  • Digoxin
  • Amiodarone
  • Anti-androgens
  • H-2 receptor antagonists
  • PPI
  • TCAs
  • Phenothiozines
  • Methyldopa
  • Diazepam
  • Steroids
  • Finasteride
  • Metoclopramide
122
Q

What drugs can be used for the treatment of gynaecomastia

A
  • Danazol

- Tamoxifen

123
Q

What condition is linked with breast chemotherapy

A

Secondary AML

124
Q

In whom does lobular carcinoma typically occur in

A

Premenopausal women

125
Q

List the typical features of lobular carcinoma

A
  • Typically has no clinical features
  • Often bilateral
  • Can be missed on mammogram
  • Can be multifocal
126
Q

Why does Actinomyocosis occur and what are the typical features

A
  • Spread of infection from the lung through the chest wall
  • Usually presents with hard lump beneath the nipple
  • Abscess formation with pus containing sulphur granules

The Thorax (5 decks)

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