Breasts & Axilla

Question 1

The glandular tissue is arranged into ____ to ____ lobes per breast that radiate about the nipple

Answer 1

15-20

Question 2

Each lobe of the breast is composed of __ to ____ lobules.

Answer 2

20-40

Question 3

Each lobule consists of milk producing ____ cells that empty into ____ ducts.

Answer 3

acini

lactiferous

Question 4

What extends from the connective tissue later through the breast and attach to the underlying muscle fascia providing support to the breast?

Answer 4

suspensory (Cooper) ligaments

Question 5

What are the muscles that form the floor of the breast? (7)

Answer 5

pectorals major and minor
serratus anterior
latassimus dorsi
subscapularis
external oblique
rectus abdominis

Question 6

What provides vascular supply to the breast?

Answer 6

branches of the internal mammary and lateral thoracic artery

Question 7

What constitutes most of the bulk of breast and gives it soft consistency?

Answer 7

subcutaneous and retromammary fat

Question 8

Where does the greatest amount of glandular tissue lie in the breast?

Answer 8

upper outer quadrant which extends into axilla, forming the tail of Spence

Question 9

What are the tiny sebaceous glands on the areola surface?

Answer 9

Montgomery tubercles or follicles

Question 10

Which lymph nodes are more superficial and accessible to palpation when enlarged?

Answer 10

axillary nodes

Question 11

What axillary lymph nodes are located along the lower border of the pectorals major inside the lateral axillary fold?

Answer 11

anterior axillary (pectoral)

Question 12

What axillary LN are high in the axilla close to the ribs?

Answer 12

midaxillary (central)

Question 13

What axillary LN lie along the lateral border of the scapula and deep in the posterior axillary fold?

Answer 13

posterior (subscapular)

Question 14

What axillary LN can be felt along the upper humerus?

Answer 14

Lateral (brachial)

Question 15

Where does the drainage from the deep retroareolar area go?

Answer 15

inter pectoral (rotter) nodes into the axillary chain

Question 16

Where does the drainage go from the superficial upper outer quadrant go?

Answer 16

scapular, brachial, intermediate nodes toward axillary lymph nodes

Question 17

Where does the drainage go from the superficial medial portion go?

Answer 17

internal mammary chain toward opposite breast and abdomen

Question 18

What happens to the breast during pregnancy in response to luteal and placental hormones?

Answer 18

the lactiferous ducts proliferate and the alveoli increase in size and number causing the breast to enlarge 2-3x prepregnant size

Question 19

What happens towards the end of pregnancy?

Answer 19

Epithelial secretory activity increases, colostrum is produced and accumulates in the acinus cells (alveoli)

Question 20

What happens to the areolae during pregnancy?

Answer 20

more deeply pigmented and their diameter increases

Question 21

What happens to vasculature during pregnancy?

Answer 21

It increases causing veins to engorge and become visible below surface of skin

Question 22

In the first few days after delivery what is secreted from the breasts?

Answer 22

colostrum containing more protein and minerals compared to milk and also antibodies

Question 23

When does milk production replace colostrum?

Answer 23

2-4 days after delivery

Question 24

What stimulates milk production?

Answer 24

surging prolactin levels, declining estrogen levels and the stimulation of sucking

Question 25

When does involution occur?

Answer 25

at the termination of lactation over a period of 3 months

Question 26

What happens to the breast after menopause?

Answer 26

glandular tissue atrophies and is replaces by fat inframammary ridge at the lower edge of the breast thickens nipples become smaller and flatter and less erectile hang more loosely as a result of tissue change and relaxation of suspensory ligaments skin becomes dry and thin loss of axillary hair may also occur

Question 27

What medications are associated with nipple discharge?(6)

Answer 27

``` contraceptives hormones phenothiazines digitalis diuretics steroids ```

Question 28

What medications can be associated with breast enlargement in males? (9)

Answer 28

``` cimetidine omeprazole spirinolactone anti androgens (finasterides) HIV meds some chemo antihypertensives some antipsychotics estrogen ```

Question 29

What genetic mutations or hereditary cancers are important in past medical history?

Answer 29

known BRCA1 or BRCA2 hereditary nonpolyposis colorectal cancer Li-Fraumeni syndrome Cowden syndrome

Question 30

What are the non modifiable risk factors? (11)

Answer 30

``` age gender genetics personal history of breast ca family history of breast ca precious breast biopsies race (whites) Previous breast radiation menstrual periods (menarche before 12 or menopause after 55) Breast density Diethylstilbestrol therapy ```

Question 31

What is the % of developing breast ca with known BRCA1 or BRCA2 mutations?

Answer 31

have a 45-80% chance of developing breast ca compared to average risk of 12%

Question 32

What is the risk if patient has one first degree relative with breast ca?

Answer 32

doubles the risk | if two first degree relatives the risk increases threefold

Question 33

Previous biopsies of what can increase risk of developing breast ca?

Answer 33

atypical hyperplasia or lobular cancer in situ (LCIS)

Question 34

Older women with more dense tissue are at ____ to ___ times the risk.

Answer 34

1.2 to 2 times

Question 35

What are the modifiable risk factors of breast ca? (5)

Answer 35

``` childbirth hormone therapy alcohol obesity and high fat diets lack of physical activity ```

Question 36

How does hormone therapy affect breast cancer risk?

Answer 36

use of combined estrogen and progesterone hormone replacement therapy (HRT) after menopause for more than 4 years increases the risk Transgender women taking hormones for 5-10 years is uncertain

Question 37

How does having more fat tissue affect breast ca risk?

Answer 37

Having more fat tissue can increase estrogen levels and increase likelihood

Question 38

What are some medications that can cross the milk-blood barrier?

Answer 38

cometidine clemastine thiouracil

Question 39

What do retractions and dimpling signify?

Answer 39

contraction of fibrotic tissue that may occur with carcinoma

Question 40

What is the appearance of skin that indicates edema of the breast caused by blocked lymph drainage in advances or inflammatory breast cancer?

Answer 40

peau d'orange (orange skin)

Question 41

Unilateral venous patterns can be the result of what?

Answer 41

increased blood flow to a malignancy

Question 42

What is a common expected finding of the areolae?

Answer 42

peppering of contender, non suppurative Montgomery tubercles

Question 43

The peau d'orange skin associated with cancer is often seen where first?

Answer 43

the areola

Question 44

What change in the nipple may suggest malignancy?

Answer 44

recent unilateral inversion of a previously everted nipple

Question 45

Supernumery nipples which are more common in blacks are associated with what in white patients?

Answer 45

congenital renal or cardiac anomalies

Question 46

Most of the benefit of mammography results from screening ages ____ to _____

Answer 46

50-74

Question 47

What are the ways to describe a breast mass shape? (6)

Answer 47

``` round discoid lobular stellate regular irregular ```

Question 48

When should nipple compression be performed?

Answer 48

When patient reports spontaneous discharge

Question 49

What is the firm transverse ridge of compressed tissue along the lower edge of the breast that is sometimes confused with a mass?

Answer 49

the inframammary ridge

Question 50

If malignancy were to reoccur post mastectomy where is it important to examine on exam?

Answer 50

at the site of the scar

Question 51

What is a common exam finding during the second trimester?

Answer 51

telangiectasias on upper chest, arms neck and face that DO NOT blanch

Question 52

What is the common age to see fibrotic changes in breast tissue?

Answer 52

20-49

Question 53

What is the common age range to see a fibroadenoma?

Answer 53

15-55

Question 54

What is the common age range to see cancer?

Answer 54

30-80

Question 55

What breast changes are usually bilateral?

Answer 55

fibrocystic changes and fibroadenoma

Question 56

What is usually the shape of a breast cancer mass?

Answer 56

irregular or stellate

Question 57

What is a common consistency of fibrocystic changes?

Answer 57

soft to firm; tense

Question 58

What is the common shape of a fibroadenoma?

Answer 58

round or discoid

Question 59

What is the common consistency of a cancer mass?

Answer 59

hard, stone like

Question 60

What breast masses are usually mobile?

Answer 60

fibrocystic changes and fibroadenoma

Question 61

What breast mass is usually tender?

Answer 61

fibrocystic changes

Question 62

What type of breast mass does not vary with menses?

Answer 62

fibroadenoma and cancer

Question 63

What is a benign fluid filled cyst formation caused by ductal enlargement?

Answer 63

fibrocystic changes

Question 64

What are fibrocystic changes associated with?

Answer 64

long follicular or luteal phase of the menstrual cycle

Question 65

When are fibrocystic changes the worst?

Answer 65

premenstrually

Question 66

What are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit?

Answer 66

fibroadenoma

Question 67

What can a fibroadenoma occur?

Answer 67

may occur at any age during the reproductive years

Question 68

When does a fibroadenoma regress?

Answer 68

after menopause

Question 69

Do fibroadenomas fluctuate with the menstrual cycle?

Answer 69

NO

Question 70

benign breast lump occurs as inflammatory response to local injury

Answer 70

fat necrosis

Question 71

What is epithelial hyperplasia producing a warlike tumor in a lactiferous duct causing spontaneous nipple discharge?

Answer 71

intraductal papillomas and papillomatosis

Question 72

What is a benign condition of the subareolar ducts that produce nipple discharge

Answer 72

duct ectasia

Question 73

Subareolar ducts become dilated and blocked with desquamating secretory epithelium, necrotic debris and chronic inflammatory cells

Answer 73

duct ectasia

Question 74

What does duct ectasia occur most commonly?

Answer 74

menopausal women

Question 75

What is the characteristic of the nipple discharge in duct ectasia?

Answer 75

spontaneous unilateral or bilateral that is often green or brown in color and may be sticky

Question 76

What is elevated levels of prolactin, resulting in milk production, occur as a result of disruption of the communication between the pituitary and hypothalamus glands?

Answer 76

galactorrhea

Question 77

What are the common causes of galactorrhea? (7)

Answer 77

``` pituitary- secreting tumors hypothalamic-pituitary disorders systemic diseases numerous medications herbs physiologic conditions local factors ```

Question 78

What are the possible medical conditions associated with galactorrhea?

Answer 78

``` amenorrhea pregnancy post abortion hypothyroidism Cushing syndrome chronic renal failure ```

Question 79

What are the possible medications associated with galactorrhea?

Answer 79

``` phenothazines tricyclic antidepressants some htn meds estrogens H2 receptor blockers marijuana amphetamines opiates ```

Question 80

What is migration of malignant epithelial cells from the underling intraductal carcinoma chia the lactiferous sinuses into nipple skin?

Answer 80

Paget disease

Question 81

What is commonly seen with Paget disease?

Answer 81

red, scaling, crusty patches on nipple, areola and surrounding skin that may be unilateral or bilateral that does not respond to steroids

Question 82

What is the most common infectious agent causing mastitis?

Answer 82

staph aureus

Question 83

When is mastitis most common?

Answer 83

in lactating patients after milk is established usually the second to third week after delivery however it can occur at any time

Question 84

What is characterized by sudden breast swelling, tenderness, redness and hear often accompanied by chills and fever

Answer 84

mastitis

Question 85

What is the presentation of mastitis?

Answer 85

tender, hard breast mass with an area of fluctuation, erythema and heat may have discharge of pus (suppuration) underlying put filled abscess may given bluish tint to skin

Question 86

What is the result of increased body fat; hormone imbalance from puberty or aging, by testicular, pituitary or hormone secreting tumors, by liver failure or by a variety of medications in males?

Answer 86

gynecomastia