Ch 18 Breasts

Question 1

Breasts lie anterior to these 2 muscles:
_____ major and ______ anterior

located between ribs __ and ___

Answer 1

pectoralis major
serratus anterior

between ribs 2 and 6

Question 2

4 groups of axillary lymph nodes:

1. ____ axillary lymph nodes: receive lymph from _____ –> flow to ____ and _____ nodes
2. _____ (anterior) lymph nodes: lie inside anterior axillary fold
3. ____ (posterior) lymph nodes: lie deep in posterior axillary fold
4. ____ lymph nodes: along humerus inside upper arm

Answer 2

1. Central axillary lymph nodes: receive lymph from other 3 groups –> infraclavicular and supraclavicular nodes
2. Pectoral (anterior)
3. Subscapular (posterior)
4. Lateral

Question 3

Thelarche (beginning of breast development) precedes menarche by ____ years
Menarche occurs during Tanner stage ___ or ____ of breast development

Answer 3

two

menarche: stage 3 or 4

Question 4

Breast cancer risk factors:

• ____ menarche (____ age 11)
• ____ menopause (____ age 55)

Answer 4

early menarche (before age 11)
late menopause (after age 55)

Question 5

Paget’s disease starts on ___ and spreads to ____
Symptoms:

Paget’s = ______ carcinoma

Answer 5

Pagets: starts on nipple, spreads to areola
Early: unilateral clear yellow discharge, crusty at nipple apex
Later: red, excoriated, ulcerated nipple with bloody discharge

Intraductal carcinoma
any dermatitis from nipple must be explored and investigated immediately

(eczema and other dermatitis rarely state on nipple unless caused by breastfeeding –> usually starts on areola/surrounding area and THEN spreads to nipple)

Question 6

How do you define average risk for breast cancer screening? (4 components)

Answer 6

• no previous hx of breast cancer
• no hx of breast cancer in first degree relative
• no BRCA gene mutatation
• no chest wall radiation

Question 7

Characteristics of malignant breast lump:

• age
• shape:
• consistency:
• demarcation:
• number
• mobility:
• tenderness:
• skin retraction:
• pattern of growth:

Answer 7

• age: 30 to 80 (esp 50+)
• shape: irregular
• consistency: firm
• demarcation: poorly defined
• number: one
• mobility: fixed
• tenderness: none usually, might have pain
• skin retraction: yes
• pattern of growth: constant

most common in upper outer quadrant

Question 8

Characteristics of fibroadenoma:

• age
• shape:
• consistency:
• demarcation:
• number
• mobility:
• tenderness:
• skin retraction:
• pattern of growth:

Answer 8

Fibroadenoma:

• age: 15-30 years
• shape: round
• consistency: rubbery, firm
• demarcation: well defined
• number: usually one
• mobility: very mobile, slippery
• tenderness: no
• skin retraction: no
• pattern of growth: fast, constant

Question 9

Characteristics of benign breast disease

• age
• shape:
• consistency:
• demarcation:
• number
• mobility:
• tenderness:
• skin retraction:
• pattern of growth:

Answer 9

Benign breast disease

• age: 30-55 (less common after menopause
• shape: round
• consistency: firm to soft, rubbery
• demarcation: well defined
• number: usually multiple
• mobility: yes
• tenderness: present, worse before menses
• skin retraction: no
• pattern of growth: changes size rapidly

Question 10

Gynecomastia can occur with:

• ______ syndrome
• liver cirrhosis because _____
• adrenal disease
• (hypo or hyper)thyroidism?

Answer 10

• Cushing
• estrogens cannot be metabolized
• hyperthyroidism

Question 11

Gynecomastia can occur with:

• substances: (2)
• ____ treatment for prostate cancer
• antibiotics: (2)
• MH meds: (2)
• cardiac meds: (3)

Answer 11

• alcohol and marijuana
• estrogen treatment for prostate cancer
• flagyl, isoniazid
• diazepam, TCA
• spironolactone, ACE-I, digoxin