Chapter 21 PT 2

Question 1

the breast is a modified ______ gland located in the superficial fascia of the anterior chest wall.

Answer 1

sweat

Question 2

sonographically the breast is divided into three layers located between the skin and the pectoralis major muscle on the anterior chest wall. these layers are the _______.

Answer 2

subcutaneous, mammary, and retromammary

Question 3

fat is the least ______ tissue within the breast.

Answer 3

echogenic

Question 4

the fatty tissue appears ______, whereas the ducts, glands, and supporting ligaments appear echogenic.

Answer 4

hypoechoic

Question 5

the _______ quadrant of the breast contains the highest concentration of lobes.

Answer 5

upperouter

Question 6

each lobule contains ______ (milk-producing glands) that are clustered on the terminal ends of the ducts like grapes on a vine.

Answer 6

acini

Question 7

the ______ muscle lies posterior to the retromammary layer.

Answer 7

pectoralis major

Question 8

the ______ tissue can situate itself in and among the areas of glandular tissue, and in some scanning planes it can mimic isoechoic or hypoechoic masses.

Answer 8

adipose or fatty

Question 9

sonographically, cancers can be difficult to differentiate in the fatty breast because most cancer appear ______ and can be difficult to differentiate from the normal breast tissue.

Answer 9

hypoechoic

Question 10

the main arterial supply to the breast comes from the internal ______ and the lateral _______ artery.

Answer 10

mammary, thoracic

Question 11

lymphatic drainage from all parts of the breast generally flows to the ______ lymph nodes.

Answer 11

axillary

Question 12

the primary function of the breast is ______ transport.

Answer 12

fluid

Question 13

the ______ system is critical in the transport of fluids within the breast.

Answer 13

ductal

Question 14

an important function during the reproductive years is for the breast to make ______ from nutrients and water taken from the bloodstream.

Answer 14

milk

Question 15

milk is produced within the ______ and carried to the nipple by the ducts.

Answer 15

acini

Question 16

breast development begins before ______ and continues until the patient is approximately 16 years old.

Answer 16

menarche

Question 17

during this time of development, the ductal system proliferates under the influence of ______.

Answer 17

estrogen

Question 18

during pregnancy, acinar development is accelerated to enable milk production by estrogen, ______, and prolactin.

Answer 18

progesterone

Question 19

the hormone produced by the pituitary gland that stimulates the acini to produce and excrete milk is called ______.

Answer 19

prolactin

Question 20

the expulsion of the placenta after the birth of a baby causes a drop in circulating progesterone, initiating ______ production within the breast.

Answer 20

milk

Question 21

the physical stimulation of suckling by the baby initiates the release of ______ (produced by the hypothalamus and released by the pituitary gland), which further incites prolactin secretion, stimulating additional milk production.

Answer 21

oxytocin

Question 22

full maturation of the acini occurs during lactation and is thought to be mildly protective against the development of breast _______.

Answer 22

cancer

Question 23

ultrasound may be used for screening purpose in ______ breasts that are ______ and difficult to penetrate by mammography, to evaluate masses.

Answer 23

young, dense

Question 24

ultrasound is also useful in ______ structures within uniformly dense breast tissue where mammography is limited.

Answer 24

differentiating

Question 25

a ______ aspiration can be performed to determine whether a lesion is a complex cyst or truly a solid mass.

Answer 25

cyst

Question 26

what basic clinical information must the sonographer have for any patient referred for breast ultrasound?

Answer 26

patients age, risk factor for cancer, symptoms, location and clinical impression of lumps

Question 27

pertinent clinical information that should be provided by the referring physician includes size and location of the lump, when it was noticed, and its relation to the ______.

Answer 27

menstrual cycle

Question 28

a dominant cyst is frequently ______ or ______, smooth, soft, and easily moveable.

Answer 28

round or oval

Question 29

fibroadenomas are usually similar in shape, but they are often quite firm and rubbery in consistency and ______ on ultrasound.

Answer 29

homogeneously solid

Question 30

breast cancer is usually lobular or ______ in shape, uneven in surface contour, and fixed or poorly moveable.

Answer 30

irregular

Question 31

most breast masses that arise during the adolescent years are ______.

Answer 31

fibroadenomas

Question 32

an ______ implant rupture occurs when there is a breach of the membrane surrounding an implant, but the silicone that leaks out is still confined within the fibrous scar tissue that forms around the implant.

Answer 32

intracapsular

Question 33

as the implant collapses and the membrane folds inward, a series of discontinuous echogenic lines parallel to the face of the transducer may be seen and are referred to as the "stepladder sign" or ______ sign.

Answer 33

linguine

Question 34

the use of the ______ positions is unique to the breast and can often pick up subtle abnormalities extending toward the nipple along the ductal system from the mass.

Answer 34

radial/ antiradial

Question 35

_______ tend to grow within the ducts and will often follow the ductal system in a radial plane, toward the convergence at the nipple.

Answer 35

malignancies

Question 36

to be considered a simple cyst, a lesion must meet which three criteria on ultrasound?

Answer 36

devoid of internal echoes, smooth inner margins within capsule, posterior acoustic enhancement

Question 37

discuss the disruption of breast architecture with both benign and malignant tumors of the breast.

Answer 37

benign usually are slow growing and do not invade surrounding tissue, tend to grow horizontally

Question 38

a rounded or oval shape is usually associated with ______ lesions, whereas sharp, angular margins are associated with ______ lesions.

Answer 38

benign, malignant

Question 39

the normal tissue planes of the breast are _______ oriented.

Answer 39

horizontally

Question 40

benign lesions tend to grow within the normal tissue planes, and their long axis lies _____ to the chest wall.

Answer 40

parallel

Question 41

malignant lesions are able to grow through the connective tissue and may have a ______ orientation when imaging the breast from anterior to posterior.

Answer 41

vertically

Question 42

if a mass measures longer in the anteroposterior dimension (______) then in either transverse or sagittal planes (______), the mass has a vertical orientation that is usually described as being "taller than wide" is suspicious for malignancy.

Answer 42

height, width

Question 43

malignant masses will often demonstrate increased ______ within the lesion and often have a feeder vessel, which can be identified with careful evaluation.

Answer 43

vascularity

Question 44

lesions more common to younger women are ______ disease and fibroadenomas.

Answer 44

fibrocystic

Question 45

older or postmenopausal women are more likely to have ______ papillomas, duct ectasia, and cancer.

Answer 45

intraductal

Question 46

skin dimpling or ulceration and nipple retraction nearly always result from ______.

Answer 46

cancer

Question 47

benign tumor are rubbery, ______, and well delineated, whereas malignant tumors are often stone hard and irregular with a gritty feel.

Answer 47

mobile

Question 48

clinical signs and symptoms of ______ include the lumps and pain that the patient feels that fluctuate with every monthly cycle.

Answer 48

fibrocystic conditions

Question 49

the growth of a fibroadenoma is stimulated ______.

Answer 49

estrogen

Question 50

sonographically, fat necrosis appears as an irregular, complex mass with low-level echoes, may mimic a ______ lesion, and may appear as fat, but is separated and difficult from the rest of the breast parenchyma.

Answer 50

malignant

Question 51

______ may result from infection, trauma, mechanical obstruction in the breast ducts, or from other conditions.

Answer 51

acute mastitis

Question 52

an intraductal papilloma is a small, ______ tumor that grows within the acini of the breast.

Answer 52

benign

Question 53

in ______ tissue, most cancer growth occurs along the borders.

Answer 53

fibrotic

Question 54

______ and ______ are frequently used as pathways for new tumor development.

Answer 54

lymphatics and blood vessels

Question 55

if the tumor is ______ is continues to grow in one area, compressing and distorting the surrounding architecture.

Answer 55

encapsulated

Question 56

most cancer originates in the ______ ductal lobular units, whereas a smaller percentage originates in the glandular tissue.

Answer 56

terminal

Question 57

______ refers to breast tumors that arise from the epithelium, in the ductal and glandular tissue, and usually have tentacles.

Answer 57

carcinoma

Question 58

breast carcinomas are generally categorized by two factors: where the cancer cells originate (______ or ______) and whether the cancer is prone to spreading (______ or ______).

Answer 58

ductal or lobular, noninvasive or invasive

Question 59

carcinomas that do not normally spread outside of the duct or lobule are called noninvasive, noninfiltrating, or ______ cancers, whereas cancers that spread into nearby tissue are said to be invasive or infiltrating.

Answer 59

in situ