Medbear Breast Flashcards

1
Q

Describe on the breast anatomy

A
  • The breast is a MODIFIED SWEAT GLAND that is located between subcutaneous fat and the fascia of the pectoralis muscle and serratus anterior muscle
  • It consists of fat, fibrous tissue and glandular tissue
  • It extends from the lateral sternal border to the mid-axillary line, 2nd rib -> 6th rib
  • The axillary tail (axillary tail of Spence) pierces the deep fascia and enters the axilla
  • It consists of 15-20 lobules of glandular tissue that drains into a lactiferous duct which converges towards the nipple
  • Areole is lubricated by glands of Montogomery
  • Suspensory ligament of astley cooper divides the breast lobules into segments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In advanced breast carcinoma, what is the pathophysiology of skin dimpling?

A

It is due to malignant infiltration and contraction of Cooper’s ligament

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

What is the embryological origin of the breast?

A

Ectodermal and mesodermal origin

The breast begins development in the embryo about 7-8 weeks after conception

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

State the arterial supply and venous drainage of the breast.

A

Arteries
1. Internal thoracic artery
2. Branches of axillary artery
3. 2nd - 5th intercostal arteries

Venous drainage
1. Internal thoracic
2. Axillary vein
3. Lateral thoracic
4. Intercostal veins

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

State the (5) nerve supplies of the breast

A
  • Long thoracic n -> innervates SERRATUS ANTERIOR (winged scapula)
  • Thoracodorsal n -> inervates LATISSIMUS DORSI (weak arm adduction)
  • Median pectoral n -> innervates PECTORALIS MAJOR and MINOR
  • Lateral pectoral n -> innervates PECTORALIS MAJOR only
  • Intercostobrachial n (off 2nd IC nerve) - sensation to medial arm and axilla
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

State the (3) lymphatic drainage of the breast

A
  1. Axillary nodes
  2. Internal Mammary nodes
  3. Inter-pectoral (Rotter’s nodes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the anatomic/surgical division of axillary nodes into level 1, 2 and 3 (relative to pectoralis minor)***

A

Level 1 = lateral to lateral border of pectoralis minor

Level 2 = Posterior to pectoralis minor and below the axillary vein

Level 3 = Medial to medial border pectoralis minor, extending up to apex of axilla

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

State the origin and insertion of pectoralis major

A

Origin = Medial clavicle, sternum, anterior 2-6th ribs, external oblique, rectus abdominis fascia

Insertion = Upper humerus, 10cm from humeral head on lateral side of intertubercular sulcus

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

State the nerve supply of pectoralis major.

A

Medial and lateral pectoral nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

State the origin and insertion of pectoralis minor

A

Origin = anterolateral surface of 3rd to 6th ribs

Insertion = coracoid process of scapula

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

State the innervation of pectoralis minor

A

Medial pectoral nerve

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

State the origin and insertion of serratus anterior

A

Origin = anterolateral aspect of upper 8th ribs

Insertion = anterior surface of medial aspect of scapula

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

State the nerve innervation of serratus anterior

A

Long thoracic nerve

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

State the origin and insertion of rectus abdominis

A

Origin = Pubic line

Insertion = Xiphoid process and ribs 5-7

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

State the nerve innervation of rectus abdominis

A

Segmental motor nerve from 7th to 12th intercostal nerve

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

State the origin and insertion of external oblique

A

Origin = Lower 8 ribs (5-12)

Insertion = Iliac crest, pubic tubercle, linea alba

17
Q

State the nerve innervation of external oblique

A

Segmental motor nerve from 7th to 12th intercostal nerve

18
Q

State the axilla anatomy based on the following:
Apex
Base
Anterior
Posterior
Lateral
Medial

A

Apex = Costoclavicular ligament

Base = Skin and axillary fascia

Anterior = Pectoralis major and minor, subclavius muscle

Posterior = Subscapularis, teres major and latissimus dorsi muscle

Lateral = Intertubercular sulcus

Medial = Ribs and intercostal muscle covered with the serratus anterior

19
Q

State the anatomic boundaries of axillary dissection (level 2 dissection) for the following aspect:
Superior border
Medial border
Lateral border
Anterior border
Posterior border

A

Superior border = Axillary vein
Medial border = Chest wall
Lateral border = Skin flap
Anterior border = Pectoralis minor
Posterior border = Latissimus dorsi

20
Q

Differentiate between Paget’s disease and eczema of the nipple.

A
21
Q

State the differentials for gross bloody discharge (red) from the nipple

A
  • Intraductal papilloma
  • Mammary ductal carcinoma
  • Fibrocystic change -> Do triple assessment
22
Q

State the differentials for clear (serous) or straw coloured (yellow) discharge from the nipple

A
  • Ductal papilloma
  • Ductal carcinoma
  • Mammary ductal ectasia (Could also present with green, brown or black discharge)
23
Q

What could be the diagnosis if there is purulent, foul-smelling nipple discharge?

A

Lactational mastitis or breast abscess

24
Q

What could be the diagnosis if there is white milky nipple discharge?

A
  • Drug-related galactorrhea
  • Spontaneous galactorrhea
  • Lactation
25
Q

What would you suspect if there is blood stained (spot on bra)?

A
  • Paget Disease
  • Dermatitis/Eczema
26
Q

What causative agents are found in lactational mastitis?

A

Staphylococcus aureus

27
Q

How is drug-related galactorrhoea is treated?

A

Medication that might affect hypothalamic-pituitary axis

  1. Deplete dopamine -> Dopamine normally inhibit prolactin (e.g TCA, METHYLDOPA, BENZODIAZEPINES)
  2. Dopamine receptor blocker (e.g HALOPERIDOL)
  3. Estrogenic effect (e.g DIGITALIS)
28
Q
A