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ENRP II > Normal/Abnormal Breast Exam > Flashcards

Normal/Abnormal Breast Exam Flashcards

1
Q

the breast are a modified ___ gland

A

sebaceous

secrete sebum

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2
Q

the breast are composed of what 4 things

A

fat, connective tissue, glands, milk ducts

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3
Q

how many lobes are in a normal breast and where do the majority of them lie

A

12-20 and most in the upper outer quadrant (tail of spence)

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4
Q

lobules consist of cluster of secretory cells lined by _____ cells (contractile)

A

myoepithelial

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5
Q

what is the most common route of metastasis in breast cancer?

A

internal mammary lymph nodes and ipsilateral lymph nodes to the breast cancer

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6
Q

breast tissue is ___ sensitive

A

hormonally

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7
Q

estrogen is responsible for growth of ______ and _____ in the breasts

A

adipose tissue and lactiferous ducts

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8
Q

progesterone is responsible for stimulation of _______ and _____ growth

A

lobular and alveolar budding/growth

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9
Q

what are some congenital anomalies of the breast

A

absence of breast, accessory breast/nipples along the milk line.

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10
Q

what is polythelia

A

extra nipples

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11
Q

what is polymastia

A

accessory breasts

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12
Q

breast complaints require a ____ evaluation

A

timely

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13
Q

two most common breast complaints

A

pain or a mass

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14
Q

risk factors for breast cancer

A

age, history of breast cancer, atypical hyperplasia, high breast tissue density, first degree relatives, early menarche, late menopause, no pregnancies (unopposed estrogen), birth-control, postmenopausal obesity, tall high, jewish

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15
Q

during physical exam of the breasts what must you do

A

evaluate both breasts and include the axilla and chest wall

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16
Q

what diagnostic tests can we use on breast pathology

A

mammogram, ultrasound, MRI, fine needle aspiration (FNA), and core. biopsy

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17
Q

palpable masses almost always get a _____

A

biopsy

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18
Q

mammograms are able to detect lesions about ___ years before they become palpable. ____ and ____ are suspicious findings.

A

2 years

densities and calcifications

(can detect less than 1cm masses)

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19
Q

mammography is best in women ____ years or older, why?

A

40 years

under 40 the breast are more dense and harder to detect masses

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20
Q

describe the difference between screening mammography and diagnostic mammography

A

screening is when there are no complaints just a checkup with 4 images, 2 craniocaudal and 2 mediolateral

diagnostic is done in women with a complaint or palpable mass, contralateral breast should also be imaged.

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21
Q

ultrasound in breast is best when evaluating women ____ years old and allows you to differentiate between ___ and ___ lesions

A

younger than 40 (higher breast density)

cystic vs solid

(also used to guide core needle biopsies)

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22
Q

MRI of breasts is useful in adjuct with? and is used for ?

A

mammography

post cancer diagnosis for STAGING and BRCA carriers

(very expensive)

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23
Q

fine needle aspiration biopsy is useful in determining ____ vs ____ masses

A

solid vs. cystic

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24
Q

FNAs are done where

A

in office

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25
Q

FNA use a gauge needle of what size, clear fluid requires? blood fluid requires? FNA overall looks at the ____ of the breast

A

22-24 gauge needle

clear- no further evaluation

bloody- sent to cytology and patients need a diagnostic mammogram/ultrasound

cytology

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26
Q

if a cyst completely disappears after FNA when should they return to the clinic for a clinical breast exam

A

4-6 months

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27
Q

after FNA if a cyst reappears or does not resolve with FNA you must do what?

A

get them a mammogram/ultrasound and preform a different biopsy

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28
Q

a core needle biopsy takes tissue with a needle ___ - ____ gauge and is used to get tissue from a ______ mass for diagnosis

A

14-16 gauge

larger sold mass

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29
Q

how many samples and how long are the core needle biopsies of tissue

A

3-6 samples, 2 cm long

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30
Q

mastalgia

A

breast pain

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31
Q

cyclic mastalgia starts at the ___ phase and ends after ______

A

luteal

ends after onset of menses

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32
Q

noncyclic mastalgia is?

A

not associated with the menstrual cycle and can be caused by tumors, mastitis, cysts, oral contraceptives

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33
Q

extramammary mastalgia can be caused by?

A

trauma to the chest wall, shingles, fibromyalgia

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34
Q

what is the only FDA approved treatment for mastalgia

A

danazol

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35
Q

what are the side effects of danazol

A

menstrual irregularities, benign intracranial hypertension, altered blood sugar, deepens voice, unusual hair growth, weight gain

36
Q

selective estrogen receptor modulators like tamoxifen can be used to treat mastalgia off label but can cause increased risk of ____ and ____

A

endometrial hyperplasia and deep vein thrombosis

37
Q

oral contraceptives can help with mastalgia becuase?

A

they block the cyclic component of breast pain

38
Q

what can patients due to provide symptom relief with breast pain?

A

wear a fitting bra, reduce weight, exercise, decrease caffeine, vitamin E supplements and evening primrose oil

39
Q

nipple discharge is usually _____

A

benign

40
Q

nipple discharge could be a sign of ____ or ___ disorder

A

cancer or endocrine

41
Q

with nipple discharge you want to further categorize it wether that be unilateral/bilateral, color, consistency, spontaneous/expressed.

For example: non-spontaneous, non-bloody, bilateral discharge is most consistent with ____changes or ______ _____

A

fibrocystic changes or ductal ectasia

42
Q

milky nipple discharge is common with childbearing but may indicate ________ or ________

A

hyperprolactinemia or hypothyroidism

43
Q

what medications can cause a milky nipple discharge?

A

psychotropics (anxiety meds) or oral contraceptives

44
Q

breast masses concerns for malignancy signs

A

greater than 2 cm

immobility

poorly defined margins

firm

skin dimpling/retraction/color changes

bloody nipple

ipsilateral lymphadenopathy

45
Q

bloody nipple discharge is considered ___ until proven otherwise

A

cancer

46
Q

with bloody nipple discharge there is concern for?

A

intraductal carcinoma, invasive ductal carcinoma, or a begning intraductal papilloma

47
Q

bloody nipple discharge is evaluated with

A

breast ductography (localize the duct involved)

and requires ductal excision

48
Q

non proliferative benign breast masses have a ___ risk of developing cancer

A

1.0 risk (equal to general population)

49
Q

proliferative without atypia breast mass has a ____ risk of developing cancer

A

1.5-2.0 risk

50
Q

proliferative with atypia breast mass has a ___ risk of developing cancer

A

8.0-10.0 risk

51
Q

what are the common noproliferative breast masses?

A

fibrocystic changes, adenosis, lactational adenoma, fibroadenomas

52
Q

what are fibrocystic changes in the breast

A

a spectrum of changes observed in the normal breast

dilated lobules and cysts

53
Q

in fibrocystic chnage cysts rupture and cause scarring and inflammation what causes the cysts to rupture?

A

estrogen/hormone stimulation

54
Q

what is adenosis

A

lobular growth with an increased number of glands (too many acini per lobule)

55
Q

what is lactational adenomas caused by?

A

hormonal response

56
Q

what is a fibroadenoma

A

a solid, mobile, rubbery bengin tumor in the female breast that is typically 2-4 cm

57
Q

what is a galactocele

A

cystic dilation with milky fluid

58
Q

galactocele occurs when

A

near time of lactation

59
Q

galactoceles can have a secondary infection that may produce ?

A

acute mastitis

60
Q

a galactocele can typically be ___ aspirated

A

needle

61
Q

benign breast masses that are proliferative without atypia types

A

epithelial hyperplasia

sclerosing adenosis

complex sclerosing lesions/radial scar

papillomas

62
Q

what is epithelial hyperplasia?

A

overgrowth of cells that line the ducts

63
Q

what is sclerosing adenosis

A

increased fibrosis in breast lobules

64
Q

what is complex sclerosing lesions/radial scar

A

tubules that are trapped in dense stroma surrounded by radiating arms of epithelium

65
Q

what are the proliferative breast lesions with atypia

A

LCIS or DCIS

66
Q

what is LCIS

A

a risk factor for developing breast cancer when malignant cells replace the normal epithelium lining the lobules of the breast (lobular carcinoma insitu)

67
Q

what is ductal carcinoma insitu

A

a precursor lesion when the ducts are filled with atypical epithelial cells and women are at an increased risk for invasive cancer or DCIS reocurrence

68
Q

how do we treat DCIS and LCIS

A

excision and then treatment with selective estrogen receptor modulators (HER2, tamoxifen)

69
Q

most breast cancer happen after the age of ____ expect for african americans which is typically around age 45

A

50

70
Q

what is the gail model-breast cancer risk

can be falsely elevated with?

high risk patients

A

determine the risk of developing breast cancer

falsely elevated in patients with multiple breast biopsies

high risk patients are counseled on prophylactic therapy (1.7% risk or higher)

71
Q

4 histology types of breast cancer?

A

ductal, lobular, nipple(pagets), inflammatory

72
Q

ductal breast cancer is the most common and spreads to the ____ nodes, and is most common in women aged ____

A

regional nodes

50 years old

73
Q

lobular breast cancer is the most aggressive and can be ________ (multifocal/bifocal)

A

multifocal

74
Q

nipple breast cancer also known as pagets disease presents as a ?

A

superifical skin lesion

75
Q

inflammatory breast cancers present with swelling and redness and ___ of the surrounding tissues

A

induration

76
Q

the ____ at diagnosis of breast cancer is one of the most important indicators of prognosis

A

stage

77
Q

5 year survival rates

localized disease-

regional disease-

metastatic disease -

A

LD- 99%

RD-86%

MD- 27%

78
Q

use ____ ___ in addition to staging to determine prognosis

A

receptor status (estrogen or progesterone receptor)

79
Q

if there are estrogen or progesterone receptors found this is a ____ finding

A

positive

80
Q

Her2/neu finding in breast cancer is a ____ prognosis

A

worse

81
Q

surgical therapy for breast cancer

A

lumpectomy with radiation

mastectomy

( they both have the same outcomes)

82
Q

___ therapy is used in combination with surgical therapy to reduce reoccurrence

A

medical

83
Q

chemotherapy kills _____ cells

A

cancer

84
Q

hormone therapy works in premenopausal women to ?

A

antagonize estrogen and reduce the risk of cancer in breasts

85
Q

aromatase inhibitors work by?- post menopausal women

A

preventing estrogen production in postmenopausal women

86
Q

Herceptin (trastuzumab) acts on?

A

protein made by Her2/neu

87
Q

side effects of trastuzumab

A

heart failure, respiratory problems, serious allergic reactions

ENRP II (25 decks)

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