Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Surgery - Breast > Flashcards

Surgery - Breast Flashcards

1
Q

US for breast best to detect masses of what size?

A

> 1cm in diameter

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

Acute mastitis

  • causes
  • description
  • tx
A

Usually due to S. aureus. It is a cellulitis (vs breast abscess needing drainage)

Need to r/o breast cancer!

Dicloxacillin
Cephalosporins

Cont breast feeding as can dec progression of mastitis to breast abscess

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

Mammo guidelines

A
  • Should start at age 40

- DO NOT DO before 20 (breast too dense) or lactation (all is milk)

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

Fibroadenoma

  • description
  • management
A

Young women (< 35 yo)
Firm, mobile, rubbery mass
Increase size/tenderness with menstruation

FNA
Sonogram
OPTIONAL removal

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

Giant juvenile fibroadenomas

  • description
  • management
A

Young adults
Rapid growth

YES remove
To avoid deformity and distortion of breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cystosarcoma phyllodes

  • description
  • management
A

30-50 yo
LARGE bulky mass that is mobile and arises from lobular tissue
Most benign, but can turn malignant

Core or incisional bx
YES remove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Fibrocystic disease

  • description
  • management
A 
30s-40s
Tender + grow w/ menstrual cycle
Usually not increase risk of carcionma
Diff histo types:
- fibrosis
- cystic
- sclerosing adenosis (microcalcificatiosn on mammo)
- epithelial hyperplasia

Mammo if no dominant or persistent mass
If persistent mass –> aspiration (not FNA)
If aspiration doesn’t disappear –> formal bx needed

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

Intraductal papilloma

  • description
  • management
A

Young women
Grows in lactiferous ducts
No increased cancer risk
Bloody nipple discharge

Mammogram to ID other lesions – will not show papilloma b/c too tiny
Galactogram (dx and for surgery resection)

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

Breast abscess

  • description
  • management
A

In lactating women

I & D
Bx of abscess wall

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

Treatment for breast cancer during pregnancy

A

No radiation
No chemo in 1st trimester
OK to keep pregnancy

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

DCIS

  • description
  • management
A

Can’t mets
Usually looks like microcalcifications on mammo
comedo has highest malignant potential

Diffuse lesions: Total simple mastectomy + Sentinel node bx

1 lesion: Lumpectomy + radiation

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

Breast cancer – resectable
- what do you do?

How about if not resectable?

A

Resectable:
Lumpectomy + axillary sampling + postop rad
Modified radical mastectomy + axillary sampling (sentinel lymph nodes)

Not resectable:
Chemo

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

Breast Cancer mets

  • where does it go?
  • dx?
  • Tx?
A

Brain

<3 vertebral pedicles

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

Tx breast cancer in premenopausal? postmen?

A

Pre = tamoxifen

Post = anastrozole

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

Breast Cancer stage I

A

Tumor ≤ 2cm in diam
(-) mets
(-) nodes

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

Breast Cancer stage IIA

A

Tumor ≤ 2cm in diam + mobile axillary nodes
OR
Tumor 2-5 cm in diam, (-) nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Breast Cancer stage IIB

A

Tumor 2-5cm in diam + mobile axillary nodes
OR
Tumor > 5 cm, (-) nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Breast Cancer stage IIIA

A

Tumor > 5cm + mobile axillary nodes
OR
Any size + fixed axillary nodes, (-) mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Breast Cancer stage IIIB

A 
Peau d’orange       OR
Chest wall invasion/fixation       OR
Inflammatory cancer      OR
Breast skin ulceration     OR
Breast skin satellite mets    OR
Any tumor + ipsilateral internal mammary lymph nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Breast Cancer stage IIIC

A

Any size tumor, (-) mets

+ supraclavicular, infraclavicular, or internal mammary lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Breast Cancer stage IV

A 
Distant mets (including ipsilateral supraclavicular nodes)
-	Loves: lymph nodes, lung/pleura, liver, bones, brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Metastatic breast cancer to bone - test to dx?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Mammo results w/ strong correlation with breast cancer

A

(1) breast calcifications that are
(a) smaller than 2 mm,
(b) punctate, microlinear, or branching,
(c) clustered along ducts or concentrated in clusters >5 calcifications per square centimeter;

(2) stellate-shaped lesions;
(3) masses with ill-defined borders or nodular contours;
(4) solitary dominant masses that are significantly larger than any other mass in either breast; and
(5) areas of increased noneffacing tissue density or distorted breast architecture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do breast cysts look like on mammo?

How do you confirm the nature of theses cysts?

A

Round, well-circumscribed densities

Confirm w/ breast US

25
Q

Breast cyst suspicion - what do you do?

A

Aspirate and cytologic exam of cyst fluid

If lesions don’t disappear w/ aspiration —> excise

26
Q

BRCA 1 and 2 - associations

A

BRCA 1 - breast + ovarian

BRCA 2 - breast

27
Q

Breast cancer screening for non-high risk pts

A

Monthly breast self exam @20

Mammo @ 40 q 1-2 yrs until 50
Mammo @ 50 q 1 year

28
Q

Breast cancer screening for high risk pts

A

Initial mammo at 30 q 1-2 yrs until 40

Mammo @ 40 q 1 year

29
Q

Diffuse + multicentric DCIS - tx?

A

Simple masectomy w/ or w/o reconstruction

30
Q

Small breast lesion - cancer - tx?

A

Wide excision
+
Radiotherapy

31
Q

LCIS - chance to develop into invasive cancer over 20 years?

A

15-20%

It is incidental finding in histopath

It is a malignant disease marker

32
Q

Tx LCIS

A

close observation

Exam + mammo q 6 months for the next several years

33
Q

What things are essential to est in breast cancer?

A

Dx
Completely eradicate primary tumor
Determine if lymph node involvement
Determine if mets present

34
Q

Arterial supply to breast

Venous return

A

Internal mammary
Lateral thoracic artery

Veins:

  • axillary
  • internal mammary veins
35
Q

What is a modified radical mastectomy

A

Remove

  • breast tissue
  • skin
  • axillary lymph nodes

Spares
- pec major

36
Q

Simple masectomy

A

Removes:

  • breast tissue
  • nipple-areolar complex
  • skin
37
Q

Borders of the breast for masectomy

A 
Superior - clavicle
Inferior - inframammary fold
Medial - sternum
Lateral - latissimus dorsi
Posterior - pec major
38
Q

Borders of axilla

A

Superior - axillary v
Posterior - Long thoracic N
Lateral - latissius dorsi
Medial - pec minor

39
Q

Levels of axillary lymph nodes

A

1 - lateral to pec minor

2 - deep to pec minor

3 - medial to pec minor

higher level of involvement, worse prognosis

40
Q

How do you evaluate sentinel node?

A

INject blue vital dye or

Technetium - 99 labeled sulfur colloid

around primary tumor - will go to axillary lymph nodes

Gammaprobe will ID radiotracer

41
Q

Contraindications to reconstructiton after mastectomies

A

Primary lesions involving chest wall
Extensive local or regional disease
Stage 3 or 4 cancer

42
Q

Tx Stage 0, 1 (< 1cm) stage tumors

A

Lumpectomy
axillary sampling
Radiation

43
Q

Tx Stage 1 w/ larger tumors (1-2 cm)

A

Lumpectomy
axillary sampling
post-op radiation
adjuvant therapy (based on ER status and menopause)

44
Q

Tx Stage 2 cancer

A

Lumpectomy
axillary sampling
post-op radiation
adjuvant therapy (based on ER status and menopause)

OR

modified radical masectomy

45
Q

Development of coma in pt w/ hx of breast cancer - what should you be suscpicious abotu?

A

Hyperacalcemia!!!

46
Q

Who gets offered chemotherapy?

A

Stage 2 or greater

they ahve a 33-44% risk of recurrence of disease at 20 years w/ locoregional control only

Usually do”

  • 5-FU/doxorubicin/cyclophosphamide
  • Taxol
  • trastuzumab
47
Q

How long do you give antiestrogen therapy for pts w/ ER or PR + tumors?

A

5 years

48
Q

What are the benefits of neoadjuvant therapy? Does it make a difference?

A

This is chemo before surgery

Improvements in breast conservation rate + better cosmetic results

NO shown survival difference

49
Q

Tamoxifen s/e

A

uterine cancer

50
Q

DCIS vs invasive ductal - what is difference?

A

Both from ductal hyperplasia

But DCIS is without basement membrane penetration

Both are more likely to be unilateral breast (vs bilateral in lobular)

51
Q

Paget’s disease

A

Eczematous patches on nipple

Usually has undelrying DCIS

52
Q

Reasons for gynecomastia in men

A

Hyperestogenism

  • cirrhosis
  • testicular tumor
  • puberty

Kleinfelter’s

Drugs: SDCAK
Spironolactome
Digitalis
Cimetidine
Alcohol
Ketoconazole

Steroids

53
Q

Tx inflammatory carcinoma of breast

A

Chemo first

Then radiation + masectomy

54
Q

Causes of bloody nipple discharge

Next step

A

Intraductal papilloma
Ductal ectasia
Carcionma

–> B/l mammo + US

55
Q

Ddx of nipple discharge (all kinds)

A 
Pregnancy
Infections (mastitis/abscess)
Pituitary adenoma
Meds (metoclopramide, TCAs, OCPs)
Hypothyroidism 
Fibrocystic changes 
Intraductal papilloma (usually unilateral)
Diffuse papillomatosis (serous discharge, increased risk of cancer)
Carcionma

Can use ductogram for some to figure out if the etiology is in duct!

56
Q

How do you tell if there is a bit of blood in a discharge?

A

Hemoccult test

57
Q

When can you do a ductogram?

A

ONLY if they have active discharge

IF abnormal, need surgical bx
If normal, may suggest underlying carcionma

58
Q

Most common factor increasing risk of breast cancer

A

having 1 or more 1st degree relatives who have had breast cancer

59
Q

Atypical ductal hyperplasia

  • characteristics
  • management
A

Hyperplasia of ducts of lobules
Looks like DCIS
Assoc cancer risk is 4-5x higher

Management:
- core bx –> shows atypical ductal hyperplasia –> needle loc + excision

Surgery (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions