Thursday - breast diseas clinical - Onello

Question 1

why do men have nipples

Answer 1

until week 6, development is about the same in m/f.

gland development is due to placental hormones

Question 2

polythelia
polymastia
athelia
amastia
thelarche

Answer 2

too many nips
too many boobs
no nips
no boobs
onset of secondary breast development ~12yo

Question 3

tanner staging 1-5

breast

Answer 3

1 - preadolecent - elevated, no glandular tissue or increased pigmentation

2 - glandular tissue. nip and breast are single mound

3 - increased glandular. increased diameter and pigmentation

4 - nipple and areola form mound above breast

5 - nipple protrudes more

Question 4

tanner staging 1-5

female genitals

Answer 4

1 - no pubic hair
2 - strait hair between labia
3 - more hair, gets darker
4 - hair is dense and curled
5 - more abundant - may go to thigh

Question 5

tanner staging 1-5

male

Answer 5

1 - no hair
2 - light hair, scrotum becomes more textured
3 - hair goes to penis. testes and penis larger
4 - more hair, curling. glans gets bigger
5 - hair goes to thighs

Question 6

gynecomastia causes

Answer 6

normal development usually

kleinfelters
testicular feminization
hormone tumor
hyper/o thyroid
cirrhosis
drugs
obesity

Question 7

breast feeding is more common in:

Answer 7

weathy
eductaed
white
non-smoker

Question 8

continuing breastfeeding

Answer 8

less than 35% are exclusively breast feeding @ 4 mo

recommended for 6mo

Question 9

choosing treatment for sore breast

Answer 9

lactMed website

- says Dicloxacillin is safe

Question 10

history q’s on breast exam

Answer 10

duration (pain/discharge)
change over time
relationship to menses
fam hx
gyn/endo hx

Question 11

breast exam

good/bad findings

Answer 11

inspect supine
skin changes
discharge?
clavicular and axillary nodes
masses?

fine - smooth, mobile, well demarcated

bad - firm, irregular, fixed, skin thethering, ulceration, edema, nipple scaling, contour change

Question 12

bi-rads

Answer 12

breast imaging reporting and data system
category 0-6
0- incomplete
1 - negative routine
2 - benign finding
3 - probably benign finding - short f/u
4 - suspicious --> biopsy 23-33% risk
5 - highly suggestive - biopsy, 95% risk
6 - known malignancy

Question 13

Ultrasound for breast screening

Answer 13

best for 30 yo or younger

Question 14

fibroadenoma vs cyst

Answer 14

cyst is anechoic

- lots of through transmission behind cyst

Question 15

MRI for breast advantages

disadvantages

Answer 15

sensitive for small changes
good for dense breasts
used to determine if need surgery/type

takes long time
expensive
non-specific
can’t see calcifications

Question 16

SCINTIMAMMOGRAPHY

Answer 16

uses Tc99m - concentrates in mitochondria

best for palpable lesions

not used for screening

Question 17

PET scan

Answer 17

metabolic activity
shows vascularization/ox consumption

expensive

Question 18

race differences in breast cancer

Answer 18

highest in whites

lowest in hispanics

Question 19

Fibroadenoma

Answer 19

benign. 20-30 y/olds
smooth round, mobile, affects by menses, usuall painless

hyperplastic of single duct

10% go away spontaneously

Question 20

cystadenoma phylloides

Answer 20

painless. cellular stroma, nuclear atypis, mitotic figures

excise with wide margins

Question 21

Abcess

Answer 21

usually staph or strep

Question 22

cyst

Answer 22

fluid filled, mobile round, non-tender

watch for 2-3 mo. aspiration

Question 23

trauma

Answer 23

usually cant recall
fibrotic scar/calcification - need tissue diagnosis
tx = watch it

Question 24

fibrocystic changes

Answer 24

common
usually bilateral
increase size and pain near menses

Question 25

lipoma

Answer 25

fatty
well defined
semi-firm, non-tender

take it out

Question 26

mammary duct ectasia

discharge

Answer 26

periductal fibrosis –>inflammation. usually thick grey and black
benign
self limiting
unilateral

tx = surgical
dx = ultrasound

Question 27

discharge

intraductal papilloma

Answer 27

wart-like
usually not palpable
serous/bloody discharge
40-50y/o

Question 28

fine needle aspiration pros cons

Answer 28

fast, painless, cheap, no mark, little chance of infxn, immediate results

less acurate
can't use with implants
I don''t know what she means by these:
in situ vs. invvasive
palpable lesion
cytotechnologist

Question 29

core needle biopsy pros cons

Answer 29

basicaly same as fine needle.

cons
less acurate
not complete description of tumor

Question 30

excisional biopsy

Answer 30

accurate
complete info about tumor
rare false -
may be treatment

cons
expensive
invasive/painful
time to heal
more risk of infection