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SB82 Breast
SB82 Breast - loosely taken from Fiser's ABSITE review
| Question | Answer |
|---|---|
| Breast is formed from this embryonal structure ___________ | Ectoderm milk streak |
| Estrogen is responsible for development of these breast structures ______________ | Ducts |
| Progesterone is responsible for development of this breast structures _____________ | Lobules |
| What hormone synergizes estrogen and progesterone in breast development? ___________ | Prolactin |
| Injury to what structure in breast surgery results in a winged scapula? __________ | Long thoracic nerve |
| What artery brings blood to the serratus anterior muscle? ____________ | LATERAL thoracic artery |
| What nerve innervates the latissimus dorsi? ______________ | Thoracodorsal |
| Which nerve innervates the pectoralis major ONLY? ________________ | Lateral pectoral nerve |
| Where is the intercostobrachial nerve encountered during axillary dissection? | Just inferior to the axillary vein |
| What is the significance of Batson’s plexus? | It is comprised of valveless veins that that allow direct metastasis of breast cancer to the spine |
| What percentage of lymphatic drainage from the breast goes to the axillary nodes? | 97% |
| A patient comes in with primary axillary lymphadenopathy. What is the most common diagnosis? _____________ | Lymphoma |
| What is the significance of Cooper’s ligaments? | Suspensory ligaments of the breast that can cause skin dimpling if involved with a cancerous lesion |
| What is the most common organism in breast abscesses? _________ | Staph aureus |
| A non-lactating woman arrives at your office with a swollen, painful breast. Incisional biopsy confirms infectious mastitis. What are the common causes of her condition? | In non-lactating women, the common causes are autoimmune disorders (lupus) and chronic inflammatory diseases (acinomyces, TB, syphilis) |
| What condition may masquerade as infectious mastitis? ___________ | Necrotic cancer |
| Biopsy of a patient’s breast lesion returns with a pathology report of dilated mammary ducts, inspissated secretions, and marked periductal inflammation. What is the likely diagnosis? ____________ | Mammary duct ectasia |
| What is the characteristic discharge associated with mammary duct ectasia? | Creamy |
| How would you clinically determine if a male patient has gynecomastia? | A 2-cm pinch of tissue is present |
| Neonatal breast enlargement is due to ________________ | Circulating maternal estrogens |
| Polythelia is most likely present in this location ____________ | Axilla |
| Term for ‘accessory breast tissue’ ______________ | Polythelia |
| What findings would you expect to see in a patient with Poland’s syndrome? | Hypoplasia of the chest wall, amastia, hypoplastic shoulder, no pectoralis muscle |
| Workup for mastodynia | H+P and bilateral mammogram |
| Most common cause of cyclic mastodynia ___________ | Fibrocystic change |
| Superficial vein thrombophlebitis of the breast _____________ | Mondor’s disease |
| On a patient’s screening mammogram, you notice a cluster of calcifications. What is the next step? ___________ | Excisional biopsy |
| Excisional biopsy of a cluster of calcifications noted on screening mammography shows regular nuclei without mitoses. What is the diagnosis? ___________ | Sclerosing adenosis |
| What is the most common cause of bloody nipple discharge? ____________ | Intraductal papilloma |
| Treatment of intraductal papilloma ___________ | Excision |
| Most common breast lesion in adolescents and young women _____________ | Fibroadenoma |
| Workup for suspected fibroadenoma in patients younger than 30 versus patients older than 30 | Younger than 30 – core needle biopsy. Older than 30 – excisional biopsy |
| Green nipple discharge is usually due to ________ | Fibrocystic change |
| Bloody nipple discharge is usually due to ____________ | Intraductal papilloma |
| Workup for suspected intraductal papilloma ____________ | Galactogram |
| Serous nipple discharge is usually due to _______________ | Cancer |
| Definition of diffuse papillomatosis | Papillomas within multiple ducts of both breasts |
| Mammogram in diffuse papillomatosis shows this appearance ___________ | Swiss cheese appearance |
| What percentage of patients with diffuse papillomatosis may get breast cancer? _________ | 40% |
| Which is considered a premalignant lesion, DCIS or LCIS? __________ | DCIS |
| What margin do you need for DCIS excision? | 2-3 mm |
| What is the most aggressive subtype of DCIS? ___________ | Comedo |
| At what size DCIS should you be worried about risk for recurrence? | > 2.5 cm |
| What percentage of patient’s with DCIS get cancer if not resected? | 40-60% |
| Treatment for DCIS | Simple mastectomy versus lumpectomy and radiation |
| What percentage of patients with LCIS are at risk of developing breast cancer? _______ | 40% |
| What percentage of patients with LCIS who develop breast cancer will develop ductal adenocarcinoma? | 70% |
| LCIS is primarily found in which population of women, premenopausal or postmenopausal? | Premenopausal |
| What is the risk of having a synchronous breast cancer (in the opposite breast) at the time of diagnosis of LCIS? | 5% |
| Breast cancer screening decreases mortality by _________% | Twenty-five |
| A mass needs to be greater than __________ mm to be detectable by mammography | Five |
| A mammogram is read as BIRAD-3. What is the appropriate action? | Short interval follow up with imaging (within 6 months) |
| A mammogram is read as BIRAD-4. What is the appropriate action? | Further immediate imaging vs. biopsy |
| Nodes located between the pectoralis major and minor muscles _________ | Rotter’s nodes |
| What is the 5-year survival of breast cancer patients with 1-3 lymph nodes on axillary dissection? | 60% |
| A T2 lesion is what size? | 2-5 cm |
| Which genetic mutation is associated with breast AND ovarian cancer? | BRCA1 |
| What percentage of breast cancers are negative for both hormone receptors? | 10% |
| Male breast cancers are usually hormone ______________(positive / negative) | Positive |
| Treatment for male breast cancer | Modified radical mastectomy |
| Ductal carcinoma comprises ______________% of all breast cancers | 85% |
| Which type of ductal breast carcinoma is hormone positive? _________ | Medullary |
| Lobular breast carcinoma comprises what percentage of breast cancers? | 10% |
| Absolute contraindications for breast-conserving therapy | >2 primary tumors in separate quadrants, persistent positive margins, pregnancy, prior irradiation, diffuse microcalcifications |
| A patient who has undergone axillary dissection has sudden, early post-op arm swelling. What is the likely diagnosis? ____________ | Axillary vein thrombosis |
| What are the indications for radiation therapy after mastectomy?>4 nodes, skin/chest wall involvement, positive margins, tumor > 5 cm, extracapsular nodal invasion, inflammatory cancer, fixed axillary nodes | |
| Indications for post-operative chemotherapy for breast cancer include everyone except ________ | Postmenopausal women with hormone-positive disease – get tamoxifen |
| A patient presents to your office complaining of a scaly nipple lesion. Biopsy shows Paget cells. What is the likely diagnosis? | DCIS or ductal adenocarcinoma |
| A biopsy of what clinically appears to be a giant fibroadenoma returns with a pathology report of disordered stromal and epithelial elements. How would you determine if this is malignant? | Mitoses per high-powered field |
| A giant fibroadenoma with a pathology report of disordered stromal and epithelial elements is likely ___________________ | Cystosarcoma phyllodes |
| What percentage of Cystosarcoma phyllodes are malignant? | 10% |
| How does Cystosarcoma phyllodes spread? _________ | Hematogenously |
| What is the treatment for Cystosarcoma phyllodes? | Wide local excision with negative margins |
| What is Stewart-Treves syndrome? | Lymphangiosarcoma that develops 5-10 years after lymphedema resulting from ALND for breast cancer |
Created by:
StudyBug82
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