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