Fiser Chapter 24 BREAST Flashcards Preview

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Flashcards in Fiser Chapter 24 BREAST Deck (105)
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1

Breast develops from what

Ectoderm milk streak

2

Estrogen, progesterone, and prolactin in breast development

Estrogen -> duct development (double layer of columnar cells)

Progesterone -> lobular development

Prolactin -> synergizes estrogen and progesterone

3

Cyclic hormone changes in breast

Estrogen -> increases breast swelling and growth of glandular tissue

Progesterone -> increases maturation of glandular tissue, withdrawal causes menses

FSH, LH surge -> ovum release

After menopause, lack of estrogen and progesterone results in atrophy of breast tissue

4

Long thoracic nerve

Serratus anterior; injury causes winged scapula

5

Blood and nerve supply to serratus anterior

Long thoracic nerve

Lateral thoracic artery

6

Thoracodorsal nerve

Latissimus dorsi; injury causes weak arm pull-ups and adduction

7

Blood and nerve supply to latissimus dorsi

Thoracodorsal nerve

Thoracodorsal artery

8

Pectoralis muscle nerves

Pectoralis major: medial pectoral nerve, lateral pectoral nerve

Pectoralis minor: medial pectoral nerve

9

Intercostobrachial nerve

Lateral cutaneous branch of 2nd intercostal nerve

Provides sensation to medial arm and axilla; encountered just below axillary vein when performing ax dissection; can transect without serious consequences

10

Breast blood supply

Branches of internal thoracic artery, intercostal arteries, thoracoacromial artery, and lateral thoracic artery

11

Batson's plexus

Valveless vein plexus that allows direct hematogenous metastasis of breast CA to spine

12

Breast lymphatic drainage

97% to axillary nodes

2% to internal mammary nodes (any quadrant can drain to internal mammary nodes)

13

Primary axillary adenopathy

#1 is lymphoma

14

Breast cancer with positive supraclavicular nodes

N3 disease

15

Cooper's ligaments

Suspensory ligaments; divide breast into segments

Breast CA involving these strands can dimple the skin

16

Breast abscess most common bacteria

Staph aureus; strep

Usually associated with breastfeeding

17

Breast abscess tx

Perc or I&D; discontinue breast feeding; breast pump, antibiotics

18

Infectious mastitis most common bacteria

S aureus most common in nonlactating women, can be due to chronic inflammatory diseases (actinomyces) or autimmune disease (SLE) -> may need to r/o necrotic cancer (need incision biopsy including skin)

Most commonly associated with breastfeeding though

19

Smoker with nipple piercing, presents with noncyclical mastodynia, erythema, nipple retraction, creamy discharge from nipple. On biopsy has dilated mammary ducts, inspissated secretions, marked periductal inflammation

Periductal mastitis: mammary duct ectasisa or plasma cell mastitis

-can have sterile or infected subareolar abscess

-Tx: ABX and reassurance, if typical creamy discharge is present that is not bloody and not associated with nipple retraction
-If bloody or nipple retraction or recurs, INCISIONAL BIOPSY WITH SKIN to r/o inflammatory breast CA

20

Lactating woman with breast cyst filled with milk

Glactocele

Tx: Aspiration or I&D

21

Causes of galactorrhea

-Increased prolactin (pituitary prolactinoma)
-OCPs
-TCAs
-Phenothiazines
-Metoclopramide
-Alpha-methyl dopa
-Reserpine

-Often associated with amenorrhea

22

Gynecomastia causes

-Cimetidine
-Spironolactone
-Marijuana
-Most are idiopathic
-2-cm pinch
-Tx: will likely regress; may need to resect if cosmetically deforming or causing social problems

23

Neonatal breast enlargement due to what

Circulating maternal estrogens; will regress

24

Accessory breast tissue (most common in axilla)

Polythelia

25

Most common breast anomaly

Accessory nipples (can be found from axilla to groin)

26

Side effect of breast reduction

Compromised lactation

27

Hypoplasia of chest wall, amastia, hypoplastic shoulder, no pectoralis muscle

Poland's syndrome

28

Mastodynia workup, tx

Cyclic mastodynia: pain before menstrual period, most commonly from fibrocystic disease

Continuous mastodynia: most commonly represents acute or subacute infection; continuous mastodynia is more refractory to treatment than cyclic mastodynia

Dx: H&P, bilateral mammogram

Tx: danazol, OCPs, NSAIDs, evening primrose oild, bromocriptine, stop caffeine/nicotine/methylxanthines

29

Superficial vein thrombophlebitis of breast; feels cordlike; can be painful

Mondor's disease

-Associated with trauma and strenuous exercise

-Usually in lower outer quadrant

Tx: NSAIDs

30

Breast pain, nipple discharge (yellow-to-brown), lumpy breast tissue, varies with hormonal cycle; dx and cancer risk?

Fibrocystic disease (many types- papillomatosis, sclerosing adenosis, apocrine metaplasia, duct adenosis, epithelial hyperplasia, ductal hyperplasia, lobular hyperplasia)

-Only cancer risk is in ATYPICAL DUCTAL OR LOBULAR HYPERPLASIA. Resect these lesions
-Do NOT need negative margins with atypical hyperplasia, just remove all suspicious areas (ie calcifications) that appear on mammogram