Path Spring 1 Breast

Front 1

what are the components of breast milk

Back 1

Clostrum: first milk. high in protein and IgA

Second Milk: lots of fat and calories, source of complete nutrition, IgA, lactoferrin- antibacterial, anti-inflammatory, PMN, macro, lymphs, cytokines, fibronectin, lysozyme

Front 2

what are all of the goodies in second milk

Back 2

1. high fat, calories. complete nutrition
2. IgA
3. PMN, macro, ly,phs
4. cytokines, fibronectin, lysozyme
5. lactoferrin- bacteriacidal, anti-inflammatory

Front 3

whats colostrum

Back 3

its the first milk, its lots of protein and lots of IgA


**the second milk is higher in fat adn calories and is more complete nutrition

Front 4

why is breast best

Back 4

1. decreased SIDS, more likely to live in general
2. less likely to become obese as kid. less DM, less HTN, less total cholesterol
3. better immune fx, even after you stop breast feeding
4. better tolerance to foods, less allergies
4. decreased AI/allergice diseases (DM I, asthma, celiac, chrons)
5. decreased infections

Front 5

what does breast feeding as an infant do to lipid levels in adult

Back 5

less likely to become obese when breast fed
less DMII, less HTN, less cholesterol when given the breast

Front 6

what diseases are less likely in adults who were breast fed as infants

Back 6

autoimmune / allergic

DM i
asthma
celiac
chrons

Front 7

what 3 infections are less common in breast fed babies

Back 7

1. diarreha to all infectious causes
2. NEC- necrotizing enterocolotis (super common in premies)
3. otitis media- protection for ~3 years!!!

Front 8

ok so a baby who is breast fed is...

1. less likley to be obese
2. better immune system *less AI/allergic diseases. less likely to have infection
3. more likley to survive as infants (less SIDS)

is there any benefit for mom

Back 8

1. Less Breast cncaer
2. make uterus smaller faster
3. suppression of ovulation- no period so you can recover lost Fe stores, promotes optimim spacing or pregnancy

Front 9

there are TONS pf great reasons to breast feed. what are some CI

what are disadvantages

Back 9

CI: HIV, HEP B

Disadvantage: more neonatal jaundice, if mom is malnourished so is babe (vit D and Fe esp)

Front 10

pros and cons of breast feedign

Back 10

PROS
1. better for baby- increased survivability, less obseity, less allergies, less AI disease, less infections etc etc

2. Good for mom : less breast cancer, shirnk uterus, suppress ovulation to prevent preggo and recover lost Fe

Disadvantages
increased neonatal jaundice, if mom is malnourished (vit D and Fe) so is babe

Front 11

what are the developmental disorders and locations of milkline remnants

Back 11

milkline remnants- nipple or breast anywhere from axilla to groin

Front 12

what is the ddx of inverted nipples

Back 12

1. congenital failure of eversion at puberty
2. cancer

Front 13

what are the disorders of breast size

1. HUGE
2. UL failure of development

Back 13

1. macromastia- due to virginal hypertrophy, response to hormones in puberty

2. Congenital Hypoplasia

Front 14

ok so a girl has one boob bigger than the ohter, it happened at puberty. what is this called

what is the other way it can present

Back 14

macromastia, can also he HUGE BOOBS

Front 15

what is jevenile virginal hypertrophy

Back 15

its when you have giant boob(s) bc of hormonal response at puberty

Front 16

whats on teh DDX for palpable breast mass

which masses need to be biopsied

Back 16

1. invasive carcinoma
2. fibroadenoma
3. cysts
4. fat necrosis

**ALL Must be biopsied

Front 17

ut oh, i found a lump... DDX?

Back 17

1. cancer
2. fibroadenoma
3. cyst
4. fat necrosis

Front 18

what causes nipple discharge that is BL and milky

Back 18

1. stim of nipple
2. prolactin pit adenoma
3. hypothyroidism
4. drugs: OCT, TCA, methyldopa, phenothiazides

**NOT ASSOCIATED with cancer

Front 19

what kind of nipple discharge is concerning, what is not

Back 19

Concern: spontaneous UL

Not concerning: BL milky bc of stimulation, prolatcin/pit adenoma, hypothyridism, drugs

Front 20

why might a preggo have bloody nipple discharge

Back 20

bc of really fast lobe growth

Front 21

whats on the ddx of bloody, serous nipple discharge

Back 21

1. in preggo bc of rapid lobe growth
2. benign solitary large duct papilloma
3. cancers

Front 22

a solitary large duct papilloma cuases what sx

Back 22

serous/bloody nipple disharge

Front 23

whats breast pain called? what can cause non cyclic breast pain

Back 23

mastalgia
mastodynia

*ruptures cyst/infection
*angina referred to rbeast
* uncommon cancer

Front 24

your pt has calcifications on mammography, wahts the ddx

Back 24

1. benign clustered calcifications can be fibrocystic change, or fat necrosis

2. small irregular linear or branching clusters can be ductal carcinoma in situ

Front 25

whats a more concerning calcification on mammography

clustered
irregular linear, branching

Back 25

clustered: benign, fibrocystic change or fat necrosis

linear or branching: ductal carcinoma in situ

Front 26

what info does US give for breast lump

Back 26

cystic v solid. ALWAYS FNA

Front 27

what are the causes and clinical circumstances of acute mastitis

Back 27

its when staph aureus or strep gets into a cracked nipple that has just started lactating. aureus more likely to abcess, strep more likely to spread

tx w/AB and milk drainiage

Front 28

what are the pathogenesis and clinical features of periductal mastitis

Back 28

not assocaited with lactation, recurrent subareolar abcess.

sq metaplasia of lactiferous ducts

males get it too, common in smokers

Front 29

what breast lesion is common in males, femals who smoke. its NOT associated with lactation

Back 29

periductal mastitis

recurrent subareolar abcess, get sq metaplasia of lacteriferous ducts, sq epithelium extends into sinuses and rupture with inflammation

Front 30

ok so I have a keratin plug in a lacterifierous sinus, the duct is plugged bc of sq metaplasia. whats teh deal

Back 30

periductal mastitis

**get a subaerolar abcess. tends to recurr, seen in men. assoicated with smoking

Front 31

what are associations with mammary duct ectasia

Back 31

seen in 40-60
poorly defined, palpable
resembels cancer but its of no clinical concern

Front 32

what are assocaitions of fat necrosis

Back 32

seen after trauma, radiation, surgery

**necrosis is chalky white

presents like cacner

Front 33

what are assocaitions with lymphocytic lobulitis

Back 33

breast mass in person with DM I, AU thyroiditis,

Front 34

what are associations with granulomatous mastitis

Back 34

seen with systemic granulomatous disease
TB
lactation sensitization
foerign body- piercing

Front 35

what mass presents like cancer but its seen in 40-60 yo. poorly defined, secretions, little clinical sig

Back 35

mammary duct ectasia

Front 36

what breast disease is associated with DMI, AI thyroiditis,

Back 36

sclerosing lymphocytic lobilitis

Front 37

benign breast epithelial lesion, whats the liklihood it will become cancer

1. nonproliforative
2. proliforative
3. atypical hyperplasia
4. carcinoma in situ

Back 37

1. non proliforative has no risk for cancer
2. proliforative- some risk for cacner
3. atypical hyperplasia- high risk for cacner
4. carcinoma in situ: 10x increase in risk of low grade ductal carcinoma in stiu

Front 38

what are the clinical features of fibrocystic breast change

Back 38

its non proliforative, not associated with cancer. common, lumpy breasts, many cases are clinically insignificant

Front 39

what does fibrocystic breast change look like, what is the significance of it

Back 39

lumpy bumpy breasts, firm lesion
calcifications
nipple discharge
common

Front 40

the cysts associated with fibrocystic change look like what

Back 40

Fibro: 2 to cyst rupture, secretions are released into breast and make them firm

CYSTIC: brown/blue color externally, internal its a green turbid fluid at micro the cyst is apocrine metaplastic cells

NO INCREASE IN risk of cancer

Front 41

tell me about the cyctic and fibrotic part of fibrocystic changes in breast

Back 41

fibro: bc of cyst rupture

cyst: blue/brown color with apocrine metaplastic cells

**not associated with and increased risk of cancer

Front 42

apocrine metaplasia is associated with what

Back 42

cyst in fibrocystic breast

at gross its a blue dome cyst

Front 43

other than fibrous parts nad cyctic parts in fibrocystic breasts, what else is going on

Back 43

1. adenosis: icnreased number of acini
2 ductal hyperplasia
3. lactational adenoma: palpable mass in preggo

Front 44

what are all of the proliforative breast disease that are NOT associated with atypia

Back 44

1. epithelial duct hyperplasia
2. sclerosing adenosis
3. complex sclerosing lesion
4. papillomas:
-large duct: usually solitary lesion in lacteriferous dict, presents with nipple discharge
-small duct: multiple lesion, progression of hyperplasia

**none of these have atypia

Front 45

what are some proliforative breast diseases that are associated with atypia

Back 45

4-5 x risk of developing cancer

1. atypical ductal/lobar hyperplasia