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110 Cards in this Set

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  • Back
In women, the breast extends from the ____ rib to the ____ rib
second or third - sixth or seventh
______ extend from the connective tissue layer through the breast and attach to the underlying muscle fascia, providing further support
Suspensory ligaments (Cooper ligaments)
Vascular supply to the breast is primarily through branches of the ____ artery and the ___ artery
internal mammary, lateral thoracic
Which arteries supply the superficial breast
intercostal arteries
The greatest amount of glandular tissue lies in the___ quadrant
upper outer
In the axillae the mammary tissue is in direct contact with the ____.
axillary lymph nodes
The nipple is composed of epithelium that is infiltrated with ___ and ___ smooth muscle fibers
circular and longitudinal
Tiny sebaceous glands may be apparent on the areola surface
Montgomery tubercles or follicles
Patterns of Lymph Drainage: Upper outer quadrant
Scapular, brachial, intermediate nodes toward axillary nodes
Patterns of Lymph Drainage: Medial portion
Internal mammary chain toward opposite breast and abdomen
Patterns of Lymph Drainage: Posterior chest wall and portion
Posterior axillary nodes (subscapular) of the arm
Patterns of Lymph Drainage: Anterior chest wall
Anterior axillary nodes (pectoral)
Patterns of Lymph Drainage: Upper arm
Lateral axillary nodes (brachial)
Patterns of Lymph Drainage: Retroareolar area
Interpectoral (Rotter) nodes into the axillary chain
Patterns of Lymph Drainage: AREOLA AND NIPPLE
Midaxillary, subclavicular, and supraclavicular nodes
The anterior axillary (pectoral) nodes are located along the lower border of the ___________
pectoralis major inside the lateral axillary fold
The midaxillary (central) nodes are high in the __________
axilla close to the ribs
The posterior axillary (subscapular) nodes lie along the lateral border of the ___ and deep in the ___
scapula, posterior axillary fold
lateral axillary (brachial) nodes can be felt along the _____.
upper humerus
__ (breast development) represents an early sign of puberty in adolescent girls
Thelarche
It is unusual for the onset of menses to occur before which Tanner Stage
Stage 3
Approximately ___% are menstruating at stage 4 and are beginning a reasonably regular menstrual cycle
75%
The average interval from the appearance of the breast bud (Tanner stage?) to menarche is __ years
(stage 2), 2
breasts can enlarge ___ times their pre-pregnancy size
two to three
Toward the end of pregnancy, as epithelial secretory activity ___, colostrum is produced and accumulates in the ____.
increases, acinus cells (alveoli)
Colostrum contains more ___ and ___ than does mature milk
protein and minerals
Milk production to replace colostrum begins 2 to 4 days after delivery in response to surging ___ levels, declining ___ levels, and the stimulation of ___
prolactin, estrogen, sucking
After menopause, ___ continues to atrophy gradually and is replaced by fat deposited in the breasts.
glandular tissue
About 18% of breast cancer diagnoses are in women in their ___
40s
77% of breast cancer diagnoses are in women older than ___
50 years of age
The incidence of male breast cancer is less than ___% of that of female breast cancer.
1%
Women with an inherited___ mutation have a 35% to 85% chance of developing breast cancer during their lifetime
BRCA1 or BRCA2
A woman with cancer in one breast has a ___increased risk of developing a new cancer in the other breast or in another part of the same breas
threefold to fourfold
Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately ___ a woman's risk, and having two first-degree relatives increases her risk ___
doubles, fivefold
What 3 hereditary cancer syndromes are risk factors for breast cancer?
hereditary nonpolyposis colorectal cancer, Li-Fraumeni syndrome, or Cowden syndrome
Proliferative breast disease without atypia or unusual hyperplasia slightly increases the risk of breast cancer (____ times greater risk)
1.5 to 2
Atypical hyperplasia increases a woman's breast cancer risk by ___times
4 to 5
Fibrocystic changes without proliferative breast disease ___ affect breast cancer risk
DOES NOT
___ women are slightly more likely to develop breast cancer than are ___ women, but ___ women are more likely to die of this cancer
White, Black, Black
Women and men who as children or young adults had radiation therapy to the chest area as treatment for another cancer (such as ___ or ___) have a significantly increased risk for breast cancer.
Hodgkin disease or non-Hodgkin lymphoma
Women who started menstruating at an early age (before age __) or who went through menopause at a late age (after age __) have a slightly higher risk of breast cancer.
age 12, age 55
Women who received ___ in the 1940s through the 1960s during their pregnancies have a slightly increased risk of developing breast cancer.
diethylstilbestrol
Nulliparity or late age at birth of first child (after age __) is associated with an increased risk of breast cancer.
30
Use of combined estrogen and progesterone hormone replacement therapy (HRT) after ____ increases the risk of breast cancer by 26% compared to the risk in women who have not used HRT.
menopause (greater than 4 years of use)
Is there a risk of breast cancer with drinking alcohol?
yes, one alcoholic drink a day have a very small increase in risk, and those who have two to five drinks daily have about 1½ times the risk of women who drink no alcohol.
Overweight women are ___% more likely to die of breast cancer as compared to normal weight women.
60%
The American Cancer Society recommends BSE as an option for women starting in their ___
20s
If you menstruate, the best time to do BSE is ___ days after your period ends, when your breasts are least likely to be tender or swollen
2 or 3
The sensitivity of CBE in detecting breast cancer ranges from ___% and the specificity from ___%
40% to 69%, 88% to 99%
Breast cancer is the most common type of cancer among women in the United States and is the ___ leading cause of cancer death in women
second
Recommendations for CBE: Older than 40 years of age
annually
Recommendations for CBE: Younger than 40 years of age ____
every 1 to 3 years
Recommendations for Mammogram: Women at average risk
yearly starting at 40 years of age and continuing for as long as a woman is in good health
Recommendations for Mammogram Women at increased risk (e.g., family history, genetic tendency, past breast cancer):
consider more frequent CBE, earlier mammographic screening, additional tests (e.g., breast ultrasound or magnetic resonance imaging)
Recommendations for BSE
Optional. Monthly starting during age 20s. Women should be familiar with their breasts and report any changes to their health care provider
Medications that can cross the milk-blood barrier
cimetidine, clemastine, thiouracil
Women's breasts vary somewhat in shape, from __ to __ or __
convex to pendulous or conical
Retractions and dimpling signify the contraction of fibrotic tissue that occurs with ____
carcinoma
A peau d'orange appearance of the skin indicates edema of the breast caused by blocked lymph drainage in advanced or_______
inflammatory carcinoma
When are venous patterns of the breast a concern?
unilateral venous patterns, can be produced by dilated superficial veins from increased blood flow to a malignancy
A peppering of nontender, nonsuppurative Montgomery tubercles is a _____ finding
common expected
Recent unilateral inversion or retraction of a previously everted nipple suggests _____
malignancy.
Retraction is seen as a flattening, withdrawal, or inversion of the nipple and indicates inward pulling by ___ or ___
inflammatory or malignant tissue
The fibrotic tissue of ___ can also change the axis of the nipple, causing it to point in a direction different from that of the other nipple.
carcinoma
Supernumerary nipples, which are more common in __ women than in ___ women, appear as one or more extra nipples located along the ______
black>white, embryonic mammary ridge (the "milk line")
In some cases, supernumerary nipples may be associated with ___ or ___, particularly in whites.
congenital renal or cardiac anomalies
Seated with arms over the head or flexed behind the neck: This adds __________, accentuates dimpling, and may reveal variations in contour and symmetry
tension to the suspensory ligaments
Seated with hands pressed against hips with shoulders rolled forward (or alternatively have the patient push her palms together): This _______, which can reveal deviations in contour and symmetry
contracts the pectoral muscles
Seated and leaning forward from the waist: This also causes ____. The breasts should hang equally. This maneuver can be particularly helpful in assessing the contour and symmetry of large breasts, because the breasts fall away from the chest wall and hang freely. As the patient leans forward, support her by the hands
tension in the suspensory ligaments
sentinel nodes___
Virchow nodes
___ nodes are the first sign of invasion of the lymphatics by abdominal or thoracic carcinoma
Virchow
Where are the Virchow nodes?
supraclavicular fossa
Where is the tail of Spence?
upper outer quadrant of the breast with tissue extending from this quadrant into the axilla
In the ___ technique, begin at the top of the breast and palpate, first downward, then upward, working your way down over the entire breast
vertical strip
In the ____ technique, begin at the outermost edge of the breast tissue and spiral your way inward toward the nipple
concentric circle
To use the ___, palpate from the center of the breast in radial fashion, returning to the areola to begin each spoke
wedge method
____ can be used to confirm the presence of fluid in certain masses.
Transillumination
Nipple compression should be performed only if the patient reports_____.
spontaneous nipple discharge, especially if unilateral
chemoprevention for breast cancer
Tamoxifen
In infants, If you squeeze the breast bud gently, a small amount of clear or milky white fluid, commonly called "____," is sometimes expressed.
witch's milk
Many males at puberty have transient unilateral or bilateral ___ masses
subareolar
Gynecomastia can be associated with the use of either___ or ___.
illicit or prescription drugs
During the second trimester, vascular spiders may develop on the upper chest, arms, neck, and face as a result of __________.
elevated levels of circulating estrogen
In Lactating Women, Engorgement is not an unusual condition in the first 24 to 48 hours after the breasts fill with milk; however, its later development may signal the onset of ___
mastitis.
A clogged duct left unattended will probably result in the development of ___
mastitis.
Breast changes in older adults
flattened, elongated, and suspended more loosely from the chest wall as the result of glandular tissue atrophy and relaxation of the suspensory ligaments
Hormone replacement therapy can result in____, which can be painful.
fluid-filled breast cysts
_______ caused by ductal enlargement is associated with a long follicular or luteal phase of the menstrual cycle. The lesions are filled with fluid and are usually bilateral and multiple.
FIBROCYSTIC CHANGES
Fibrocystic disease occurs most commonly in women between ___ years of age
30 and 55
___ are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit.
Fibroadenomas
___ may occur in girls and women of any age during their reproductive years and account for the majority of breast tumors in young women. generally asymptomatic and do not change with the menstrual cycle.
Fibroadenomas
___ rarely appear in older women; therefore any new solid lesion in an older woman should be considered malignant until proven otherwise
Fibroadenomas
Peak incidence of malignancy is between ages___ years, with the majority of malignant breast tumors occurring in women older than 50 years of age
40 and 75
About 80% of patients with breast cancer have a___ in the breast as the initial symptom
painless lump
mass or thickening in the breast; marked asymmetry of breasts; prominent unilateral veins; discolorations (erythema or ecchymosis); peau d'orange; ulcerations; dimpling, puckering, or retraction of skin or areola; fixed inversion or deviation in position of the nipple; crusting or erosion of the nipple or areola; or change in surface characteristics (e.g., moles or scars)
findings associated with breast cancer
____ is a response to local injury. It is felt as a firm, irregular mass, often appearing as an area of discoloration
Fat necrosis
These benign 2- to 3-cm tumors of the subareolar ducts may occur singly or in multiples. common cause of serous or bloody nipple discharge. They need to be excised and examined to rule out malignancy.
INTRADUCTAL PAPILLOMAS AND PAPILLOMATOSIS
____ of the breast is a surface manifestation of underlying ductal carcinoma. A red, scaling, crusty patch forms on the nipple, areola, and surrounding skin. The lesion appears eczematous but, unlike eczema, may occur unilaterally, and does not respond to steroids
Paget disease
___ is a smooth, firm, mobile, tender disk of breast tissue located behind the areola in males. It may be unilateral or bilateral. In adult men it can be caused by hormone imbalance; by testicular, pituitary, or hormone-secreting tumors; by liver failure; or by antihypertensive medications or those containing estrogens or steroids
Gynecomastia
Inflammation of the sebaceous glands in the areola results in ______. They may become tender and suppurative
RETENTION CYSTS
Lactation not associated with childbearing is most commonly caused by drugs, especially ___, __, ___, __
phenothiazines, tricyclic antidepressants, some antihypertensive agents, and estrogens.
Intrinsic causes of galactorrhea include ___, ___, ___, ___, ___.
prolactin-secreting tumors, pituitary tumors, hypothyroidism, Cushing syndrome, and hypoglycemia
Enlargement of breast tissue in boys is caused by___, __, ___, and medications containing __ or ___
puberty, hormonal imbalance, testicular or pituitary tumors; estrogens or steroids
Prepubertal breast enlargement of unknown cause in girls can occur in the absence of other signs of sexual maturation. The degree of enlargement varies from very slight to fully developed breasts. It usually occurs bilaterally, with the breasts continuing to enlarge slowly throughout childhood until full development is reached during adolescence
PREMATURE THELARCHE
___ is inflammation and infection of the breast tissue characterized by sudden onset of swelling, tenderness, erythema, and heat; it is usually accompanied by chills, fever, and increased pulse rate.
Mastitis
Mastitis is most common in lactating women after milk is established, usually the ___ week after delivery; however, it may occur at any time
second to third
Common strain for Mastitis
Staphylococcus aureus
In Mastitis, The underlying ___ may impart a bluish tinge to the skin
pus-filled abscess
_____occurs most commonly in menopausal women. The subareolar ducts become blocked with desquamating secretory epithelium, necrotic debris, and chronic inflammatory cells. This condition is often bilateral and is characterized by pain, tenderness, periods of inflammation, and a nipple discharge that is spontaneous, sticky, multicolored, and from multiple ducts. Nipple retraction may occur. There is no known association with malignancy.
Mammary duct ectasia
Discharge
Depression or inversion
Discoloration: pregnancy
Dermatologic changes: Paget disease
Deviation: compare opposite side
Mnemonics
Five Ds Related to Nipples