Y2B3 Do15 Cs Breast Disease

Front 1

what are morgani tubercles and where are they located

Back 1

periphery of the areola
secretes oils for lubrication and decrease bacterial breeding
looks like white bumps that have stuff that comes out when you squeeze them

Front 2

where do 97% of the lymph drain from the breast?

Back 2

axillary lymph node

Front 3

what dose estrogen do to the breast

Back 3

stimulates ductal growth

Front 4

what does progesterone do

Back 4

ductal branching

Front 5

what happens to the number of lobules with menopause

Back 5

decreases

Front 6

in mammogenesis, what happens at birth, prepubertal, and puberty stages

Back 6

birth = 10-12 primitive ductal elements
prepubertal- canalization into ductal structures
puberty- FSH and LH stimulate ovaries --> icnreased estrogen

Front 7

when are the 2x in life that the breast goes through lobular involution

Back 7

post lactation - glandular atrophy --> apoptotic death and tissue remodeling

menopause- atrophy of glands, decrease in lobules and CT

Front 8

what are the main changes in each trimester of pregnancy

Back 8

1- high progesterone stops breast tissue from further developing. lobules differentiate into milk containing sacks. progesterone stops breast from continuing to grow and release milk

2- prolactin triggers glandular production of colostrum. HPL = secretion of colostrum

3- epithelial cells separate into secretory cells

post partum = prolactin and oxytocin = letdown of milk

Front 9

when is the best time to do a breast exam?

Back 9

x7-9 days after your period because it is your least amt of hormones

Front 10

when you're sitting upright, what LN are you checking for?

Back 10

cervical, supraclavicular, infraclavicular, axillary

Front 11

what are some things you want to document?

Back 11

bulging, discharge, asymmetry, contour, nipple inversion, ulceres, retraction, dimpling

Front 12

what do you want to document if you feel masses

Back 12

firm, soft, mobile, fixed matted
distance to areola
quadrant
R/L breast

Front 13

roughly when do you start getting breast exams?

Back 13

20-39 Q 3 yrs annually after

Front 14

when do you start mammograms

Back 14

roughly 40-50 and stop at 75

Front 15

what is the MC complaint to the PCP?

Back 15

breast pain/mastalgia

Front 16

when does cyclic mastalgia usu occur?

Back 16

late in luteal phase
bilateral
poorly localized
estrogen stimualtes ducts
progesterone stimulates stroma

Front 17

how does noncyclic mastalgia differ from cyclic

Back 17

unilateral pain
focal pain

Front 18

what are some causes of noncyclic mastalgia

Back 18

cyst
rupture of ectatic duct
mastitis
fibroadenoma
stretching coopers ligaments
fat necrosis

Front 19

when would you get a mammogram dt mastalgia?

Back 19

pt >35 and probably noncyclic

Front 20

what is the tx for cyclic breast pain

Back 20

NSAIDS
lower estrogen
danazol
vit E supplement

Front 21

what are some ssx for nipple discharge? and how do you dx

Back 21

only with compression
multiple ducts involved
dx with CBE or mammogram if >35
usu dt overstimulation

Front 22

what are some ssx of pathologic nipple discharge

Back 22

spontaneous discharge
a/w mass
persistent
gross/occult blood

Front 23

what is the treatment for pathologic nip discharge

Back 23

duct excision

you usually want to localize duct
dx with mammogram

Front 24

if i am not pregnant and i have nipple discharge, what hormone should i check out to indicate that i possibly have galactorrhea?

Back 24

prolactin

Front 25

what is the treatment for galactorrhea?

Back 25

bromocriptine

Front 26

is spontaneous nip discharge good or bad

Back 26

BAD BAD BAD

Front 27

if i have a 35 yo female pt with a mass, what dx test should i do?

Back 27

mamogram

Front 28

if i have a 16 yo female with a mass, what test should i do?

Back 28

US

Front 29

if i have a high risk female pt or a pt with recurrent breast ca, what test should i do?

Back 29

MRI

Front 30

if i have a solid lesion, what dx test shoudl i do?

Back 30

core needle bx

Front 31

what test is good for a cyst eval

Back 31

fine needle aspiration

Front 32

what are some lesions that dont increase the risk of breast ca

Back 32

simple breast cyst
papillary apocrine change
epithelial related calcifications
mild hyperplasia of unusual type

Front 33

i use breast US and fine needle aspiration to dx this. usually occurs in 35-50 yo women and influenced by hormoen fluctation. what am i?

Back 33

simple breast cyst

no tx necessary

Front 34

this is a proliferation of ductal epithelial cells

Back 34

papillary apocrine change

Front 35

this is benign in ducts, lobules, stroma, blood vessel walls

Back 35

epithelial related calc

Front 36

increase in # of epithelial cells but celsl DONT cross midline

Back 36

mild hyperplasia of usual type

Front 37

this has a slight increase in risk of getting breast ca. drs usually find this secondary to abnormal mammogram. no tx is needed

Back 37

usual ductal hyperplasia

Front 38

this has nipple discharge as its main sx. can be bloody. dx is made via ductogram and the tx is excision. what am i?

Back 38

intraductal papilloma

Front 39

which lesion can be canerous, must have it excited out, but if excision is negative, no further tx is necessary. fibroelastic core with radiating ducts and lobules

Back 39

radial scars

Front 40

this is usu seen in young women 15-35. hormonal influence. dx with core bx/excision

tx: remove or F/U in 3-6 months with repeat breast US

Back 40

simple fibroadenomas

Front 41

ADH and ALH are atypical hyperplasias. what are some things to do if you find these?

Back 41

stop OCP, HRT
yearly mammogram
2x/yr CBE
dx with core bx followed by wire localization breast bx

Front 42

if i am an older white female that is nulliparous with fam hx of brca 1/2 what do i have an increased chance of getting?

Back 42

breast ca

Front 43

what are some suspicious mass characteristics

Back 43

solitary
discrete
hard
painless
adherent to surrounding tissue

Front 44

why is lactation good?

Back 44

cheap
decreases length of lochia for mom
increase weight loss
decrease risk of breast ca

for child, decreases infection
better digestive tract formation
decreases other disease chances

Front 45

contraindications for breast feeding

Back 45

HIV, drugs, etoh, untreated TB, t cell lymphocytic infection

fetal reasons: galactosemia

Front 46

what is a reason of inadequate milk production

Back 46

boob job/insufficient breast tissue
increased androgens
reatined POC
pituitary insufficiency
dopamine agonist

Front 47

if i have mastitis, what am i mc cuased by?

Back 47

staph aureus

Front 48

what is the tx for mastitis

Back 48

dicloxacillin
TMP-SMX
abscess= drainage or needle aspiration

Front 49

what is the tx of postpartum yeast infection

Back 49

miconazole/clotrimazole
if you have fissures use topical bacitracin
use fluconazole

Front 50

describe fibrocystic breast changes

Back 50

Benign, Pain, nodularity
Most of pts. not at increased CA risk
Often age 35 to 50
Often decreases post-menopause, unless HRT
Mammogram, Ultrasound