24 Breast ANATOMY AND PHYSIOLOGY
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Questions and Answers

Which hormone is responsible for the maturation of glandular tissue in the breast?

  • Prolactin
  • FSH
  • Estrogen
  • Progesterone (correct)

Which nerve innervates the serratus anterior muscle and can result in winged scapula if injured?

  • Medial pectoral nerve
  • Long thoracic nerve (correct)
  • Thoracodorsal nerve
  • Lateral pectoral nerve

After menopause, which hormones' lack results in atrophy of breast tissue?

  • Prolactin
  • Progesterone
  • FSH
  • Estrogen (correct)

Which artery supplies the latissimus dorsi muscle and can result in weak arm pull-ups if injured?

<p>Thoracodorsal artery (B)</p> Signup and view all the answers

Which hormone synergizes with estrogen and progesterone in breast development?

<p>Prolactin (B)</p> Signup and view all the answers

Which nerve provides sensation to the medial arm and axilla and is most commonly injured during axillary dissection?

<p>Intercostobrachial nerve (B)</p> Signup and view all the answers

Which condition typically presents with noncyclical mastodynia, erythema, and nipple retraction?

<p>Periductal mastitis (A)</p> Signup and view all the answers

What is the most common cause of bloody nipple discharge?

<p>Intraductal papilloma (B)</p> Signup and view all the answers

Which condition is characterized by superficial vein thrombophlebitis of the breast, often associated with trauma and strenuous exercise?

<p>Mondor’s disease (B)</p> Signup and view all the answers

What is the primary cause of neonatal breast enlargement?

<p>Circulating maternal estrogens (D)</p> Signup and view all the answers

Which condition is characterized by breast cysts filled with milk and may occur during breastfeeding?

<p>Galactocele (B)</p> Signup and view all the answers

What is a major neurovascular structure to be preserved in an axillary dissection to prevent direct hematogenous metastasis of breast cancer to the spine?

<p>Batson’s plexus (C)</p> Signup and view all the answers

Which condition can be associated with increased prolactin levels and amenorrhea?

<p>Galactorrhea (B)</p> Signup and view all the answers

In which condition are accessory nipples most commonly found?

<p>Axilla (A)</p> Signup and view all the answers

What is the most common lymphatic drainage pathway for breast tissue?

<p>Axillary nodes (D)</p> Signup and view all the answers

Which condition is characterized by sequala from infectious mastitis or periductal mastitis?

<p>Breast abscess (B)</p> Signup and view all the answers

What is the primary cause of lactational mastitis?

<p>Blockage of lactiferous ducts (C)</p> Signup and view all the answers

Which condition requires excisional biopsy including skin if it fails to resolve after 2 weeks or recurs?

<p>Breast abscess (A)</p> Signup and view all the answers

What is the main side effect of aromatase inhibitors in the context of breast cancer treatment?

<p>Fractures (A)</p> Signup and view all the answers

Which medication is recommended for HER2/neu receptor-positive tumors either > 1 cm or if nodes are positive?

<p>Trastuzumab (B)</p> Signup and view all the answers

What is the characteristic skin lesion associated with Paget's disease of the breast?

<p>Scaly and ulcerated skin lesion on the nipple (A)</p> Signup and view all the answers

What is the likely diagnosis when breast cancer presents as axillary metastases with unknown primary?

<p>Occult breast cancer (D)</p> Signup and view all the answers

What is the recommended treatment if cancer is present in Paget's disease of the breast?

<p>Simple mastectomy (A)</p> Signup and view all the answers

What is the primary action of aromatase inhibitors in the treatment of breast cancer?

<p>Block conversion of testosterone to estrogen in the periphery (A)</p> Signup and view all the answers

What is the lifetime risk of ovarian cancer for individuals with BRCA II mutations?

<p>20% (A)</p> Signup and view all the answers

What is the recommended age to start BRCA screening with yearly mammogram and breast MRI?

<p>25 (B)</p> Signup and view all the answers

What is the prognosis of tumors that are both progesterone receptor and estrogen receptor positive?

<p>Better prognosis than receptor-negative tumors (A)</p> Signup and view all the answers

Which gene mutation is NOT associated with an increased risk of breast cancer?

<p>NF1 (B)</p> Signup and view all the answers

At what age should consideration be given to total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) in BRCA families with a history of breast cancer?

<p>25 (A)</p> Signup and view all the answers

What is the recommended age to start yearly pelvic exam + U/S and CA-125 for BRCA screening?

<p>25 (D)</p> Signup and view all the answers

Which factor is NOT considered in the considerations for prophylactic mastectomy?

<p>Family history of diabetes (A)</p> Signup and view all the answers

In which stage of breast cancer is distant metastasis present?

<p>Stage IV (D)</p> Signup and view all the answers

What percentage of breast cancers are negative for both estrogen and progesterone receptors?

<p>10% (D)</p> Signup and view all the answers

Which syndrome is associated with an increased risk of breast cancer?

<p>Li-Fraumeni syndrome (C)</p> Signup and view all the answers

Which type of breast cancer has the worst prognosis?

<p>Inflammatory carcinoma (D)</p> Signup and view all the answers

What is the recommended age to start BRCA screening with yearly mammogram and breast MRI for individuals with a family history of breast cancer?

<p>25 (D)</p> Signup and view all the answers

Which model calculates the 5 year and lifetime risk of breast cancer using age, race, ethnicity, and other factors?

<p>Gail model (C)</p> Signup and view all the answers

In which group of women should the Gail model not be used for risk assessment?

<p>Women with personal history of breast cancer (A)</p> Signup and view all the answers

What is the approximate median survival for untreated breast cancer?

<p>2-3 years (B)</p> Signup and view all the answers

What is the approximate percentage of breast cancers that have negative mammogram and negative ultrasound?

<p>10% (B)</p> Signup and view all the answers

Which imaging technique is recommended for patients under 40 if the clinical exam or ultrasound is indeterminate or suspicious for breast cancer?

<p>Mammogram (A)</p> Signup and view all the answers

Which imaging techniques are recommended for patients over 40 years old for breast mass workup?

<p>Mammograms and ultrasound (C)</p> Signup and view all the answers

What does FNA provide in the evaluation of breast masses?

<p>Cytology (just the cells) (B)</p> Signup and view all the answers

What does CNBx provide in the evaluation of breast masses?

<p>Architecture (histology) (A)</p> Signup and view all the answers

"Rotter's nodes" are located between which muscles?

<p>&quot;Rotter's nodes&quot; are located between the pectoralis major and pectoralis minor muscles (C)</p> Signup and view all the answers

What is the most common site for distant metastasis in breast cancer?

<p>Bone (B)</p> Signup and view all the answers

Which factor is directly related to the number of positive nodes in breast cancer staging?

<p>Tumor size (C)</p> Signup and view all the answers

What is suggested for high-risk individuals in terms of screening for breast cancer?

<p>Annual mammogram and MRI starting age 25-40 (B)</p> Signup and view all the answers

Which of the following is an absolute contraindication to breast-conserving therapy?

<p>Presence of diffuse malignant-appearing microcalcifications (D)</p> Signup and view all the answers

What is the main reason for performing an axillary lymph node dissection (ALND) instead of a sentinel lymph node biopsy (SLNB)?

<p>Higher accuracy in detecting tumor deposits with ALND (C)</p> Signup and view all the answers

What is the exception to requiring a formal ALND after a positive finding on sentinel lymph node biopsy (SLNB)?

<p>Women younger than 18 with early stage tumors and less than 3 positive nodes on SLNB (B)</p> Signup and view all the answers

What is the most common nerve injury after mastectomy?

<p>Intercostal brachiocutaneous nerve injury (D)</p> Signup and view all the answers

What is the recommended margin for surgical margins in lumpectomy without radiation therapy?

<p>1 cm (D)</p> Signup and view all the answers

What is the chemotherapy regimen used for positive nodes regardless of menopausal status?

<p>Taxanes, Adriamycin, and cyclophosphamide (TAC) (A)</p> Signup and view all the answers

What is the main side effect of tamoxifen therapy?

<p>Risk of thromboembolism (D)</p> Signup and view all the answers

What percentage of local recurrence is expected within 2 years after the first operation for breast-conserving therapy without radiation?

<p>10% (B)</p> Signup and view all the answers

What are the absolute contraindications to XRT?

<p>Pregnancy, scleroderma, active SLE, and previous XRT exceeding recommended dose (A)</p> Signup and view all the answers

'No ink on tumor' margins following breast-conserving therapy is a requirement before starting which treatment?

<p>$5,000$ rad radiotherapy (XRT) (B)</p> Signup and view all the answers

What is the first-line neoadjuvant chemotherapy for locally advanced or inflammatory breast cancer to shrink tumor and improve resectability?

<p>TAC (taxanes, Adriamycin, and cyclophosphamide) (D)</p> Signup and view all the answers

Which breast lesion is characterized by a slow-growing, well-circumscribed, painless, firm, and rubbery mass that can enlarge in pregnancy?

<p>Giant fibroadenoma (B)</p> Signup and view all the answers

What is the most common color of the discharge associated with fibrocystic disease?

<p>Brown (A)</p> Signup and view all the answers

Which breast lesion presents as a stellate, irregular, spiculated mass that resembles breast cancer but has a central fibroelastic core with ducts and lobules radiating outward?

<p>Radial scar (A)</p> Signup and view all the answers

What is the most common type of breast cancer worldwide?

<p>Ductal carcinoma in situ (DCIS) (C)</p> Signup and view all the answers

Which type of discharge is considered worrisome for cancer if it is persistent, unilateral, bloody, or spontaneous?

<p>Serous (A)</p> Signup and view all the answers

Which breast lesion has a tightly packed epithelial component with sparse connective tissues and is considered benign?

<p>Tubular fibroadenoma (D)</p> Signup and view all the answers

What is the management approach for a patient with spontaneous nipple discharge, regardless of the color or consistency?

<p>Excisional biopsy of duct area causing the discharge (C)</p> Signup and view all the answers

Which breast lesion has a slightly increased risk of cancer and can be identified by the presence of epithelial calcifications, apocrine hyperplasia/metaplasia, sclerosing adenosis, or cysts larger than 3 cm?

<p>Complex fibroadenoma (B)</p> Signup and view all the answers

Which breast lesion can cause large, coarse calcifications known as 'popcorn lesions' on mammography due to degeneration?

<p>Giant fibroadenoma (A)</p> Signup and view all the answers

Flashcards

Which hormone is responsible for breast gland maturation?

Progesterone is responsible for the development of glandular tissue in the breasts during puberty and pregnancy.

Which nerve innervates the serratus anterior muscle?

The long thoracic nerve innervates the serratus anterior muscle. Injury to this nerve can cause a winged scapula, where the scapula protrudes outwards.

What hormone is most important for breast development?

Estrogen is essential for the growth and development of breast tissues. After menopause, estrogen levels decline, leading to atrophy of the breast tissue.

Which artery supplies the latissimus dorsi muscle?

The thoracodorsal artery supplies blood to the latissimus dorsi muscle. Damage to this artery can result in weak arm pull-ups because the muscle is deprived of oxygen.

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Which hormone synergizes with estrogen and progesterone in breast development?

Prolactin works in synergy with estrogen and progesterone to promote breast development and lactation.

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Which nerve is commonly injured during axillary dissection?

The intercostobrachial nerve provides sensation to the medial arm and axilla. It is frequently injured during axillary dissection, a surgical procedure.

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What condition presents with non-cyclical breast pain, redness and nipple retraction?

Periductal mastitis is a condition characterized by breast pain, redness, and nipple retraction. It is not associated with menstrual cycles.

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What is the most common cause of bloody nipple discharge?

Intraductal papillomas are benign growths within the milk ducts. They are the most common cause of bloody nipple discharge.

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What condition is characterized by superficial vein thrombophlebitis of the breast?

Mondor's disease is a condition that affects the superficial veins in the breast. It often arises due to trauma or strenuous exercise.

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What is the primary cause of neonatal breast enlargement?

After birth, a baby's breasts may enlarge due to circulating maternal estrogens. This is a temporary condition and naturally resolves.

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What condition is characterized by milk-filled cysts in the breast?

A galactocele is a fluid-filled cyst in the breast. It commonly occurs in breastfeeding mothers when milk ducts get blocked.

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What neurovascular structure is important to preserve in an axillary dissection?

Batson's plexus is a network of veins that drain blood from the spinal cord. It is important to preserve this plexus during axillary dissection to reduce the risk of cancer spreading to the spine.

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Which condition is associated with elevated prolactin levels and amenorrhea?

Galactorrhea is a discharge of milk-like fluid from the breast outside of pregnancy or breastfeeding. Elevated prolactin levels and amenorrhea can be associated with this condition.

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Where are accessory nipples most commonly found?

Accessory nipples are extra nipples that can develop anywhere along the "milk line" during embryonic development. They are most common around the axilla.

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What is the most common lymphatic drainage pathway for breast tissue?

The majority of lymph fluid from the breast drains to the axillary nodes, which are located under the arm pit.

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What condition can arise from infectious mastitis?

A breast abscess develops when an infection in the breast tissue doesn't clear. It can be a sequela of mastitis or periductal mastitis.

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What is the primary cause of lactational mastitis?

Lactational mastitis is an inflammatory condition of the breast tissue that commonly occurs during breastfeeding due to blocked milk ducts.

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When is excisional biopsy of a breast abscess recommended?

A breast abscess that doesn't improve after two weeks or keeps recurring should be surgically removed including the surrounding skin.

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What is a major side effect of aromatase inhibitors?

Aromatase inhibitors are used to treat breast cancer by lowering estrogen levels. One potential side effect is weakened bones, leading to fractures.

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Which medication is recommended for HER2/neu-positive tumors?

Trastuzumab is a targeted therapy used for HER2/neu-positive breast tumors, especially those larger than 1 centimeter or affecting the lymph nodes.

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What is the characteristic skin lesion in Paget's disease of the breast?

Paget's disease of the breast is a rare type of breast cancer affecting the nipple and areola. It typically presents with a scaly, ulcerated lesion on the nipple.

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What is the likely diagnosis if axillary metastases are found with an unknown primary tumor?

Occult breast cancer is diagnosed when axillary lymph nodes are involved but the primary breast tumor is not identified.

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What is the recommended treatment for Paget's disease?

Simple mastectomy involves removing the entire breast tissue, but not the lymph nodes. It is recommended for Paget's disease of the breast to ensure complete removal of cancerous cells.

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What is the primary action of aromatase inhibitors in treating breast cancer?

Aromatase inhibitors work by inhibiting the conversion of testosterone to estrogen in the body. This reduces estrogen levels, slowing down the growth of estrogen-sensitive breast cancer cells.

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What is the lifetime risk of ovarian cancer with BRCA2 mutations?

Individuals with BRCA2 gene mutations have an increased lifetime risk of developing ovarian cancer.

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When should BRCA screening with yearly mammogram and breast MRI start?

BRCA screening with annual mammograms and breast MRI should begin at age 25 for individuals with BRCA mutations.

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What is the prognosis of tumors that are both progesterone receptor and estrogen receptor positive?

Breast cancer tumors that are both estrogen receptor (ER) and progesterone receptor (PR) positive typically have a better prognosis than those that are negative for both receptors.

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Which gene mutation is NOT associated with an increased risk of breast cancer?

The NF1 gene mutation is not associated with an increased risk of breast cancer.

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When should TAH and BSO be considered in BRCA families with a history of breast cancer?

In families with BRCA mutations and a history of breast cancer, a total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) should be considered starting at age 25.

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When should yearly pelvic exams, ultrasounds, and CA-125 start for BRCA screening?

Yearly pelvic exams, ultrasounds, and CA-125 blood tests should begin at age 25 for BRCA screening.

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Which factor is NOT considered in prophylactic mastectomy decisions?

Prophylactic mastectomy (removing both breasts to prevent cancer) is a personal decision and is influenced by factors like family history, gene mutations, and personal risk assessment. Family history of diabetes is not a direct factor.

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In which stage of breast cancer is distant metastasis present?

Stage IV breast cancer is characterized by the presence of distant metastases, meaning the cancer has spread to other parts of the body.

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What percentage of breast cancers are negative for both estrogen and progesterone receptors?

Approximately 10% of breast cancers are negative for both estrogen and progesterone receptors. These tumors are typically more aggressive and may respond less well to hormone therapy.

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Which syndrome is associated with an increased risk of breast cancer?

Li-Fraumeni syndrome, a rare genetic disorder, is associated with a higher risk of developing various cancers, including breast cancer.

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Which type of breast cancer has the worst prognosis?

Inflammatory breast cancer is a rare and aggressive form of breast cancer with a poor prognosis. It spreads rapidly and involves the skin, lymph nodes, and blood vessels.

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When should BRCA screening with yearly mammogram and breast MRI start for individuals with a family history of breast cancer?

Annual mammograms and breast MRIs should start at age 25 for individuals with a family history of breast cancer.

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Which model is used to calculate breast cancer risk?

The Gail model calculates the 5-year and lifetime risk of developing breast cancer based on various factors, including age, race, ethnicity, and family history. However, it is not used for women who have already had breast cancer.

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In which group of women should the Gail model be used for risk assessment?

The Gail model is not used for women with a personal history of breast cancer because it is designed for women who have never had breast cancer.

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What is the approximate median survival for untreated breast cancer?

Without treatment, the median survival time for breast cancer is approximately 2-3 years. This means that 50% of people with breast cancer will survive for at least 2-3 years without treatment.

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What is the estimated percentage of breast cancers missed by mammograms and ultrasounds?

Approximately 10% of breast cancers are missed by both mammograms and ultrasounds.

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Which imaging technique is recommended for patients under 40 with suspicious findings?

Mammograms are recommended for patients under 40 with indeterminate or suspicious breast cancer findings on clinical exams or ultrasounds.

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Which imaging techniques are commonly used for workup of breast mass in patients over 40?

Mammograms and ultrasounds are commonly used for breast mass workup in patients over 40 years old.

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What does FNA provide in the evaluation of breast masses?

A Fine Needle Aspiration (FNA) is a procedure that uses a thin needle to obtain cells from a suspicious breast mass. It provides cytology, which means it examines the cells under a microscope.

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What does CNBx provide in the evaluation of breast masses?

A Core Needle Biopsy (CNBx) is a procedure that uses a larger needle to obtain tissue samples from a suspicious breast mass. This tissue sample allows for histological evaluation, which means examining the arrangement of cells and tissues under a microscope.

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Where are "Rotter's nodes" located?

Rotter's nodes are located between the pectoralis major and pectoralis minor muscles. They are part of the axillary lymph node chain and can be involved in breast cancer metastasis.

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What the most common location of distant metastasis in breast cancer?

Bone metastasis is the most common site for breast cancer to spread.

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Which factor is directly related to the number of positive nodes in breast cancer staging?

The number of involved lymph nodes in breast cancer staging is directly related to the size of the tumor. Larger tumors are more likely to have spread to lymph nodes.

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What is suggested for high-risk individuals in terms of breast cancer screening?

High-risk individuals for breast cancer, especially those with a strong family history or BRCA mutations, are recommended to undergo annual mammograms and MRIs starting at age 25-40.

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What is an absolute contraindication to breast-conserving therapy?

Diffuse malignant microcalcifications, which are small calcium deposits indicative of cancer, are an absolute contraindication to breast-conserving therapy (lumpectomy). This means lumpectomy cannot be performed and a mastectomy is required.

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What is the main reason for performing an axillary lymph node dissection (ALND) instead of a sentinel lymph node biopsy (SLNB)?

Axillary lymph node dissection (ALND) involves removing all lymph nodes in the armpit, while sentinel lymph node biopsy (SLNB) only removes a few nodes. ALND is done when greater accuracy is needed to determine if the cancer has spread to the lymph nodes.

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