Seidel 16 Beast

In women, the breast extends from the ____ rib to the ____ rib

______ extend from the connective tissue layer through the breast and attach to the underlying muscle fascia, providing further support

Vascular supply to the breast is primarily through branches of the ____ artery and the ___ artery

Which arteries supply the superficial breast

The greatest amount of glandular tissue lies in the___ quadrant

In the axillae the mammary tissue is in direct contact with the ____.

The nipple is composed of epithelium that is infiltrated with ___ and ___ smooth muscle fibers

Tiny sebaceous glands may be apparent on the areola surface

Patterns of Lymph Drainage: Upper outer quadrant

Patterns of Lymph Drainage: Medial portion

Patterns of Lymph Drainage: Posterior chest wall and portion

Patterns of Lymph Drainage: Anterior chest wall

Patterns of Lymph Drainage: Upper arm

Patterns of Lymph Drainage: Retroareolar area

Patterns of Lymph Drainage: AREOLA AND NIPPLE

The anterior axillary (pectoral) nodes are located along the lower border of the ___________

The midaxillary (central) nodes are high in the __________

The posterior axillary (subscapular) nodes lie along the lateral border of the ___ and deep in the ___

lateral axillary (brachial) nodes can be felt along the _____.

__ (breast development) represents an early sign of puberty in adolescent girls

It is unusual for the onset of menses to occur before which Tanner Stage

Approximately ___% are menstruating at stage 4 and are beginning a reasonably regular menstrual cycle

The average interval from the appearance of the breast bud (Tanner stage?) to menarche is __ years

breasts can enlarge ___ times their pre-pregnancy size

Toward the end of pregnancy, as epithelial secretory activity ___, colostrum is produced and accumulates in the ____.

Colostrum contains more ___ and ___ than does mature milk

Milk production to replace colostrum begins 2 to 4 days after delivery in response to surging ___ levels, declining ___ levels, and the stimulation of ___

After menopause, ___ continues to atrophy gradually and is replaced by fat deposited in the breasts.

About 18% of breast cancer diagnoses are in women in their ___

77% of breast cancer diagnoses are in women older than ___

The incidence of male breast cancer is less than ___% of that of female breast cancer.

Women with an inherited___ mutation have a 35% to 85% chance of developing breast cancer during their lifetime

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

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 ___

What 3 hereditary cancer syndromes are risk factors for breast cancer?

Proliferative breast disease without atypia or unusual hyperplasia slightly increases the risk of breast cancer (____ times greater risk)

Atypical hyperplasia increases a woman's breast cancer risk by ___times

Fibrocystic changes without proliferative breast disease ___ affect breast cancer risk

___ women are slightly more likely to develop breast cancer than are ___ women, but ___ women are more likely to die of this cancer

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.

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.

Women who received ___ in the 1940s through the 1960s during their pregnancies have a slightly increased risk of developing breast cancer.

Nulliparity or late age at birth of first child (after age __) is associated with an increased risk of breast cancer.

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.

Is there a risk of breast cancer with drinking alcohol?

Overweight women are ___% more likely to die of breast cancer as compared to normal weight women.

The American Cancer Society recommends BSE as an option for women starting in their ___

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

The sensitivity of CBE in detecting breast cancer ranges from ___% and the specificity from ___%

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

Recommendations for CBE: Older than 40 years of age

Recommendations for CBE: Younger than 40 years of age ____

Recommendations for Mammogram: Women at average risk

Recommendations for Mammogram Women at increased risk (e.g., family history, genetic tendency, past breast cancer):

Recommendations for BSE

Medications that can cross the milk-blood barrier

Women's breasts vary somewhat in shape, from __ to __ or __

Retractions and dimpling signify the contraction of fibrotic tissue that occurs with ____

A peau d'orange appearance of the skin indicates edema of the breast caused by blocked lymph drainage in advanced or_______

When are venous patterns of the breast a concern?

A peppering of nontender, nonsuppurative Montgomery tubercles is a _____ finding

Recent unilateral inversion or retraction of a previously everted nipple suggests _____

Retraction is seen as a flattening, withdrawal, or inversion of the nipple and indicates inward pulling by ___ or ___

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.

Supernumerary nipples, which are more common in __ women than in ___ women, appear as one or more extra nipples located along the ______

In some cases, supernumerary nipples may be associated with ___ or ___, particularly in whites.

Seated with arms over the head or flexed behind the neck: This adds __________, accentuates dimpling, and may reveal variations in contour and symmetry

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

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

sentinel nodes___

___ nodes are the first sign of invasion of the lymphatics by abdominal or thoracic carcinoma

Where are the Virchow nodes?

Where is the tail of Spence?

In the ___ technique, begin at the top of the breast and palpate, first downward, then upward, working your way down over the entire breast

In the ____ technique, begin at the outermost edge of the breast tissue and spiral your way inward toward the nipple

To use the ___, palpate from the center of the breast in radial fashion, returning to the areola to begin each spoke

____ can be used to confirm the presence of fluid in certain masses.

Nipple compression should be performed only if the patient reports_____.

chemoprevention for breast cancer

In infants, If you squeeze the breast bud gently, a small amount of clear or milky white fluid, commonly called "____," is sometimes expressed.

Many males at puberty have transient unilateral or bilateral ___ masses

Gynecomastia can be associated with the use of either___ or ___.

During the second trimester, vascular spiders may develop on the upper chest, arms, neck, and face as a result of __________.

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 ___

A clogged duct left unattended will probably result in the development of ___

Breast changes in older adults

Hormone replacement therapy can result in____, which can be painful.

_______ 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 disease occurs most commonly in women between ___ years of age

___ are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit.

___ 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.

___ rarely appear in older women; therefore any new solid lesion in an older woman should be considered malignant until proven otherwise

Peak incidence of malignancy is between ages___ years, with the majority of malignant breast tumors occurring in women older than 50 years of age

About 80% of patients with breast cancer have a___ in the breast as the initial symptom

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)

____ is a response to local injury. It is felt as a firm, irregular mass, often appearing as an area of discoloration

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.

____ 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

___ 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

Inflammation of the sebaceous glands in the areola results in ______. They may become tender and suppurative

Lactation not associated with childbearing is most commonly caused by drugs, especially ___, __, ___, __

Intrinsic causes of galactorrhea include ___, ___, ___, ___, ___.

Enlargement of breast tissue in boys is caused by___, __, ___, and medications containing __ or ___

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

___ 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 is most common in lactating women after milk is established, usually the ___ week after delivery; however, it may occur at any time

Common strain for Mastitis

In Mastitis, The underlying ___ may impart a bluish tinge to the skin

_____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.

Discharge
Depression or inversion
Discoloration: pregnancy
Dermatologic changes: Paget disease
Deviation: compare opposite side