Assessment of Breasts and Genitalia Flashcards
Trauma Informed Care Considerations for B&G assessment
- promote culture of: safety, healing, empowerment
- ask for consent at each step
- explain what will be done, how, and why
- observe body language
- avoid false reassurance
Inclusive Care
Be mindful and thoughtful in ensuring there is no discrimination against individuals who identify as LGBTQI2S
Inclusive Care Considerations
- don’t assume
- ask
- review your workplace to promote inclusion
Anatomical Structures of the breast
Pectoralis major muscle Axillary tail of Spence Nipple Areola Montgomery's glands
Breasts Landmarks
Upper inner quadrant Upper outer quadrant Lower inner quadrant Lower outer quadrant Axillary tail of spence
Lymphatic Drainage (Breasts)
Axillary Nodes:
a. central axillary
b. pectoral (anterior axillary)
c. subscapular (posterior axillary)
d. lateral axillary
Dev Considerations (Breasts and Female Genitlia) - Adolescence
Puberty around age 8-10, estrogen hormones
a. Thelarche (breast development)
b. Adrenarche/pubarche (axillary/pubic hiar)
c. Height spurt
d. Menarche (first period)
*tanner staging
Dev Considerations (Breasts) - Pregnancy
- increase in size
- blue venous patterns
- nipples and areolae become larger, nipples more erectile
- striae
Dev Considerations (Breasts) - Aging Adult
Post-menopause
- fat/glandular tissue atrophy
- breast size and elasticity decrease
- ovarian secretion of progesterone and estrogen decrease
- less dense, lumps more palpable
The Male Breast
Rudimentary structure consisting of thin disk of tissue, nipple and areola
gynecomastia - increase in breast gland tissue in men, hormonal imbalance, usually transient and unilateral
Subjective Assessment of Breasts and Axilla
a. History of present illness
b. Review of System (trauma, discharge, lump, skin changes, pain or swelling)
c. Associated Symptoms
d. Medical History (surgery, routine check up)
e. Personal and social history
f. Family history
Objective Assessment of Breasts
a. General (state of health, general appearance, colour, nutritional status)
b. Vital Signs
c. Inspection
d. Palpation
LACE (for breasts assessment)
- Look
- symmetry, masses, dimpling, skin colour, edema, venous pattern, lymphatic drainage area
- nipples: size, shape, direct, lesions, discharge, supernumerary (extra nipple) - Arm positions
- hands raised above head (check contour)
- hands on hips (check for retraction) - Check lymph nodes
- supraclavicular nodes
- axillary nodes - Examine breast tissue
- consistency, elasticity of tissues, tenderness, thickening, lumps or masses
Description of Masses (breasts)
- location
- size
- shape
- consistency
- fixed or movable
- nipple
- skin over the lump
- tenderness
- lymphadenopathy
Breast Cancers
- likely age: 30-80 yo
- irregular, star-shaped
- hard, dense, fixed
- often painless
- grows constantly
- most common in upper outer quadrant
- late stage: dimpling, nipple retraction, discharge
Invasive ductal carcinoma (IDC)
a form of breast cancer that breaks out of ductal walls and into surrounding tissues, can penetrate into blood or lymph vessels and spread to other organs
Paget’s disease
Rare cancer involving nipple and areola
- can happen to men or women
Risk factors for Breast Cancer
Non-modifiable:
- female, age 50-69
- client or family hx
- menarche < age 11 or menopause > 55 (increased exposure to hormones)
- BRCA gene mutation
Modifiable:
- nullip or first child > 30
- hormonal contraceptive use
- obesity
Other:
- physical inactivity
- smoking
- high birth weight
Breast Cancer Assessment/Screening
Gail Model
Breast Cancer Risk Assessment Tool
Tyrer-Cuzick Model
MOHTLC BRCA 1/2 Genetic Testing (requires eligibility)
Ontario Breast Screening Program (OBSP) (after 50yo, q2y)
Breast Cancer Screening Guidelines
CTFPHC recommends NOT screening before 40
- younger individuals have denser breasts, imaging difficult to interpret
Remember B-R-E-A-S-T mnemonic Breast mass Retraction Edema (peau d'orange) Axillary mass Skin changes/scaly nipple Tender breast
Structures of the Male Genitalia
External:
Penis
Glans penis
Scrotum
Internal: Urethra Testis Epididymis Vas deferens Prostate
Prostate Gland
surrounds bladder neck urethra
2cm behind symphysis pubis (cartilaginous joint)
Bulbourethral gland (right below, secrets clear mucus)
Subjective Assessment of Male Genitalia
a. History of present illness
b. review of system (discharge, itching, lesions, pain, testicular pain or swelling)
c. associated symptoms
d. medical history
e. personal and social history
f. family history
Objective Assessment of Male Genitalia
a. General (state of health, general appearance, colour, nutritional status)
b. Vital Signs
c. Inspection
d. Palpation
Health history of Male Genitalia
- urinary symptoms
- past genitourinary history (STIs, hernias)
- penis (pain or discharge)
- scrotum (pain or swelling)
Scrotal Assessment
- cup one testicle at a time
- examine by rolling the testicle between your thumb and fingers using slight pressure
- assess spermatic cord and epididymis
- assess irregularities between testicles
Description of Masses (Male Genitalia)
- size, contour, nodularity
- tenderness
- proximal or distal to testis
- does it reduce when supine
- transillumination (using light to illuminate for masses)
Inspect and Palpate for Hernia
Inguinal region
- palpate external inguinal ring
- palpate in femoral canal area
Palpate Prostate Gland
Press into gland ( from anus)
- size: 2.5-4cm
- heart shape, palpable groove
- smooth, rubbery, slightly movable, non-tender
Dev Considerations (Male Genitalia) - Infants and Adolescent
Infants
- testes descend along inguinal canal to scrotum
(cryptorchidism-testes not descended)
- uncircumcised/circumcised
Adolescent
Puberty around age 11
*tanner staging
Dev Considerations (Male Genitalia) - Aging Adult
- no definite end to fertility
- pubic hair decreases
- penis size decreases
- testes decreases in size, less firm
- slower and less intense sexual response
- decrease seminal volume
Testicular Cancer
Risk factors
- 15-49 yo
- undescended testicles
- family hx
Symptoms
- lump or swelling
- tenderness
- heaviness in abdomen or scrotum
Self exam: Timing, Shower, Examine changes
Prostate Cancer
Risk factors
- age >65
- family hx
- African ancestry
- diet high in fat
Symptoms
- urinary symptoms
- painful ejaculation
Subjective Assessment of Female Genitalia
a. History of present illness
b. review of system (discharge, skin changes, irritation, bleeding, pain or swelling)
c. associated symptoms
d. medical history
e. personal and social history
f. family history
Objective Assessment of Female Genitalia
a. General (state of health, general appearance, colour, nutritional status)
b. Vital Signs
c. Inspection
- skin colour, hair distribution
- vaginal opening and perineum: lesions, masses, colour, discharge, scars
d. Palpation
- mass, tenderness, swelling, discharge, pain
- Skene’s glands
- Bartholin’s glands
Structures of Female Genitalia
External: Labia majora Labia minora Clitoris Mons pubis Hymen Urethral meatus
Internal: Cervix Uterus Ovary Fallopian tube Vagina Anterior and Posterior Fornix
Health History of Female Genitalia
- menstrual hx
- obstetric hx
- menopause
- urinary symptoms
- vaginal discharge
- sexual activity
- contraceptive use
- STI
Assessment Considerations (Female Genitalia)
a. Lithotomy position
b. Maintain respect
c. Communicate
Speculum Exam
- Proper size and lubricate
2. Inspect cervix and its os
Bimanual Exam
- Cervix
- Uterus
- Adnexa
Dev Considerations (Female Genitalia) - Infant
Engorgement of external genitalia
Dev Considerations (Female Genitalia) - Pregnancy
a. Goodell’s sign: softening cervix at 206 weeks
b. Chadwick’s sign: cervix looks cyanotic
c. Hegar’s sign (ischemic of uterus softens at 6-8 weeks)
d. Uterus increases in size and capacity
Dev Considerations (Female Genitalia) - Aging Adult
- Mensus (irregular, then ceases)
- uterus and cervix shrink
- ovaries atrophy
- pelvic musculature weakens
- vagina shortens, narrows, epithelium atrophies
Cervical Cancer
Risk factors:
- sexual intercourse at early age
- multiple sex partners
- hx of STIs
- increasing age
- compromised immunity (HIV)
- HPV infection
- smoking
- low SES
Ovarian Cancer
Risk Factors:
- age >50
- hx of cancer
- family hx of ovarian or breast cancer (BRCA 1/2)
- nulliparous
- smoking
- asbestos
- obesity?
