Block 1 - Breast Exam

Question 1

Generally describe changes in breast development and milk production during lactation

Answer 1

During pregnancy, placenta secretes high amounts of estrogen. Estrogen causes breast duct system to grow and branch. Progesterone, likewise, causes breasts to mature to milk production capability. Together they inhibit milk secretion. With loss of placenta at birth, estrogen and progesterone levels drop sharply. Prolactin, which promotes milk secretion, reaches 10x level increases at time of birth.
Summary: As estrogen/progesterone levels go down, prolactin levels go up.

Question 2

Define amastia

Answer 2

Absence of breast tissue. May be due to rare congenital abnormality or more likely a bilateral mastectomy.

Question 3

Define lactation

Answer 3

Production and release of milk by mammary glands.

Question 4

Define polymastia

Answer 4

Condition of having more than two breasts.

Question 5

Define galactorrhea

Answer 5

Lactation not associated with childbearing. Usually due to disruption of communicatoin b/t hypothalmus and pituitary glands leading to increased prolactin.

Question 6

Define mastalgia

Answer 6

Pain in the breast. Caused by hormonal fluctuations, trauma, cyst, infection.

Question 7

Define inverted nipple(s)

Answer 7

Nipple(s) that are retracted/tucked inward. Can be congenital or acquired. If acquired, can be suggetive of inflammatory or malignant tissue.

Question 8

Define everted nipple(s)

Answer 8

Nipple(s) that point outward.

Question 9

Define gynecomastia

Answer 9

Enlargement of breast tissue in males. Usually occurs at birth, briefly around puberty, or in adults >50 years old. Caused by hormonal stimulation, pituitary or testicular tumors, excess body fat, medications.

Question 10

Define Montgomery’s tubercles

Answer 10

Sebaceous glands in the areola that produce oily secretions to lubricate and protect the nipple.

Question 11

Define supernumerary nipple

Answer 11

Congenital accessory breast tissue that may or may not contain glandular tissue. Located along “milk line.” More common in blacks than whites.

Question 12

When is the most appropriate time in female menstrual cycle to perform a physical examination of the breast?

Answer 12

The week after menstruation.

Question 13

Discuss specific signs/symptoms noted during CBE: mass

Answer 13

Swelling, growth, or lump in breast tissue. Most are non-cancerous. Note characteristics (covered on another card).

Question 14

Discuss specific signs/symptoms noted during CBE: pain

Answer 14

Any tenderness, discomfort, or pain associated with breast tissue. Note temporal sequence, character (pulling, stinging, burning, aching), location on breast, radiation to axilla, relationship to menses (cyclic), and recent trauma.

Question 15

Discuss specific signs/symptoms noted during CBE: nipple discharge

Answer 15

Any fluid that seeps out of the nipple. Note character (spontaneous vs provoked), uni/bilateral, temporal sequence, color, consistency, odor, amount, associated symptoms (eg inflammation). Discuss pregnancy and lactation if pertinent.

Question 16

Discuss specific signs/symptoms noted during CBE: retraction

Answer 16

Dimpling. Pulling back of skin on breast or areola/nipple indicating inward pulling by inflammatory or malignant tissue. Note temporal sequence, severity, and associated symptoms (eg pain).

Question 17

Discuss specific signs/symptoms noted during CBE: peau d’orange

Answer 17

Dimpled condition of the skin of the breast resembling the skin of an orange. Sometimes found in inflammatory breast CA.

Question 18

Describe features of breast mass that should be included in pt’s record

Answer 18

Location: Using clock position and distance relative to nipple.
Size: Length, width, thickness (in cm).
Shape: Round, discoid, lobular, stellate, regular vs irregular.
Consistency: Firm, hard, or soft.
Tenderness
Mobility: Movable vs fixed; if fixed - to skin or underlying fascia.
Borders: Discrete vs ill-defined.
Retraction: Presence or absence of dimpling, altered contour.