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Patient Assessment > Breast and Axillae > Flashcards

Breast and Axillae Flashcards

1
Q

Breast nodules are often bilateral or unilateral?

A

bilateral and can occur throughout the breast

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2
Q

when does nodularity of the breast increase?

A

possibly before menses

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3
Q

is uneven breast tissue normal or abnormal

A

normal

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4
Q

extra nipples along the “milk line” that present as a small nipple/areola

A

supernumerary nipples

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5
Q

what node is most likely to be palpable

A

central nodes

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6
Q

node that is in the center of the axilla in the axillary fat, midway between A and P axillary fold

A

Central nodes

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7
Q

node located between the pectoralis minor and major muscles

A

Rotter’s nodes

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8
Q

where does the central nodes drain into

A

into the infraclavicular and supraclavicular nodes

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9
Q

where do most lymphatic vessels of the breast drain into?

A

the axillary nodes

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10
Q

what 3 groups drain into the central nodes? are they palpable

A
  1. pectoral (anterior)
  2. subscapular (posterior)
  3. lateral (humeral or deep)

no they are not palpable

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11
Q

small nipple and areola overlaying a thin disc of undeveloped breast tissue consisting of primarily ducts

A

the male breast

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12
Q

a benign breast enlargement caused by a proliferation of a palpable glandular tissue

A

gynecomastia

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13
Q

how big is the glandular tissue in gynecomastia?

A

> 2cm in size

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14
Q

what causes gynecomastia?

A
  • increased estrogen
  • decreased testosterone
  • medications (spironolactone)
  • Klinefelter syndrome
  • antipsychotics
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15
Q

common/concerning symptoms of the breast

A
  • breast lump
  • discomfort or pain
  • nipple discharge
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15
Q

accumulation of subareolar fat

A

pseudogynecomastia (man boobs)

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16
Q

what should be asked for pts with breast lump or mass?

A
  1. location
  2. how long has it been there
  3. any variation in size or with menstraution
  4. any dimpling of the skin?
  5. family history
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17
Q

MC breast mass for age 15-25 years?

A

fibroadenoma

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18
Q

smooth, rubbery, round, mobile and nontender breast mass

A

fibroadenoma

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19
Q

MC breast mass in age 25-50

A

Cyst, fibrocystic changes, cancer

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20
Q

mass that is soft/firm, round, mobile, tender

A

cysts

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21
Q

mass that is nodular and rope like

A

fibrocystic change

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22
Q

mass that is irregular, firm, mobile/fixed

A

cancer

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23
Q

MC masses in pregnant/lactating patients

A
  • lactating adenomas
  • cysts
  • mastitis
  • cancer
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24
Q

Breast pain that fluctuates with hormone changes from menstrual cycle

A

cyclic mastalgia

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25
Q

breast pain related to an internal injury or anatomical change

A

non-cyclic mastaglia

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26
Q

breast pain that is felt in the breast but originates from another location

A

Extramammary mastalgia

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27
Q

what type of pain NEEDS diagnostic imaging

A

focal

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28
Q

a discharge of milk containing fluid unrelated to pregnancy or lactation

A

galactorrhea

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29
Q

what is the MC cause of galactorrhea

A

hyperprolactinemia

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30
Q

when is nipple discharge more likely to be pathologic?

A
  • blood/serous
  • unilateral
  • spontaneous
  • with a mass
  • arising from a single duct
  • > 40yo
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31
Q

When is the best time to do a breast exam in female patients that are still menstruating

A

5-7 days after onset of menstruation

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32
Q

what are the 4 positions of breast exams

A
  1. arms at the side
  2. arms over the head
  3. hands pressed against the hips
  4. leaning forward
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33
Q

why do we do 4 different positions for breast exam

A

b/c certain positions can bring out dimpling or retraction

34
Q

thickening of the skin and prominent pores of the breast

A

Peau d’orange

35
Q

what does peau d’orange suggest?

A

breast cancer

36
Q

Nipple that points inward and is depressed below the areolar surface but can be moved out from the sulcus

A

inverted nipple

37
Q

what is a benign variant of nipple shape that can cause difficulty with breastfeeding

A

inverted nipple

38
Q

nipple that is pulled inward and is tethered by an underlying duct

A

retracted nipple

39
Q

what can a retracted nipple suggest?

A

possible underlying cancer

40
Q

what nipple variation may be depressed, flat, broad, or thickened?

A

retracted nipple

41
Q

how should the patient be positioned for a breast exam

A
  1. lying supine with their hand on their forehead
42
Q

what is the area borders of a breast exam

A

rectangular area from the clavicle to the inframammary fold and from the midsternal to the posterior axilla

43
Q

what pattern should the breast be examined in?

A

verticle strip pattern
small circles at each examining points w varying pressure

44
Q

how to describe the location of a mass

A

by quadrant of the clock with cm from the nipple

45
Q

how should the size of a mass be described

A

cm

46
Q

how should the shape of a mass be described?

A
  • round
  • cystic
  • disc-like
  • irregular contour
47
Q

how should the consistency of a mass be described

A

soft, firm, hard

48
Q

how should the boundary of a mass be described

A

delimitation
well circumscribed or not

49
Q

what are you palpating the nipple for?

A

thickening and elasticity

50
Q

firm disc of glandular enlargement, often tender

A

gynecomastia

51
Q

soft, fatty enlargement of breast from obesity

A

pseudogynecomastia

52
Q

normal nodes are

A

soft
small
non tender

53
Q

how to palpate for the axillae

A

sunder the axillae

54
Q

what should you inspect a mastectomy scar for

A
  • masses
  • unusual noduality
  • inflammation
  • infection
55
Q

should you palpate the mastectomy scar?

A

yes, gently

56
Q

where should you palpate the breast post breast reconstruction

A
  • breast tissue and incision lines
  • pay attention to the upper/outter quadrant
  • note any enlarged lymph nodes
57
Q
A
58
Q

what causes should be considered for bilateral nipple discharge?

A
  • hyperthyroidism
  • pituitary prolactinoma
  • medications
    not pregnancy
59
Q

what causes should be considered for unilateral bloody discharge?

A
  • intraductal papilloma
  • ductal carcinoma in situ
  • paget disease
60
Q

what type of discharge is usually benign

A
  • multiductal
  • clear, green or black
  • non bloody
61
Q

what is the most common solid benign tumor?

A

Fibroadenoma

62
Q

what can cause an increase in size of fibroadenoma

A

pregnancy or estrogen therapy

63
Q

what can cause a fibroadenoma to regress

A

menopause

64
Q

a fluid filled sac within the breast that is benign

A

breast cyst (common in middle aged women)

65
Q

irregular or stellate shape with firm or hard consistency mass

A

cancer

66
Q

what causes cysts that are tender/painful and palpable as nodular rope-like densities

A

fibrocystic changes

67
Q

are fibrocystic changes benign

A

yes

68
Q

painless, well circumscribed, round, mobile mass

A

fibroadenoma

69
Q

what are the visible signs of breast cancer?

A
  • retraction signs (contours, dimpling, deviation)
  • edema of the skin
  • thickened skin/enlarged pores
  • paget disease
70
Q

what is an uncommon form of breast cancer?

A

paget disease of the nipple

71
Q

where is edema first seen as a sign of breast cancer

A

in the lower portion of the breast

72
Q

scaly, eczema like lesion on the nipple that may weep, crust or erod with ulceration into the areola

A

paget disease of the nipple (starting)

73
Q

how often is an in situ/invasive ductal/lobular carcinoma present in pagets disease

A

60%

74
Q

what is the most important risk factor of female breast cancer

A

AGE

75
Q

what are the other risk factors of female breast cancer?

A
  • BRCA mutation
  • dense breast tissue
  • personal/family history
  • early menarche (<12 yo) or late menopause (>55 yo)
  • high dose radiation at a young age
76
Q

what age should breast cancer screening be started?

A

age 40

77
Q

how often should mammograms be conducted?

A

every 2 years (Biennial)

American cancer society says q1 year

78
Q

why is dense tissue a risk factor for female breast cancer

A
  • harder to detect
  • more common in dense
79
Q

what percentage of breast cancer is male pts

A

<1%

80
Q

what are risk factors of male breast cancer?

A
  • age
  • radiation
  • BRCA mutation
  • Klinefelter syndrome
  • testicular disorders
  • family history
  • alochol use
  • cirrohsis
  • diabetes
  • obesity
81
Q

when is male breast cancer typically found?

A

age 60-70

82
Q
A

Patient Assessment (20 decks)

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