breast and axillae exam 3

Question 1

gynecomastia

Answer 1

Some men develop benign breast enlargement from gynecomastia, a proliferation of palpable glandular tissue generally defined as more than 2 cm, or pseudogynecomastia, an accumulation of subareolar fat. Causes of gynecomastia include increased estrogen, decreased testosterone, and medication side effects

Question 2

common or concerning symptoms of breast exam

Answer 2

Breast lump or mass Breast discomfort or pain Nipple discharge

Question 3

medications associated with breast pain

Answer 3

hormone replacement therapy; psychotropic drugs such as selective serotonin reuptake inhibitors; and haloperidol spironolactone, and digoxin

Question 4

The best time for breast examination in a patient who is still menstruating is

Answer 4

5 to 7 days after the onset of menstruation because breasts tend to swell and become more nodular before menses from increasing estrogen stimulation. For postmenopausal women and for men, any time is appropriate

Question 5

breast exam performance recs

Answer 5

It is advisable that you adopt a standardized approach, especially for palpation, and to use a systemic up-and-down search pattern, varying palpation pressure, and a circular motion with the fingerpads in the breast examination

Question 6

key components of breast exam

Answer 6

In women:
-Inspect the breasts in four views: arms at sides, arms over head, arms pressed against hips, and leaning forward (skin appearance, size, symmetry, contour, nipple characteristics).
-Palpate the breasts (consistency, tenderness, nodules, nipple for color, consistency, and quantity of any discharge).
-Inspect the axillae (rash, irritation, infection, unusual pigmentation).
-Palpate the axillary nodes (size, shape, delimitation, mobility, consistency, and any tenderness).

In men:
-Inspect the nipple and areola (nodules, swelling, ulceration).
-Palpate the areola and breast tissue (nodules)

Question 7

Thickening and prominent pores (peau d’orange) suggest

Answer 7

breast cancer

Question 8

Eczematous changes with rash, scaling, or ulceration on the nipple extending to the areola occurs in

Answer 8

Paget disease of the breast, associated with underlying ductal or lobular carcinoma

Question 9

Cancers with fibrous strands attached to the skin and fascia over the pectoral muscles may cause

Answer 9

inward dimpling of the skin during muscle contraction.

Question 9

how long does a thorough exam take for each breast?

Answer 9

3 min per breast

Question 10

currently the best validated technique for detecting breast masses

Answer 10

the vertical strip pattern

Question 11

Tender subareolar cords suggest

Answer 11

mammary duct ectasia, a benign but sometimes painful condition of dilated ducts with surrounding inflammation and, at times, with associated masses.

Question 12

nonpuerperal galactorrhea

Answer 12

Milky discharge unrelated to a prior pregnancy and lactation

Question 13

axillary nodes that suggest malignancy

Answer 13

Nodes that are large (≥1 to 2 cm) and firm or hard, matted together, or fixed to the skin or underlying tissues

Question 14

aspects of the gail model for determining breast cancer risk

Answer 14

incorporates age, race/ethnicity, personal history of breast cancer or ductal or lobular carcinoma in situ, chest radiation, genetic mutations, first-degree relatives with breast cancer, previous breast biopsy results, age at menarche, and age at first delivery

Question 15

retraction signs of breast cancer

Answer 15

As breast cancer advances, it causes fibrosis (scar tissue). Shortening of this tissue produces dimpling, changes in contour, and retraction or deviation of the nipple. Other causes of retraction include fat necrosis and mammary duct ectasia.