Breast and Axillae Exam Flashcards
When do dramatic structural changes occur to the breast?
At the onset of puberty and in response to the influence of sex hormones.
What is the structural support of the breast?
cooper suspensory ligaments
What influences alveolar growth within the breast?
Hormones: estrogen, progesterone, placental hormones
What two hormones induce lactation?
prolactin
placental lactogen
What is oxytocin?
A lactation hormone produced in the hypothalamus and stored in the posterior pituitary. It mediates prolactin secretion with neonatal sucking.
What should be addressed when a pt arrives with a breast concern?
OLD CARTS Onset of symptoms Location Duration Character Aggravating Factors Associated S/S Relieving Factors Timing Severity
What should be included in a PMH of a pt with breast concerns?
previous breast conditions (including biopsies) history of radiation trauma to chest presence of implants genetic disorders hepatic disorders hormonal disorders medications early menarche (before 12) late menopause (after 55) pregnancy, childbirth, breastfeeding history other malignancies
Family History for a pt with breast concerns.
Breast CA history premalignant lesions first-degree relative with ovarian or peritoneal cancer testicular or high-grade known BRCA1 or BRCA2 mutations
What ethnicity is most at risk for breast CA?
caucasion
What is the most common model employed to determine a patient’s risk for breast CA?
NIH breast cancer risk assessment tool (BCRAT)
What is the provider looking for when inspecting the breast?
size, shape, contour bulging, flattening nipple displacement or retraction skin dimpling dilated superficial veins edema nipple asymmetry
How is palpation of the breast performed?
With the woman in the supine position with one arm over her head.
How is proper breast palpation performed?
using the three middle finger pads in a continuous rolling, gliding, circular motion
What would be considered a benign mass?
well-defined, distinct shape, smooth, soft, rubber, mobile, nonfixed, no skin changes, scattered symmetrical tissue
What would be considered a malignant mass?
indistinct, irregular borders, hard, asymmetrical texture, immobile, fixed, dimpling, edema, nipple retraction, unilateral localized thickening of tissue
What laboratory test should be performed for a non pregnant patient with nipple discharge?
prolactin level
What can large amounts of breast discharge without pregnancy be indicative of?
pituitary tumor
What diagnostic imaging test is not appropriate for first-line screening for breast cancer?
breast ultrasound
What is a Digital Breast Tomosynthesis (DBT)?
A 3D mammogram
What is a key to recognizing an urgent need for breast evaluation?
lymph node assessment
What is a fibroadenoma?
proliferative lesions of parenchymal/stromal tissue typically present in women <25
What is mestalgia?
breast pain
When is nipple discharge suspicious for underlying malignancy?
when it is unilateral, occurs spontaneously, perisists, or is clear/colorless, bloody, or serous
___ breast masses require imaging for full evaluation.
ALL
____ appearing skin changes at or near the nipple should be biopsied.
eczematous
Breast tissue is ____ in young patients.
denser
