Breast and Axillae Exam

Question 1

When do dramatic structural changes occur to the breast?

Answer 1

At the onset of puberty and in response to the influence of sex hormones.

Question 2

What is the structural support of the breast?

Answer 2

cooper suspensory ligaments

Question 3

What influences alveolar growth within the breast?

Answer 3

Hormones: estrogen, progesterone, placental hormones

Question 4

What two hormones induce lactation?

Answer 4

prolactin

placental lactogen

Question 5

What is oxytocin?

Answer 5

A lactation hormone produced in the hypothalamus and stored in the posterior pituitary. It mediates prolactin secretion with neonatal sucking.

Question 6

What should be addressed when a pt arrives with a breast concern?

Answer 6

OLD CARTS
Onset of symptoms
Location
Duration
Character
Aggravating Factors
Associated S/S
Relieving Factors
Timing
Severity

Question 7

What should be included in a PMH of a pt with breast concerns?

Answer 7

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

Question 8

Family History for a pt with breast concerns.

Answer 8

Breast CA history
premalignant lesions
first-degree relative with ovarian or peritoneal cancer
testicular or high-grade
known BRCA1 or BRCA2 mutations

Question 9

What ethnicity is most at risk for breast CA?

Answer 9

caucasion

Question 10

What is the most common model employed to determine a patient’s risk for breast CA?

Answer 10

NIH breast cancer risk assessment tool (BCRAT)

Question 11

What is the provider looking for when inspecting the breast?

Answer 11

size, shape, contour
bulging, flattening
nipple displacement or retraction
skin dimpling
dilated superficial veins
edema
nipple asymmetry

Question 12

How is palpation of the breast performed?

Answer 12

With the woman in the supine position with one arm over her head.

Question 13

How is proper breast palpation performed?

Answer 13

using the three middle finger pads in a continuous rolling, gliding, circular motion

Question 14

What would be considered a benign mass?

Answer 14

well-defined, distinct shape, smooth, soft, rubber, mobile, nonfixed, no skin changes, scattered symmetrical tissue

Question 15

What would be considered a malignant mass?

Answer 15

indistinct, irregular borders, hard, asymmetrical texture, immobile, fixed, dimpling, edema, nipple retraction, unilateral localized thickening of tissue

Question 16

What laboratory test should be performed for a non pregnant patient with nipple discharge?

Answer 16

prolactin level

Question 17

What can large amounts of breast discharge without pregnancy be indicative of?

Answer 17

pituitary tumor

Question 18

What diagnostic imaging test is not appropriate for first-line screening for breast cancer?

Answer 18

breast ultrasound

Question 19

What is a Digital Breast Tomosynthesis (DBT)?

Answer 19

A 3D mammogram

Question 20

What is a key to recognizing an urgent need for breast evaluation?

Answer 20

lymph node assessment

Question 21

What is a fibroadenoma?

Answer 21

proliferative lesions of parenchymal/stromal tissue typically present in women <25

Question 22

What is mestalgia?

Answer 22

breast pain

Question 23

When is nipple discharge suspicious for underlying malignancy?

Answer 23

when it is unilateral, occurs spontaneously, perisists, or is clear/colorless, bloody, or serous

Question 24

___ breast masses require imaging for full evaluation.

Answer 24

ALL

Question 25

____ appearing skin changes at or near the nipple should be biopsied.

Answer 25

eczematous

Question 26

Breast tissue is ____ in young patients.

Answer 26

denser