Breast and Male GU Assessment (complete)

Question 1

Montgomery’s glands

Answer 1

Areola surrounds nipples contain small elevated
sebaceous gland.
secrete protective lipid material
during lactation

Question 2

Breast is composed of: (3)

Answer 2

 Glandular tissue
 Fibrous tissue including suspensory ligaments
 Adipose tissue

Question 3

Glandular tissue contains (lobes #)

Answer 3

15 to 20 lobes radiating
from nipple, and these are composed of lobules

Question 4

most breast tumors found…where? First like spot and second likely spot

Answer 4

Upper outer quadrant-axillary tail of Spence
#2 Inner lower quadrant of breast

Question 5

Upper outer quadrant called

Answer 5

Tail of spence

Question 6

What simulates breast changes?

Answer 6

Estrogen

Question 7

Developmental considerations (adolescents)
Breast development begins around…
period starts when

Answer 7

8-9 years old for african american
10 years old white girls
Period starts 2 years after breast development

Question 8

Developmental considerations (pregnancy) Breast changes

Answer 8

Breast changes start during the second month of pregnancy
-enlargement, more nodular, nipples are larger, darker and more erectile.

Question 9

Developmental considerations (pregnancy) - colostrum/lactation

Answer 9

Colostrum may be expressed after 4th month.
-thick yellow fluid-precursor for milk
- contains same amount of protein and lactose but no fat
-Lactation: begins 1-3 days post partum

Question 10

Developmental Considerations: Older Woman

Answer 10

Post menopause
- estrogen and progesterone secretion decreases causing breasts to decrease in size
-inner structures more prominent/ lumps finally palpable
- any changes should = follow up in care
-Breasts look pendulous, flat and saggy
-Nipples could be retracted but can be pulled back out
-When palpating- breasts feel more granular

Question 11

Breast cancer

Answer 11

Lower risk: Asian, Hispanic, and American Indian women

Question 12

Focused questions: Subjective

Answer 12

Pain, lump/mass, swelling, discharge, rash, trauma, Hx breast disease (family or self), surgery (implants), self-care behavior, Perform self-breast exam?, Last mammo?,
Axilla: swelling, tenderness, lump, rash

Question 13

Focused Questions: breast (Pain)

Answer 13

Pain:
Where (point to it)
burning or pulling sensation?
Is pain cyclical/ related to menses?
Brought on by strenuous activity, especially involving one arm, underwire, sex etc

Question 14

Focused Questions: breast (Lump)

Answer 14

Lump or thickening? Where? when did you notice it? any changes?
Cyclical?
Skin changes- warmth, redness, swelling, DIMPLING?
Discharge-
From nipple? when? color/ odor/ consistency? (get specimen container if necessary)

Question 15

Focused Questions: breast (Rash/swelling)

Answer 15

Rash-
When did you notice? Where did it start? nipple, areola, surrounding skin
Swelling
one spot or all over?
Cyclical/pregnancy/breastfeeding related?
Changes in bra size

Question 16

Focused Questions: breast (Trauma/Hx breast disease)

Answer 16

Any trauma or injury to breasts? Did it result in swelling/lump/break in skin?
Hx of breast disease:
Self or family?
Type and diagnosis?
When?

Question 17

How often to get a mammogram/ clinical breast exam

Answer 17

age 20-39 years- clinical breast exam every 3 years
after 40: annual

Question 18

Inspection (patient supine)

Answer 18

-Symmetry and size of breasts
-SLIGHT asymmetry (often L larger)
Skin- smooth and skin homogenous
shouldn’t be any edema or localized areas of redness, bulging, dimpling, lesions, or focal vascular pattern.

Question 19

Inspection (Nipple)

Answer 19

Should be symmetrical, on same plane.
some nipples may be flat or inverted (can be easily pulled out)
Note any dry scaling, fissure or ulceration, bleeding, discharge

Question 20

supernumerary

Answer 20

3rd nip
along the “milk line” on abdomen

Question 21

Assessment (patient seated)

Answer 21

inspect axillae.
-Lift womans arm and support it so that muscles are loose and relaxed.
-Note any rashes or infection
-Reach fingers high into axilla, move them FIRMLY down in 4 directions

Question 22

Which pattern is most common to detect breast mass, currently?

Answer 22

• Vertical strip pattern

Question 23

How to do the vertical strip pattern

Answer 23

-Use pads of first 3 fingers
-Arm over head to flatten breast
-start high in axila-palpate down to lateral breast
overlap vertical lines ending
at sternal edge

Question 24

Normal breast should be..(3)

Answer 24

smooth, firm, elastic

Question 25

Premenstrual breasts

Answer 25

engorgement, slightly enlarged

Question 26

If patient mentions a lump…

Answer 26

examine the unaffected breast first for baseline

Question 27

Signs and symptoms of breast cancer (8)

Answer 27

Irregular shape
firm to stony hard
poorly defined (no clear margins)
single in number
fixed, non mobile
usually non tender
positive skin retraction
constant growth

Question 28

S/S of advanced BC (BREAST)

Answer 28

B.R.E.A.S.T
Breast mass
Retration
Edema
Axillary Mass
Scaly nipple
Tender breast

Question 29

Best time to do a SBE

Answer 29

right after period

Question 30

Gynecomastia

Answer 30

Male growth of breast tissue-
during puberty
-normal and temporary

Question 31

Inspect Male GU: scrotum/testes

Answer 31

No lesions
Scrotum
-asymmetry is normal
-Contents should slide easily
-Testes: oval, firm, rubbery, smooth, equal, freely movable.

Question 32

Scrotum: structure and funciton

Answer 32

Loose protective sac; continuation of abdominal wall
after puberty- scrote skin deeply pigmented and has large sebaceous follicles
- scrotal wall consists of thin skin lying in folds, or rugae, and underlying cremaster of muscle

Question 33

Scrotal septum

Answer 33

inside scrotum and separates sac into halves. Each contains a testi.

Question 34

Spermatic cord

Answer 34

suspend the testes.
L teste is longer because L spermatic cord is longer

Question 35

Developmental Considerations: Infants

Answer 35

Testes develop in abdominal cavity
only get slightly larger until puberty happens

Question 36

Developmental Considerations: Adolescents

Answer 36

Puberty begins between ages of 9½ and 13½
First sign is enlargement of testes
Next, pubic hair appears, then penis size increases
Complete change in development from preadolescent to adult takes around 3 years, although normal range is 2 to 5 years

Question 37

Developmental Considerations: Adult and aging men

Answer 37

Testosterone production declines after age 55 to 60 years

Pubic hair decreases and penis size decreases
Scrotal contents hang lower, rugae decrease, and scrotum becomes pendulous
Testes decrease in size and are less firm to palpation

Question 38

Assessment: Inspect and palpate scrotum

Answer 38

-Inspect scrotum as male holds penis out of the way; alternatively, you hold penis out of the way with back of your hand
-Scrotal size varies with ambient room temperature; asymmetry is normal, with left scrotal half usually lower than right
-Spread rugae out between your fingers, lift sac to inspect posterior surface
-Normally, no scrotal lesions are present, except commonly found sebaceous cysts; these are yellowish, 1-cm nodules that are firm, nontender, and often multiple

Question 39

Assessment: Inspect and palpate scrotum

Answer 39

Palpate gently each scrotal half between your thumb and first two fingers
Palpate each spermatic cord between your thumb and forefinger, along its length from epididymis up to external inguinal ring

Question 40

Testicular cancer most common between ages..?

Answer 40

20-35

Question 41

T;S;E

Answer 41

T: timing, once a month
S: shower, warm water relaxes scrotal sac
E: examine, check for and report changes immediately