Breast & axillae

Question 1

What extends from the clavicle and 2nd rib down to 6th rib and from sternum across midaxillary line, and overlies the pectoralis major and part of serratus anterior?

Answer 1

breast tissue

Question 2

What are lobules?

Answer 2

clusters of glands that form lobes, containing milk-secreted glands (tubuloalveolar) with the ducts/sinuses open on the nipple/areola

Question 3

What’s in a breast?

Answer 3

glandular tissue, fat, connective tissue, nerves, muscular tissue

Question 4

What is a lobe?

Answer 4

15-20 segments of lobules situated radially around the areola

Question 5

What’s the areola?

Answer 5

bumpy circle with sebaceous glands, sweat glands, accessory alveolar glands, that are important for breast feeding, “glands of Montgomery”

Question 6

What do nerves do in the breast?

Answer 6

cause milk let down

Question 7

How do muscles allow milk to flow?

Answer 7

contract

Question 8

What’s the milk let-down reflex?

Answer 8

release of oxytocin from of hypothalamic nuclei when nipples are stimulated

Question 9

What does the axilla have?

Answer 9

apex, base, 4 walls

Question 10

What nodes are in the axilla?

Answer 10

lateral –> central –> subscapular –> pectoral

Question 11

What should you ask about in breast history?

Answer 11

family history, OB/GYN history - age of menarche, first birth, menopause, prior breast biopsy, hormonal medications, common complaints (cyclic? pregnant? other hormones?)

Question 12

What should you ask about the breast?

Answer 12

any lumps, pain, or discharge (and further questioning)

Question 13

What is considered pathologic discharge?

Answer 13

bloody/serous, unilateral, spontaneous, associated with a mass, or in women >40 years

Question 14

How is the male breast different?

Answer 14

small nipple/areola, thin layer of undeveloped glandular ductal tissue

Question 15

What is gynecomastia?

Answer 15

enlargement of glandular tissue

Question 16

When is the breast exam done best?

Answer 16

5-7 days after menstruation

Question 17

What should you be inspecting in a breast exam?

Answer 17

full exposure – skin, size, symmetry, contour, nipples, movement

Question 18

What should you palpating in a breast exam?

Answer 18

supine –> gentle –> physiologic nodularity –> use the finger pads in small circles

Question 19

What are you looking for in palpation in breast exam?

Answer 19

consistency, tenderness, nodules/lumps/masses - size, shape, consistency, delimination, tenderness, mobility

Question 20

What type of coverage can you do?

Answer 20

spiral, radial, vertical (preferred)

Question 21

What are you looking at in the nipple?

Answer 21

elasticity/thickening of the skin, discharge

Question 22

What are warning signs in a breast exam?

Answer 22

hardness, sores that don’t heal, redness, puckered, scaly, thickened skin, inverted nipple, breast changes, leaking

Question 23

What should you consider with special exams?

Answer 23

post-mastectomy: careful inspection of scar, looking for lymphedema of upper arm

post-breast augmentation

Question 24

What are the 5 areas you need to examine on an axilla exam?

Answer 24

central, lateral, anterior axillary, apical, posterior

Question 25

How do you feel the anterior nodes?

Answer 25

grasp anterior axillary fold with thumb and fingers, w/ fingers, palpate inside border of pectoral muscle

Question 26

How do you feel lateral nodes?

Answer 26

feel along upper humerus high in axilla

Question 27

How do you feel posterior nodes?

Answer 27

from behind patient, feel inside muscle of posterior axillary fold

Question 28

What are breast cancer risk factors?

Answer 28

family hx, known gene mutation, prior breast biopsy w/ specific pathology, early menarche, late menopause, nulliparity, prolonged interval between menarche and 1st pregnancy, menopausal hormone therapy, not breastfeeding, increasing age, certain ethnicities, higher BMI, alcohol consumption, smoking, dense breasts, prior exposure to high-dose therapeutic chest irradiation in young women

Question 29

When should screening for women with family history start?

Answer 29

10 years before known family onset

Question 30

What are risk factors of male breast cancer?

Answer 30

age, radiation exposure, BRCA gene mutations, Klinefelter syndrome, testicular disorders, alcohol use, liver disease, diabetes, obesity

Question 31

Male breast cancer are usually found at a more ____ stage

Answer 31

advanced

Question 32

T/F: Men with a BRCA1/2 inherited gene mutation should get breast cancer screening

Answer 32

true

Question 33

What should men with BRCA1/2 inherited gene mutation starting at 35?

Answer 33

clinical breast exam every year, learn how to do self-exam, consider mammography every year starting at age 50 or starting 10 years before earliest in family

Question 34

What are imaging techniques?

Answer 34

mammogram - routine vs diagnostic, difficult w/ dense breast tissue

US- cyst or solid

MRI- not routine