Breast Exam

Question 1

Describe what the following anatomical parts of the breast are:

1. Lobe?
2. Areola?
3. Milk duct?
4. Alveoli cells?

Answer 1

Question 2

1. Breast Structure consists of what? 3
2. Estrogen stimulates growth and proliferation of what?
3. ductile and alveolar secretory epithelium

Answer 2

1. Structurally consists of
   - fat,
   - fibrous connective tissue, and
   - glandular tissue
2. the ductile system
3. Progesterone release stimulates growth and development of what?

Question 3

1. What are Cooper’s ligaments?
2. Each breast has how many lobes?
3. Each lobe has grapelike clusters (called what?) which are connected to what?
4. Alveoli are lined with secretory cells capable of produing what?

5, Route of milk to the nipple? 5

Answer 3

1. Cooper’s ligaments: fibrous tissue ligaments that extend from the outer boundaries of the breast to the nipple area in a radial manner (like the spokes of a wheel)‏
2. Each breast has 15 to 25 lobes
3. Each lobe has grapelike clusters (alveoli or glands) which are connected by ducts
4. Alveoli are lined with secretory cells capable of producing milk under the proper hormonal influences
5. Route to nipple:
   - alveoli>
   - duct>
   - intralobar duct>
   - lactiferous duct and reservoir>
   - nipple

Question 4

What are the small glands or bumps that surround the nipple?

Answer 4

Areolar glands(montgomery)

Question 5

1. Talk about the lactiferous ducts and how they communicate to the nipples?
2. Why is this critical to understand clinically?
3. Montgomery’s Tubercles are what?

Answer 5

1. The lactiferous ducts EACH communicate to the nipple, they do not combine to a single duct before arriving at the nipple

2.

3. small bumps or projections on the areolar surface (these are sebaceous glands that keep the nipple area soft and elastic)‏

Question 6

Examination Techniques

Before starting what do we have to have?

6

Answer 6

1. Adequate lighting
2. Ruler/tape measure if needed
3. Small pillow or folded towel (especially helpful with large breasted women)‏
4. If nipple discharge is present, guaiac testing. (Cytology not recommended)
5. Patient with gown opening down back
6. Warm hands !!

Question 7

Lymph node palpation technique?

Which ones can we not forget to palpate? 2

Answer 7

1. Make sure patient is in a comfortable position with their arm relaxed. Use your other forearm to support her arm. (Gown can be covering chest)
2. Don’t forget to palpate supraclavicular and infraclavicular lymph nodes as well

Question 8

Breast Exam: On Inspection

1. Compare breasts for what? 7
2. What do we have to remeber when inspecting lower and lateral aspects of the breast?
3. Inspect nipples for what? 2
4. Inspect arealoas for what? 2

Answer 8

1. Inspect and compare breasts for
   - size,
   - symmetry,
   - contour,
   - skin color and
   - texture,
   - venous patterns, and
   - lesions
2. Lift breast to inspect lower and lateral aspects
3. Inspect nipples for inversion or retraction
4. Inspect areolas for color and contour

Question 9

Exam Techniques: Reinspect in Varied Positions

Such as? 3

Answer 9

1. Seated with arms over the head or flexed behind the neck (this adds tension to the suspensory ligaments and may accentuate dimpling in a pt with breast CA)‏
2. Seated with hands pressed against hips with shoulders rolled forward
3. Seated and leaning forward from the waist, make sure you support the patient’s hands (this can be particularly helpful in assessing contour and symmetry of large breasts)‏

Question 10

1. What is the preferred position for breast palpation?
2. Describe this technique?
3. What is another postion we can palpate in?
4. Describe this technique?

Answer 10

1. Supine Position (preferred)‏
2. Patient lies on back and places one arm behind her head. A small pillow or folded towel can be placed under the shoulder to spread the breast tissue more evenly over the chest wall. Breasts then palpated each individually. Extend exam peripheral to where you think is edge of breast. (Clavicle, upper axilla, lateral sidewall, sternum and lower anterior chest wall)
3. Bimanual Digital Palpation
4. Palpation performed while patient is seated. One hand is placed, palmar surface facing up, underneath the breast. The other hand then palpates the tissue feeling for masses while compressing the tissue between fingers and flat hand

Question 11

What exam technique is especially helpful in large breasted women?

Answer 11

Using a towel or small pillow is especially helpful in large breasted women

Question 12

Examination techniques for breast palpation? 3

Answer 12

Question 13

Breast palpation tips:

1. No matter which method you use, make sure to cover the entire breast tissue area, especially what?
2. Always keep _________ in contact with the breast?
3. Use the ____________ to support the tissue and assist your technique

Answer 13

1.

• up into the axilla (tail of Spence) AND
• directly over the areola and nipple
  2. palpating hand
  3. opposite hand

Question 14

What are more sensitive: fingertips or finderpads?

Answer 14

fingerpads

Question 15

Once finding a lesion, try to compress lesion between fingerpads and feel for what?

Answer 15

mobility. (may be easier with woman sitting up.)

Question 16

1. Most nipples are everted, but one or both nipples may be inverted- in these circumstances it is important to ask what?
2. Supernumerary nipples and tissue may arise along the what?

Answer 16

1. ask about lifetime history of inversion
2. “milk line”

Question 17

How to describe where the mass is on a breast?

3

Answer 17

1. Think of the breast as a clock
2. Define the mass in relationship to the “time on the clock”
3. Also, describe the distance from the areola edge

Question 18

How to describe a mass:

Characterize breast mass by what? 8

Answer 18

1. location,
2. size,
3. shape,
4. consistency,
5. tenderness,
6. mobility,
7. delineation of borders
8. retraction

Question 19

Breast cancer may cause what findings on the exam?

4

Answer 19

Skin dimpling

Flattening of the nipple

Nipple and areola retraction

Peau d’orange

Question 20

What is Peau d’orange?

Answer 20

edema of the breast which occurs from blocked lymph drainage in advanced or inflammatory carcinoma