Breast exam Flashcards
1
Q
Structure of the breasts? Hormonal stimulation?
A
- structurally consists of fat, fibrous, CT and glandular tissue
- estrogen stimulates growth and proliferation of ductile system
- progesterone release stimulates growth and development of ductile and alveolar secretory epithelium
2
Q
What are cooper’s ligaments? How many lobes does each breast have? What are alveoli?
A
- fibrous tissue ligaments that extend from the outer boundaries of the breast to the nipple area in a radial manner
- each breast has 15-25 lobes (each lobe has grapelike clusters (alveoli or glands) which are connected by ducts
- alveoli are lined with secretory cells capable of producing milk under the proper hormonal influences
- route to nipple - from alveoli through the duct then intralobar duct through the lactiferous duct and reservoir and out of the nipple
3
Q
Do the ducts combine into a single duct?
A
- no the lactiferous ducts each communicate to the nipple, they don’t combine to a single duct b/f arriving at the nipple - see if d/c is from 1 or multiple ducts
4
Q
What are montgomery’s tubercles?
A
- small bumps or projections on areolar surface (sebaceous glands that keep the nipple area soft and elastic)
5
Q
What should you have ready b/f starting breast exam?
A
- adequate lighting
- ruler/tape measure if needed
- small pillow or folded towel (for large breasted women)
- if nipple d/c present - guaiac testing
- pt with gown opening down back
- warm hands
6
Q
Palpating lymph nodes?
A
- make sure pts is comfy and has arm relaxed. Use your other forearm to support her arm and don’t forget to palpate supraclavicular and infraclavicular lymph nodes as well
7
Q
Inspection of breasts?
A
- pt in sitting position with arms hanging loosely by side - inspect and compare breasts for size, symmetry, contour, skin color, and texture, venous patterns, and lesions
- lift breast to inspect lower and lateral aspects
- inspect nipples for inversion or retraction
- inspect areolas for color and contour
8
Q
What other positions should you have pt do to reinspect?
A
- seated with arms over head or flexed behind neck (adds tension to suspensory ligaments and may accentuate dimpling in pt with breast CA)
- seated with hands pressed against hips with shoulders rolled forward
- seated and leaning forward from the waist, make sure you support pt’s hands (helpful in assessing contour and symmetry of large breasts)
9
Q
Bimanual digital palpation of breasts?
A
- palpation performed while pt is seated. One hand is placed, palmar surface facing up underneath breast, the other hand than palpates the tissue feeling for masses while compressing the tissue b/t fingers and flat hand
10
Q
Best position to to palpate breasts?
A
- supine
- pt 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. The breasts are then palpated individually. Extend exam peripheral to where you think is the edge of breast (clavicle, upper axilla, lateral sidewall, sternum, and lower anterior chest wall)
11
Q
Diff exam techniques?
A
- concentric circles
- radial spokes
- lawnmower
- cover the entire breast especially up into the axilla and directly over the areola and nipple, always keep palpating hand in contact with brest and use opposite hand to support tissue and assist your technique
- fingerpads are more sensitive than tips
- once finding a lesion - try to compress lesion b/t fingerpads to feel for mobility
- educate about BSE
12
Q
Normal variants of breasts?
A
- may be conical, convex or pendulous
- most nipples are everted, but one or both may be inverted (make sure to ask about lifetime hx of inversion)
- supernumerary nipples and tissue may arise along milk line
13
Q
What should be included in your note?
A
- if no masses - no dominant masses palpable bilaterally
- document absence of d/c, skin retraction/changes, nipple deformation
- document exam for lymph nodes as well
14
Q
Example of an excellent note in normal pt? How to describe mass?
A
- breasts appear symmetrical and similar in size, shape and contour, Nipples are w/o deformities or retractions, no skin dimpling, no dominant masses are palpable bilaterally. There are no palpable axillary, infraclavicular or supraclavicular lymph nodes
- if a mass - define in relationship to time of clock and distance from areola edge
- characterize mass by location, size, shape, consistency, tenderness, mobility, dlineation of borders and retraction
15
Q
What is Peau d’orange?
A
- edema of the breast which occurs from blocked lymph drainage in advanced or inflammatory carcinoma
