Breast Exam

Question 1

secondary reproductive glands

Answer 1

of ectodermal modified sweat gland origin

Question 2

organs of lactation

Answer 2

contain the mammary glands

Question 3

breast tissue boundaries

Answer 3

protrudes anterior to the pectoralis major muscle and includes the axillary tail of Spence

Question 4

breast lymphatics

Answer 4

drain to the axilla; less into supraclavicular nodes

Question 5

areola

Answer 5

circular pigmented zone at the tip of the breast

Question 6

glands of montgomery

Answer 6

in the skin of the areola are sebaceous glands responsible for lubrication of the nipple

Question 7

circular and longitudinal smooth muscle bands of the nipple

Answer 7

encircle the lactiferous ducts where milk is expelled during breastfeeding

Question 8

inspection of breasts

Answer 8

examine both breasts together, uncovered

• Seated, arms at sides
• Arms over head
• Hands on hips, pectoralis engaged
• Leaning forward (for pendulous breasts)
• Inspect for skin dimpling, shadows, masses, asymmetry of breasts or nipple deviation
• Use tangential lighting to highlight abnormalities

Question 9

palpating breast related lymph nodes

Answer 9

-Palpation of the axillary and supraclavicular nodes with patient sitting, arms extended 60-90 degrees
Palpating the rest, have patient lie down
-Feeling central & pectoral nodes
-Lateral chain along the humerus
-Subscapular chain along chest wall, posteriorly
-Also include supraclavicular nodes

Question 10

palpation of breast

Answer 10

• Palpation of all quadrants of the breasts with the patient supine, with one arm over the head on each side
• Cover the breast not being examined
• Stand on the side of the patient you are examining
• Palpate using flattened fingers in either circular motion or vertical strips, in each quadrant including the tail of Spence
• Palpate under the areola and nipple and test for expression of fluid from the nipple
• Note the glandular feel of the tissue; sometimes more fibrous/dense in some individuals, making the exam more difficult
• use clock position for all circular structure

Question 11

self breast exam

Answer 11

• Has become quite controversial!
• USPSTF now makes no recommendation regarding teaching women breast self exam
• ACOG and ACS still recommend for breast self exam

Question 12

breast masses

Answer 12

-Size and location, distance from nipple
-Character: tender, hard, fluctuant, etc
-Margins/borders
Mobile or fixed
-Skin or nipple changes
-Any nodes involved

Question 13

breast cancer

Answer 13

Risk factors for breast cancer

• Being a woman
• Linear increase in age after 30
• Genetic mutation (BRCA1 or BRCA2) present in 5-10% of the population, 45-65% risk of breast ca by age 70
• Must assess risk as part of health management

Question 14

augmentation mammoplasty

Answer 14

Done several ways, technically
Usually with saline implant
Incision may be on areolar line
Sub-pectoral, or most of it
-Same exam, but you’re feeling the tissue of the breast not the implant beneath it

Question 15

breast exam checklist

Answer 15

• inspect the skin, nipples and breats with patient fully exposed, seated; arms at sides, arms over head, hands on hips, and leaning forward
• palpate the breast tissue bilaterally with patient seated, leaning forward
• palpate the breast tissue bilaterally with patient supine, arm over head; examine entire breast to clavicle and including tail of Spence
• palpate areola and nipple, and gently squeeze nipple for discharge
• palpate lymph nodes in axilla and supraclavicular areas