BREAST & PELVIC EXAM

Question 1

the breast runs from the __________ to the _____________

Answer 1

clavicle to the 6th rib generally

Question 2

grape like clusters of tissue that secrete milk

Answer 2

alveoli cells

Question 3

route of milk in the breast to the nipple

Answer 3

alveoli > duct > intralobar duct > lactiferous duct & reservoir > nipple

Question 4

the breast structurally consists of ____, ______________________, & _____________

Answer 4

fat
fibrous connective tissue
glandular tissue

Question 5

role of estrogen in the breast

Answer 5

stimulates growth and proliferation of the ductile system

Question 6

role of progesterone in the breast

Answer 6

stimulates growth and development of ductile and alveolar secretory epithelium

Question 7

each breast has ______ - _________ lobes

Answer 7

15-25

Question 8

Cooper’s ligaments

Answer 8

fibrous tissue ligaments that extend from the outer boundaries of the breast to the nipple area in a radial manner (like spokes on a wheel).

Help maintain structural integrity.

Provide support to the breasts and help them maintain their shape.

They fix the breast from the skin to the pectoral fascia

Question 9

each lobe has grapelike clusters (alveoli or glands) which are connected by

Answer 9

ducts

Question 10

the alveoli are lined with __________ which produce ______________ under the proper hormonal influences

Answer 10

secretory cells

produce milk under the proper hormonal influences

Question 11

lactiferous ducts EACH communicate to the nipple

Answer 11

• The lactiferous ducts EACH communicate to the nipple - the do NOT combine to a single duct before arriving at the nipple (this is important because this allows ducts to still release milk even if one duct is blocked - therefore won’t affect entire nipple)

Question 12

Montgomery’s Tubercles

Answer 12

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

Question 13

BREAST EXAM TECHNIQUES

Answer 13

Before starting, have:

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

Question 14

LYMPH NODE PALPATION

Answer 14

⦁ make sure pt is in a comfortable position with their arm relaxed; use your other forearm to support her arm (gown can be covering the chest
⦁ don’t forget to palpate supra & infraclavicular nodes

Question 15

upon inspection of the breasts

Answer 15

• first have patient in sitting position with arms hanging loosely to the sides

⦁ inspect & compare breasts for size, symmetry, contour, skin color & texture, venous patterns, and lesions
⦁ life breasts to inspect lower & lateral aspects
⦁ inspect nipples for inversion or retraction
⦁ inspect areolas for color & contour

Question 16

inversion vs retraction of nipple

Answer 16

Inversion=tethered by single duct

Retraction= entire nipple

Question 17

reinspecting the breasts in varied positions

Answer 17

1) seated with arms flexed above head or at neck
2) seated with arms at waist and shoulders rolled forward
3) seated and leaning forward at waist

Question 18

seated & leaning forward at waist helps with

Answer 18

this can be particularly helpful in assessing contour and symmetry of large breasts

Question 19

seated with arms flexed above head helps with

Answer 19

adds tension to the suspensory ligaments and may accentuate dimpling in a pt with breast CA

Question 20

Bimanual digital palpation of the breast

Answer 20

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 21

• using a towel or small pillow is especially helpful in

Answer 21

large breasted women

Question 22

supine position (preferred) breast palpation

Answer 22

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)

Question 23

EXAM TECHNIQUES

Answer 23

• concentric circles
• lawnmower
• radial spokes

Question 24

If you discover a mass, do more than just palpation with fingerpads to delineate; Once you find a lesion,

Answer 24

try to compress the lesion between fingerpads & feel for mobility (this may be easier with the woman sitting up)

Question 25

the ___________ are more sensitive for palpation than the ___________

Answer 25

fingerpads are more sensitive than fingertips

Question 26

most nipples are

Answer 26

everted

but one or both nipples may be inverted (in these circumstances it is important to ask about lifetime history of inversion)‏

Question 27

breast shape (3)

Answer 27

• conical
• convex
• pendulous

Question 28

supernumerary nipples

Answer 28

Supernumerary nipples and tissue may arise along the “milk line”

Question 29

a good way to write a note regarding masses

Answer 29

= “no dominant masses palpable bilaterally”

Question 30

Most women have “lumpiness” referred to as

Answer 30

nodularity

Question 31

define the mass in relationship to the

Answer 31

time on the clock

Question 32

peau d’orange

Answer 32

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

Question 33

what causes peau d’orange

Answer 33

have advanced or inflammatory carcinoma, and lymph node drainage is blocked –> orange peel like appearance of breast

Question 34

Paget’s disease of the nipple

Answer 34

Paget’s disease of the nipple is a rare form of breast cancer in which cancer cells collect in or around the nipple. The cancer usually affects the ducts of the nipple first (small milk-carrying tubes), then spreads to the nipple surface and the areola

Question 35

PREPARING FOR THE PELVIC EXAM (3)

Answer 35

Empty bladder - remind the patient ahead of time to pee before coming; consider offering the patient another opportunity prior to exam

Warm speculum (but not too warm - don’t want to burn the patient)

Appropriate position; The more abducted the hips, the easier the exam. NEVER force the legs apart

Question 36

hip flexion & abduction position

Answer 36

lithotomy position

Question 37

butterfly position; legs bowed like a frog, feet touching

Answer 37

diamond shaped position

Question 38

ducts/glands between the vagina & the anus

Answer 38

Bartholin’s glands / ducts

Question 39

ducts/glands between urethral orifice & the vagina

Answer 39

Skene’s glands / ducts

Question 40

In many women, you won’t be able to inspect the labia minora well unless

Answer 40

you spread apart the labia majora

Question 41

placing the speculum

Answer 41

1) retract the labia minora laterally
2) avoid the urethra by downward pressure on the posterior vaginal introitus
3) angle the speculum about 30-40 degrees downward towards the sacral promontory - “scoop”