Breasts

Question 1

Current recommendations regarding self-breast exams (SBE)

Answer 1

USPSTF - not recommended ACA - not recommended ACOG - encourage breast self-awareness

Question 2

Current USPSTF recommendations regarding breast cancer screening

Answer 2

Mammography

50 to 74 - biennially

<50 individualize screening - pt specific

>/=75 insufficient evidence

CBE - >/= 40, insufficient evidence

Question 3

Seven characteristics of a breast nodule that should be described

Answer 3

• Location - by quadrant or o’clock - w/ cm from nipple
• Size - in cm
• Shape - round or cystic, disc-like, or irregular
• Consistency - soft, firm, hard
• Delimitation - well circumscribed or not
• Tenderness
• Mobility - in relation to the skin, pectoral fascia, and chest wall; gently move the breast near the mass and watch for dimpling

Question 4

A smooth, rubbery, round, mobile, non-tender breast mass

Answer 4

Fibroadenoma (age 15-25)

Question 5

A soft or firm, round, mobile and often tender breast mass in a 38 year old female.

Answer 5

Cyst (age 30-50)

Question 6

Your 68 year old female patient has an irregular, firm, non-tender breast nodule that is not clearly delineated from surrounding tissue.. you suspect:

Answer 6

Breast cancer until ruled out

Question 7

What are some visible signs of breast cancer?

Answer 7

• Redness
• Skin thickening - peau d’orange sign
• Prominent pores
• Flattening
• Asymmetry/change in nipple direction
• Eczematous changes w/ rash, scaling, or ulceration
• Nipple retraction - may be depressed, flat, broad, or thickened
• Abnormal contours

Question 8

Milky nipple discharge unrelated to pregnancy or lactation

Answer 8

Galactorrhea - more likely to be pathologic if bloody or serous, unilateral, spontaneous, associated w/ a mass, and occurring in women >/= 40yrs

Question 9

Nipple discharge that is usually bilateral, multi-ductal, prompted by stimulation and ranges in color from white to yellowish, green or black indicates what?

Answer 9

physiologic nipple discharge (normal)

Question 10

What are considered normal findings in the breasts of newborns?

Answer 10

Often enlarged, both in males and females from maternal estrogen effect - this may last several months Breasts may be engorged w/ a white liquid which may last 1 to 2 weeks

Question 11

Current ACA (Amer. Cancer Society) recommendations for breast cancer screenings

Answer 11

Mammo

40y - 45y- optional annual screening

45y - 54y- annual screening

>/= 55 - biennial screening w/ option to continue annual screens - continue if health/life expectancy >/= 10 years

CBE Not recommended

Question 12

How to assess the lateral portion of the breast

Answer 12

Hand on forehead with shoulders against the bed (flattens tissue)

Question 13

What is premature thelarche?

Answer 13

Breast development in a girl, most often between 6mo and 2yrs without other signs of puberty or hormone abnormalities

Question 14

Padet Disease of the Nipple

Answer 14

a scaly, eczema-like lesion on the nipple that may weep, crust, or erode

Question 15

Breast mass in a patient age 25-50, consider

Answer 15

Cyst

Question 16

What is the most important risk factor for developing breast cancer?

Answer 16

The most important risk factor is AGE - other risk factors include family hx and ovarian CA

Question 17

Your 61-year-old female patient presents with a chief complaint of spontaneous, unilateral bloody nipple discharge. As her FNP, you know this warrants further evaluation for:

Answer 17

Intraductal papilloma

Question 18

Benign breast development in men

Answer 18

gynecomastia

Question 19

A breast mass in a female age 50 or older is always considered this until proven otherwise

Answer 19

Breast cancer

Question 20

Breast mass in a patient age 15 to 25, consider

Answer 20

Fibroadenoma

Question 21

How to assess the medial portion of the breast

Answer 21

Hand on neck with shoulders against the bed

Question 22

Current ACOG (Amer. Colleg of OB/GYN recommendtions for breast cancer screenings

Answer 22

Mammo

>/= 40y- annually

CBE

20y-39y every 1-3 years

>/= 40 - annually

Question 23

Describe the location of the following breast mass

Answer 23

3cm mass in the upper outer quadrant of the left breast at 1 o’clock, approximately 2cm from the nipple

Question 24

A 40yo female presents with a single, round, soft, well-deliniated, mobile, tender breast mass. What is the most likely diagnosis?

Answer 24

Breast Cyst

Question 25

An uncommon form of breast cancer that causes crusting, weeping and erosion of the nipple and/or areola

Answer 25

Paget’s disease