Ch. 18 Breasts, Axillae, & Regional Lymph Nodes

Question 1

What types of tissue compose the breast?

Answer 1

Glandular tissue, fibrous tissue, adipose tissue

Glandular tissue is responsible for milk production, while fibrous tissue provides support and adipose tissue contributes to the breast’s shape.

Question 2

How many lobes does the glandular tissue of the breast contain?

Answer 2

15 to 20 lobes

These lobes radiate from the nipple and are composed of smaller structures called lobules.

Question 3

What do lobules in the breast contain?

Answer 3

Alveoli

Alveoli are responsible for producing milk.

Question 4

What are Cooper’s Ligaments?

Answer 4

Fibrous bands extending vertically from surface to attach on chest wall muscles

They function to support breast tissue.

Question 5

What is the function of lobes in the breast?

Answer 5

To produce milk

Lobes are embedded in adipose tissue and contain lobules.

Question 6

How can the breast be divided?

Answer 6

Into four quadrants by imaginary horizontal and vertical lines intersecting at the nipple

This division helps in identifying the location of tumors.

Question 7

Which quadrant of the breast is the site of most breast tumors?

Answer 7

Upper outer quadrant

This area is clinically significant for breast cancer diagnosis.

Question 8

What are the main components of breast anatomy?

Answer 8

Breast is composed of:
* glandular tissue
* fibrous tissue, including suspensory ligaments
* adipose tissue (fat)

Glandular tissue contains 15 to 20 lobes radiating from the nipple, composed of lobules.

Question 9

What is the function of Cooper’s Ligaments?

Answer 9

Cooper’s Ligaments function to support breast tissue.

These are fibrous bands extending vertically from the surface to attach on chest wall muscles.

Question 10

How can the breast be divided for examination?

Answer 10

Breast may be divided into four quadrants by imaginary horizontal and vertical lines intersecting at the nipple.

The upper outer quadrant is the site of most breast tumors.

Question 11

Where does most lymphatic drainage from the breast occur?

Answer 11

Most of this lymph drainage drains into the axilla.

Four groups of axillary nodes are present: central, pectoral, subscapular, and lateral.

Question 12

What changes occur in the breasts of nonpregnant women throughout the menstrual cycle?

Answer 12

Breasts feel more nodular from midcycle to start of menstruation and may feel full, tight, heavy, and tender 3-4 days prior to menstruation.

Smallest volume occurs on days 4-7 of the cycle.

Question 13

When is the best time to perform breast self-examination (BSE) for nonpregnant women?

Answer 13

Best time to perform BSE is day 4 of the cycle or immediately after the cycle.

Postmenopausal women can perform BSE any day of the month on the same day each month.

Question 14

What happens to breast tissue after menopause?

Answer 14

After menopause, ovarian secretion of estrogen and progesterone decreases, causing breast atrophy.

This leads to decreased breast size and drooping of breasts.

Question 15

What is gynecomastia?

Answer 15

Gynecomastia is the temporary enlargement of breast tissue in adolescent males.

Condition is usually unilateral and temporary.

Question 16

What are the key risk factors for breast cancer?

Answer 16

Key risk factors include:
* Family history
* Ethnicity
* Occupational risk factors
* BRCA 1 and BRCA 2 mutations
* Socioeconomic factors
* Modifiable risk factors (e.g., alcohol consumption, obesity)

Ashkenazi Jewish women have a higher risk for mutations.

Question 17

What is the recommendation for mammogram screening for women of average risk?

Answer 17

Women should receive annual screening by age 45 and preferably annually from ages 40-44.

Biennial mammography is recommended over age 55 or continuation of annual screening.

Question 18

What subjective data should be obtained regarding breast pain?

Answer 18

Questions include:
* Onset of pain
* Location
* Is it localized or diffuse?
* Is there a burning or pulling sensation?
* Relation to menstrual cycle?

Also inquire about precipitating factors like activity changes.

Question 19

What characteristics should be assessed for a breast lump?

Answer 19

Assess:
* Location
* Size
* Shape
* Consistency
* Movability
* Distinctness
* Nipple status
* Tenderness
* Lymphadenopathy

Document using a clock face for location.

Question 20

What are the characteristics of a cancerous breast mass?

Answer 20

Characteristics include:
* Nontender
* Hard
* Dense
* Immobile
* Irregular border

These features are important for differential diagnosis.

Question 21

What should be included in teaching breast self-examination (BSE)?

Answer 21

Teach:
* Correct technique
* Rationale for examination
* Expected findings

Encourage palpation while lying supine and using soap and water in the shower.

Question 22

Why is it important to assess male breasts?

Answer 22

Men are at risk for breast cancer, and examination is necessary despite the normal male breast having a flat disk of undeveloped tissue.

Gynecomastia can occur in males, particularly during puberty.

Question 23

What is the recommended sequence for breast assessment?

Answer 23

Assess in the following sequence:
* Inspect general appearance
* Inspect skin
* Check nipple
* Palpate axilla
* Palpate breast

Palpate unaffected breast first to compare.

Question 24

What are the four groups of axillary nodes?

Answer 24

• Central axillary nodes
• Pectoral (anterior)
• Subscapular (posterior)
• Lateral

Question 25

What hormonal changes affect breast tissue in nonpregnant women?

Answer 25

Breasts feel more nodular and may exhibit fullness, tightness, and tenderness due to hormonal fluctuations during the menstrual cycle.

Question 26

What changes occur in the breasts of aging women after menopause?

Answer 26

Decreased secretion of estrogen and progesterone leads to breast atrophy and a decrease in breast size, making inner structures more prominent.

Question 27

What is the second major cause of cancer death in women?

Answer 27

Breast cancer ## Footnote Early detection and improved treatment have increased survival rates.

Question 28

What does a relative risk (RR) above 1 indicate?

Answer 28

A higher likelihood of occurrence among exposed persons compared to unexposed persons.

Question 29

At what age should average-risk individuals start annual mammogram screenings?

Answer 29

40-44 years of age, preferably annually ## Footnote Everyone should receive annual screening by age 45.

Question 30

What are common subjective data questions regarding breast pain?

Answer 30

* Any pain or tenderness in breasts? * Onset of pain? * Location of pain? * Is the painful spot sore to touch?

Question 31

What should be assessed when a lump is reported in the breast?

Answer 31

* Location * Onset * Changes since first noticed * Relation to menstrual period * Changes in overlying skin

Question 32

What characteristics should be noted when assessing nipple discharge?

Answer 32

* Onset * Medications taken * Color * Consistency * Odor

Question 33

What should be included in the assessment of a rash on the breast?

Answer 33

* Appearance * Onset * Location of rash

Question 34

What is a key consideration when examining a patient?

Answer 34

Be sensitive to the patient's feelings, as many women may feel embarrassed during breast examinations.

Question 35

What equipment is necessary for a physical exam of the breasts?

Answer 35

* Small pillow * Ruler marked in centimeters * Pamphlet or teaching aid for breast self-examination (BSE)

Question 36

What is the significance of the lactiferous ducts around the nipple in aging women?

Answer 36

They become more palpable and feel firm and stringy due to fibrosis and calcification.

Question 37

True or False: Male breasts develop significantly during puberty.

Answer 37

False ## Footnote Male breast tissue remains undeveloped, but gynecomastia can occur temporarily.

Question 38

What should be noted about the general appearance of the breasts?

Answer 38

Symmetry of size and shape; slight asymmetry is common.

Question 39

What are the normal characteristics of breast skin?

Answer 39

Smooth and of even color; no edema present.

Question 40

What skin abnormalities should be noted during breast inspection?

Answer 40

Localized areas of redness, bulging, dimpling, skin lesions, focal vascular pattern.

Question 41

What is a common vascular pattern visible during pregnancy?

Answer 41

Fine blue vascular network.

Question 42

What are pale linear striae?

Answer 42

Stretch marks that follow pregnancy.

Question 43

What does dimpling indicate in breast tissue?

Answer 43

Thickening and scarring of breast tissue leading to contraction of suspensory ligaments.

Question 44

What is nipple retraction?

Answer 44

Inward pulling of the nipple due to fibrosis.

Question 45

What is peau d’orange?

Answer 45

Skin resembles an orange peel appearance due to cancer infiltration and edema.

Question 46

What does fixation of the breast indicate?

Answer 46

Asymmetry, distortion, and decreased mobility when elevating the arm; may indicate cancer fixation.

Question 47

What is indicated by deviation in nipple pointing?

Answer 47

Nipple is pulled toward a cancerous mass due to fibrosis.

Question 48

What should be observed in the axillary and supraclavicular regions during inspection?

Answer 48

Bulging, discoloration, or edema.

Question 49

What is the expected symmetry of the nipples?

Answer 49

Should be symmetric on the same plane on both breasts.

Question 50

What is considered normal regarding nipple inversion?

Answer 50

Can be unilateral or bilateral; usually can be pulled out.

Question 51

What should be checked for during nipple inspection?

Answer 51

Dry scaling, fissures, ulceration, bleeding, or discharge.

Question 52

What is a supernumerary nipple?

Answer 52

A normal variation of nipple presence. | A third nipple present in addition to two normal nipples

Question 53

What sequence of maneuvers should be performed to check for skin retraction?

Answer 53

Lift arms overhead, push hands on hips, and lean forward.

Question 54

How should the axillae be examined?

Answer 54

Inspect skin for rash or infection; palpate while the woman's arm is relaxed.

Question 55

What is the recommended palpation pattern for breast examination?

Answer 55

Vertical strip pattern.

Question 56

What are the two other common palpation patterns for breast examination?

Answer 56

* Palpating from the nipple outward like spokes on a wheel.* Palpating in concentric circles.

Question 57

How does normal breast tissue feel in nulliparous women?

Answer 57

Firm, smooth, and elastic.

Question 58

How does breast tissue feel after pregnancy?

Answer 58

Softer and looser.

Question 59

What is a normal response to premenstrual engorgement?

Answer 59

Breast tissue may feel engorged due to increasing progesterone.

Question 60

What should be noted when palpating the nipple?

Answer 60

Induration or subareolar mass.

Question 61

What should be done if a woman reports spontaneous nipple discharge?

Answer 61

Press areola inward with index finger and note color and consistency.

Question 62

What should be examined first if a woman mentions a breast lump?

Answer 62

The unaffected breast to establish a baseline of normal consistency.

Question 63

What is the main principle of teaching in breast self-examination?

Answer 63

The simpler the plan, the more likely the person is to comply.

Question 64

What technique should a woman use to inspect her own breasts?

Answer 64

Inspect in front of a mirror while disrobed to the waist.

Question 65

What is the recommended starting point for breast palpation at home?

Answer 65

In the shower, where soap and water assist palpation.

Question 66

What position should breast palpation be performed in after the shower?

Answer 66

While lying supine.

Question 67

What should a healthcare provider do while a woman palpates her own breasts?

Answer 67

Monitor her technique.

Question 68

What additional tools can aid in teaching breast self-examination?

Answer 68

A model for return demonstration and pamphlets.

Question 69

Why should the examination of male breasts not be omitted?

Answer 69

Men are at risk for breast cancer.

Question 70

What is the normal appearance of a male breast?

Answer 70

A flat disk of undeveloped breast tissue beneath the nipple.

Question 71

What is gynecomastia?

Answer 71

Benign growth of breast tissue, distinguishable from other chest wall tissues.

Question 72

How does gynecomastia feel upon examination?

Answer 72

It feels like a smooth, firm, movable disk.

Question 73

When does gynecomastia typically occur?

Answer 73

Normally during puberty and is temporary.

Question 74

What should be emphasized to an adolescent experiencing gynecomastia?

Answer 74

This change is normal, common, and temporary.

Question 75

What are the key components to assess when examining breasts?

Answer 75

* Inspect general appearance * Inspect skin * Inspect nipple for retraction * Palpate axilla * Palpate in circular or vertical pattern * Palpate nipple for discharge

Question 76

What technique should be used for large, pendulous breasts?

Answer 76

Bimanual technique.

Question 77

What should be done when comparing affected and unaffected breasts?

Answer 77

Palpate the unaffected breast first.

Question 78

What is a key educational point for patients regarding breast health?

Answer 78

Teach patients how to perform monthly self breast exams.