Chapter 14: Breasts And Axillae Flashcards
Female physical exam
Inspect with patient seated and compare.
-Size, symmetry, contour, retractions or dimpling, skin color and texture, venous patterns, lesions, supernumerary nipples
Inspect both areolae and nipples.
-Shape, symmetry, color, smoothness, size, nipple inversion/eversion/retraction, supernumerary nipples
Reinspect breasts with patient.
-Arms extended over head or flexed behind the neck; hands pressed on hips with shoulder rolled forward; seated and leaning over; recumbent position
Perform a chest wall sweep.
Perform bimanual digital palpation.
Palpate for lymph nodes in axilla, down the arm to the
elbow, in the supraclavicular and infraclavicular areas.
Palpate breast tissue with patient supine, using light, medium, and deep pressure.
Depress the nipple into the well behind the areola.
Physical Exam Components: Males and Transgender Women
Inspect breasts.
-Symmetry, enlargement, surface characteristics
Inspect areolae and nipples.
-Shape, symmetry, color, smoothness, size, nipple inversion/eversion/retraction
Palpate breasts and over areolae for lumps or nodules.
Palpate for lymph nodes in the axilla, down the arm to the elbow, and in the supraclavicular and infraclavicular areas.
breast HPI
Breast discomfort/pain
-Temporal sequence, relationship to menses, character, associated symptoms, contributory factors, medications, breast mass/lump, temporal sequence, symptoms, changes in lump, associated symptoms, medications
Nipple discharge
-Character, associated symptoms, associated factors, medications
Breast enlargement in men
-History of hyperthyroidism, testicular tumor, Klinefelter’s syndrome; medications; prostate cancer treatment; substance abuse
PMH breast
Chronic breast diseases, genetic mutations (BRCA1/BRCA2), gender identity, previous related cancers, surgeries, risk factors for breast cancer, breast imaging history, menstrual history, pregnancy, lactation, menopause, hormonal medications, other medications
FMH breasts
Breast cancer
Other cancers
Other breast disease in female and male relatives
PMH/SMH breast
Age
Breast support while exercising
Caffeine
Breast self-awareness
Alcohol
Anabolic steroids, marijuana
hx for preg and lactating pt
Pregnant patients
-Sensations, colostrum, supportive bra, breast-feeding
Lactating patients
-Hygiene practices, breast-feeding bra, nipples, associated problems, breast-feeding routine, breast milk pumping, breast-feeding cultural beliefs, food/environmental agents that affect breast milk, medications
Hx older adult breasts
Skin irritation under pendulous breasts from tissue-to-tissue contact or from rubbing of brassiere; treatment
-Monilial dermatitis
Hormone therapy during or since menopause: name and dosage of medication; duration of therapy
Breasts inspection
Patient seated with arms hanging loosely at the sides
-Size, symmetry, and contour
-Retractions or dimpling
-Skin color and texture
-Venous patterns
-Lesions
Areolae and nipples
-Shape, symmetry, color, smoothness, size, nipple inversion/eversion/retraction
Reinspect breasts in various seated positions.
-Arms extended over head or flexed behind neck
-Hands pressed on hips with shoulder rolled forward
-Seated and leaning forward from waist
Breasts palpation
Patient in seated position
-Chest wall sweep. -Nodes should not be palpable.
-Bimanual digital palpation
-Lymph node palpation
Patient in supine position
-All areas of breast tissue for lumps or nodules
-If a breast mass is felt, note characteristics and palpate its dimensions, consistency, and mobility.
-Tail of Spence
-Nipples
Infant physical exam
Breasts enlarge after birth in boys and girls.
Result of passively transferred maternal estrogen
May persist with breastfeeding
Children and adolescent exam
Asymmetry in girls
Breast buds in boys
Gynecomastia in male adolescents
Preg and lactating pt physical exam
Pregnant patients
-Increase in size; tenderness and tingling; enlarged erect nipples; vascular spiders and striae
-Colostrum
-Coarse nodularity of breast tissue
-Dilated subcutaneous veins
Lactating patients
-Engorgement
-Clogged milk ducts
-Irritated nipples
Older adult inspection
Elongation or flattening
Hanging tissue
Smaller nipple size
Palpation OA
Fine granular glandular tissue
Thickened inframammary ridge
Smaller, flatter nipples
Inspect the Breast in the following positions:
Arms extended over head
Hands pressed against hips
Pressing hands together
Leaning forward from the waist
Chest Wall Sweep
Bimanual Digital Palpation
Palpation of Axilla for Lymph Nodes
Supine Palpation of the breast
Variations Methods for Palpation:
Vertical Strips
Concentric circle palpation
Palpate out from center in Wedge Sections
Breast abnormalities
Fibrocystic changes
Benign fluid-filled cyst formation caused by ductal enlargement
Fibroadenoma
Benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit
Malignant breast tumors
Ductal carcinoma arises from epithelial lining of ducts; lobular carcinoma originates in glandular tissue of the lobes.
Fat necrosis
Benign breast lump occurs as inflammatory response to local injury.
Intraductal papillomas/papillomatosis
Benign tumors of the subareolar ducts that produce nipple discharge
Duct ectasia
Benign condition of the subareolar ducts that produce nipple discharge
Galactorrhea
Lactation not associated with childbearing
Paget disease
Surface manifestation of underlying ductal carcinoma
Mastitis
Inflammation and infection of the breast tissue
Gynecomastia
Breast enlargement in males
Breast abnormalities in children
Premature thelarche
-Breast enlargement in girls younger than 8 years of age
-Benign in the absence of pubic and axillary hair
Clinical signs of breast cancer
Skin dimpling
Flattening of nipple
Inspection of the breasts usually begins with the patient in which position?
Lateral
Sitting
Standing
Supine
ANS: B
Rationale: Inspection begins with the patient in a sitting position with arms hanging loosely at the sides.
The anterior axillary lymph nodes would best be palpated at the:
Lateral axillary fold
Anterior axillary fold
Axilla close to the ribs
Posterior axillary fold
ANS: A
Rationale: The anterior axillary lymph nodes are located along the lower border of the pectoralis major, inside the lateral axillary fold.
A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a:
Normal finding
Sign of cancer
Skin disease
Symptom of malnutrition
ANS: A
Rationale: Montgomery’s tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage.
