Class notes breast/lymph

Question 1

What is the site of most breast tumors?

Answer 1

upper outer quadrant is site of most breast tumors.

Question 2

Breast has an extensive lymphatic drainage; most (75%) drain into what side?

Answer 2

ipsilateral side.

Question 3

What are the 4 groups of axillary lodes?

Answer 3

Central axillary
Pectoral (anterior)
Subscapular (posterior)
Lateral

Question 4

in the adolescent mean age of onset breast development is: (caucasian & a. american)

Answer 4

mean age 8-9 (African American); 10 (Caucasian)

Question 5

Now—onset of breast development is earlier or later?

Answer 5

earlier.

Question 6

early breast development linked to:

Answer 6

greater BMI and reflects rise in obesity in U.S.

Question 7

Beginning of breast development precedes menarche by how many years?

Answer 7

2 years.

Question 8

Pregnant woman: after 4 months—what may be expressed in the breast?

Answer 8

colostrum

Question 9

how long can colostrum be expressed in the pregnant woman after birth?

Answer 9

until 1st few days after delivery.

Question 10

Colostrum rich with _____?

Answer 10

antibodies

Question 11

Changes to nipples during pregnancy:

Answer 11

areolae larger, darker

Question 12

Aging adult: after menopause—ovarian secretion of what hormones are decreased.

Answer 12

estrogen and progesterone

Question 13

Breast glandular tissue atrophies, replaced by what type of tissue?

Answer 13

fibrous connective tissue.

Question 14

Decreased ____, _____ in breast in aging adult

Answer 14

size and elasticity

Question 15

Drooping in aging adult breast—accentuated by what in some older women.

Answer 15

kyphosis

Question 16

Breast lumps may also be more or less palpable in aging adult?

Answer 16

more

Question 17

Male breast: during adolescence—temporary enlargement is called what?

Answer 17

gynecomastia

Question 18

Gynecomastia may also occur in aging males as a result of what deficiency?

Answer 18

testosterone deficiency

Question 19

Tumor suppressor genes are called ____, ____ affecting breast cancer

Answer 19

BRCA1 , BRCA2

Question 20

BRCA1 & BRAC2 mutation increases risk for developing what type of cancers?

Answer 20

breast and ovarian cancers.

Question 21

3 reasons women would be least likely to have had a mammogram:

Answer 21

Less than a high school education
No health insurance
Recent immigrant

Question 22

Pain: assess for:

Answer 22

PQRST

Question 23

Common pain to assess for:

Answer 23

cyclical pain

Question 24

Assess for lump:

Answer 24

how long have you had it?

Question 25

Assess for relationship of lump to:

Answer 25

menstrual cycle

Question 26

Assess for discharge in breast:

Answer 26

color, consistency, odor

Question 27

Assess for rash in breast:

Answer 27

Where did it start?

Question 28

If rash involving nipple—think about what disease?

Answer 28

Paget’s disease

Question 29

Assess for swelling of breast:

Answer 29

local or generalized? May be related to menstrual cycle, pregnancy, breastfeeding.

Question 30

Assess for trauma in breast:

Answer 30

can sustain a hematoma from blunt trauma.

Question 31

Assess history of breast disease:

Answer 31

Increased risk of breast cancer with past history breast cancer. Need to know relatives and their age at diagnosis of breast cancer.

Question 32

Some have what type of breasts? (which may make breast exam difficult)

Answer 32

Some have lumpy breasts (benign)

Question 33

Assess for surgery/radiation by asking:

Answer 33

Has the client had a breast biopsy, breast surgery (partial mastectomy; mastectomy)?

Question 34

what medications increases risk for breast cancer?

Answer 34

Oral contraceptive use; combined hormonal therapy after menopause

Question 35

What to assess in axilla?

Answer 35

assess for tenderness, swelling, lump.

Question 36

What 3 screening exams should you ask about:

Answer 36

Screening exams: ask about BSE, CSE, mammograms.

Question 37

Who would you teach about normal breast changes.

Answer 37

adolescents and pregnant women

Question 38

Is slight asymmetry normal in general appearance of breasts?

Answer 38

yes

Question 39

What do you inspect the breast for?

Answer 39

Redness, heat, vascular pattern (normal in pregnancy). | Edema—exaggerates hair follicles

Question 40

“orange peel” look is called:

Answer 40

"peau d’orange" occurs with edema in breast

Question 41

Assess axilla for:

Answer 41

edema, discoloration.

Question 42

Assess nipples for:

Answer 42

assess for discharge, nipples usually protrude

Question 43

Have client lift arms over her head and assess for:

Answer 43

assess for retraction; note lag in movement in one breast; note dimple or puckering.

Question 44

Axilla palpation:

Answer 44

rest arm on your arm—palpate in 4 directions

Question 45

Breasts—palpate with client in what position?

Answer 45

Supine position. Tuck pad under side the to be palpated Raise arm over head

Question 46

When tucking pad under side the to be palpated and raising arm over head does what to breasts:

Answer 46

(flattens tissue and displaces medially)

Question 47

Assess nipple discharge; if discharge, note what:

Answer 47

quadrant producing discharge.

Question 48

Location of lump—using a clock face note what:

Answer 48

note distance in cm from nipple or diagram breast and mark the location of the lump.

Question 49

Breast lump assess:

Answer 49

``` Location Size Shape Consistency (soft, firm, hard) Movable Distinctness—single or multiple Nipple displaced or retracted Skin over lump—erythema, dimpled, retracted Tenderness Lymphadenopathy ```

Question 50

More advanced cancer shows signs of:

Answer 50

``` Breast mass Retraction Edema Axillary mass Scaly nipple Tender breast ```

Question 51

Breast may normally be what right before menstruation?

Answer 51

tender and edematous

Question 52

Post-mastectomy—What is common sequela (complication of previous disease) of upper arms?

Answer 52

lymphedema- | due to interruption of lymphatic drainage and removal of nodes.

Question 53

When is it best to do Breast Self Exam (BSE)?

Answer 53

Right after menstrual period

Question 54

What is the steps of BSE? (supine)

Answer 54

Supine—palpate using vertical strip pattern.

Question 55

What is the step of BSE? (sitting)

Answer 55

Sitting up—palpate under arm, with arm raised.

Question 56

What is the step of BSE? (hand on hips)

Answer 56

Hand on hips with shoulder hunched—inspect in mirror, noting surface changes.

Question 57

Male breast cancer usually presents with:

Answer 57

retroareolar lump;

Question 58

In the male what is rare but strongly associated with breast cancer.

Answer 58

nipple discharge

Question 59

Adolescent gynecomastia is:

Answer 59

benign and temporary

Question 60

Adolescent gynecomastia is seen in:

Answer 60

seen in ½ adolescent boys (age 13, 14)

Question 61

Neonate—can have ____, _____ nipple discharge called:

Answer 61

clear, white discharge— called witch’s milk

Question 62

In the pre-pubertal child, nipples are located:

Answer 62

Just lateral to the mid-clavicular line between 4th and 5th ribs

Question 63

In adolescent—breast development begins between ___ - ____ years old:

Answer 63

8-10 years.

Question 64

Record child breast development using:

Answer 64

Tanner staging.

Question 65

Pregnant woman breast may appear:

Answer 65

visible blue vascular pattern; breast and nipples increase in size; striae may develop.

Question 66

Nipples appear in pregnant woman:

Answer 66

darker, more erectile; areolar widens, darkens; Montgomery glands elevated

Question 67

In pregnant woman- on palpation breasts are:

Answer 67

more nodular; colostrum may be expressed after first trimester.