Exam 2 - Breast Exam Flashcards
1
Q
How can you enhance your communication skills with the patient during a breast exam?
A
Drape the patient carefully Warm hands before touching patient Explain each step of the exam State what you are about to do before you do it Keep eye contact Watch for signs of discomfort
2
Q
What two things are examined at once?
A
Breasts and axilla
3
Q
What’s listed under breast exam ROS?
A
Review of Systems Lumps Pain or discomfort Nipple discharge Self-examination
4
Q
What is thelarche?
A
Breast development = thelarche
*Sign of puberty
5
Q
What Tanner Stage does menstruation begin at?
A
Menstruation begins at stage III or IV
6
Q
How long does it take to progress from stage II to menarche?
A
From stage II to menarche is about 2 years
7
Q
T or F: Breasts can develop at different rates in the same individual
A
True
8
Q
Describe Tanner Stage I:
A
No breast development-preadolescent girls
9
Q
Describe Tanner Stage II:
A
Elevation of breast and areola-breast bud stage
10
Q
Describe Tanner Stage III:
A
Areola and breast enlargement-adolescence, early adult
11
Q
Describe Tanner Stage IV:
A
Areola elevated to above the breast-adolescence, mid adult
12
Q
Describe Tanner Stage V:
A
Breast enlarged, areola in contour of the breast itself-late adolescence, adult
13
Q
What’re you looking for when inspecting the breasts?
A
Contour Symmetry Vascular pattern Nipples Skin characteristics
14
Q
What nipple characteristics are you inspecting for?
A
Retraction
Discharge
Skin changes
Piercings
15
Q
What skin characteristics are you inspecting for on the breasts?
A
Dimpling
Edema
Retraction
Inflammation
16
Q
By inspection, the breasts should:
A
Be symmetrical, full, rounded, smooth in all portions, without dimpling, retractions or masses
Demonstrate a faint, even vascular pattern and striae
Demonstrate everted nipples with even areola
Demonstrate axillae with even color, without masses or rash
17
Q
What is polythelia?
A
Polythelia = extra nipples
18
Q
What is polymastia?
A
Polymastia = accessory breasts
19
Q
Where is breast tissue found?
A
Breast tissue can be located anywhere along milk lines, from the axilla to the groin
20
Q
What positions do you inspect the breasts in?
A
Positions 1. Sitting with arms over head >>Dimpling and retraction 2. Hands pressed against hips >>Dimpling and retraction 3. Leaning forward >>May reveal an asymmetry of the breast or nipple. >>Retraction of nipple and areola suggests cancer
21
Q
What does retraction of the nipple suggest?
A
Retraction of nipple and areola suggests cancer
22
Q
Palpation must be systematic and gentle. What are you palpating for?
A
Tenderness Nodules Size and Mobility Shape Consistency
Firm tissue, without masses or lumps Local areas without excessive warmth or tenderness Nipples should not have discharge Axillae should be smooth Lymph nodes should not be palpable
23
Q
T or F: Men should have palpation in breast exam as well as women.
A
True
24
Q
What should not be palpable?
A
lymph nodes
25
How do you palpate the breast?
1. Palpate all four quadrants
>Several methods to use
>>Do NOT omit the tail of Spence (axillary tail)
>>>Many cancers discovered at this location
2. Palpate under the areola and nipple
3. Be aware of the infra-mammary ridge
26
Why is it important to palpate the tail of spence? Where is it?
Do NOT omit the tail of Spence (axillary tail)
| Many cancers discovered at this location
27
When a lesion is found on the breast, how is it described?
Lesions are described positionally as quadrants or as clock face numbers
28
Describe the recommended palpation technique of the breasts?
The middle three fingers are held together with the metacarpal-phalangeal joint slightly flexed
Pads of the fingers are the examining surface
Use light, medium, and deep palpation
29
What are the pectoral lymph nodes?
```
Pectoral nodes
1. Subscapular nodes
2. Supraclavicular nodes
3. Infraclavicular nodes
4. Lateral nodes
5. Central axillary nodes
***Not all lymphatics drain to the axilla
Some may drain to infraclavicular or mediastinal lymph nodes
```
30
How do you inspect the axilla?
Sitting position is preferable
Inspection
Rash, infection, unusual pigmentation, or nodules
Palpation
Use right hand to exam the left axilla and vice versa
Point fingers toward the midclavicle
Press fingers toward the chest wall and slide them downward
Check the supraclavicular, infraclavicular and epitrochlear nodes as well
31
What are you looking for when inspecting axilla?
Rash, infection, unusual pigmentation, or nodules
32
Which hand is used to examine the left axilla?
Right hand
33
What do you expect to feel in axilla?
You should feel 1 or more soft, small (
34
If lymph nodes of axilla feel large, hard, tender, or have lesions/drainage, what do you do?
If nodes feel large, hard, or tender, or if you see lesions or drainage, examine other groups of axillary lymph nodes
>Large nodes >1cm suggest malignancy
35
What type of lymph node suggests malignancy?
Any axillary lymph node greater than 1cm
36
With mastectomy and breast augmentation patients - What are you inspecting for?
Inspect the mastectomy scar and axilla carefully
>Note masses or unusual nodularity
>Note color or signs of inflammation
>Lymphedema may be present in axilla and upper arm
37
With mastectomy and breast augmentation patients - What are you palpating for?
Palpate gently along the scar-sensitive
>Use circular motion with 2 or 3 fingers
>Pay attention to the upper outer quadrant and axilla
>Note any enlargement of lymph nodes and signs of inflammation or infection
38
Why is it important to examine male breasts?
1% of breast cancer cases are male
Peak in frequency at age 71 years
Risk Factors: BRCA2 mutations, obesity, FHx, testicular conditions, work exposure to high temperatures and exhaust emissions
39
How do you examine the male breast?
Inspect the nipple and areola
>If enlarged breast distinguish obesity vs. gynecomastia
>Note nodules, swelling, discoloration, or ulceration
Palpate the nipple and breast tissue
>Note nodules
40
What is Peau d’orange?
a pitted or dimpled appearance of the skin, especially as characteristic of some cases of breast cancer or due to cellulite.
41
What is Nipple inversion?
An inverted nipple (occasionally invaginated nipple) is a condition where the nipple, instead of pointing outward, is retracted into the breast.
In some cases, the nipple will be temporarily protruded if stimulated, but in others, the inversion remains regardless of stimulus.
42
What is Nipple retraction?
A retracted nipple, unlike an inverted nipple, will not come back out when stimulated.
Nipple retraction may be caused by aging, duct ectasia, or breast cancer.
43
What causes nipple retraction?
May be caused by aging, duct ectasia, or breast cancer.
44
Left Breast Depression
Dimple in the breasts; usually from a tumor causing a dimple
45
Right Breast Mass
Tumor in the breasts; has a blueish circumference and obvious protrusion
46
Downward Pointing Nipple
Tumor takes up the space of where the nipple is causing it to point downward.
47
Breast Dimpling and Inflammation
Another abnormality of the breast
48
Examples of Breast PE Documentation
“Breasts symmetric and smooth without masses. Nipples without discharge. No axillary or epitrochlear adenopathy.”
“Breasts pendulous with diffuse fibrocystic changes. Single firm 1 X 1 cm mass, mobile, and nontender, with overlying peau d’orange appearance in right breast, upper outer quadrant at 11 o’clock, 2 cm distal from nipple. 1X1 cm rubbery and mobile bilateral axillary lymphadenopathy.”
49
Overview Summary of the Breast Exam
Remember to drape the patient to optimize comfort and completeness of the examination.
Use a pattern that allows for complete coverage of all breast tissue.
Best examination patterns include vertical strips and concentric circles.
Use the middle three fingers on the dominant hand to palpate.
Examine each site with light, then moderate, then firm pressure.
Thoroughly examine the tail of Spence.
Palpate for any axillary or supraclavicular lymph nodes.
50
What is a screening mammogram used for?
Screening Mammogram
Used to look for breast disease in women who appear to have no breast problems
51
What is a diagnostic mammogram used for?
Diagnostic Mammogram
Used to find breast disease in women who have symptoms or who have found a lump or abnormal radiological changes
* *A mammogram alone cannot prove that an area of concern is breast cancer
* *May need US and/or US-guided biopsy
52
What age is appropriate to start clinical breast examinations? How frequently are they done?
Clinical breast examination
Q3 years, ages 20-39 years
Annually after age 40 years
53
What age is appropriate to start breast self examination?
Breast self examination (BSE)
Q month beginning at age 20 years
Performed 5-7 days post onset of menses
54
What age is appropriate to start getting mammograms? How often are they done?
Mammography
| Baseline at age 40 years, then Q1-2 years up to age 49 years
55
When is it okay to start screening earlier?
FHx of breast cancer, or those with increased risk may need mammogram, US, or MRI sooner
Annually from age 50-70 years
56
When are MRIs done to screen breast cancer?
MRI
| Pt has >20% lifetime risk = MRI with mammogram annually
57
Why are Breast Self Examinations important?
90% of breast cancers are found by women themselves.
When women perform BSE properly and regularly, they can note any changes in their breasts and seek further evaluation.
When women discover lumps in their breasts, and report these findings to their healthcare provider at a very early stage, surgery can save 70-80% of proven cases.
58
How often should women perform breast self exams?
BSE should be performed Q month.
59
How is a Breast Self Examination performed?
Inspection before a mirror
>Stand and face a mirror with arms relaxed at the sides or arms resting on hips; then turn to the right and left for a side view, looking for any flattening.
>Bend forward from the waist with arms raised overhead
>Stand straight with arms raised over head and move arms slowly up and down at the sides. Look for free movement of the breasts over the chest wall.
>Press each arm firmly together at the chin level while elbows are raised to shoulder level.
Palpate standing, sitting, or lying down
60
BSE: Upright
Repeat the examination of both breasts while upright with one arm behind the head.
This position makes it easier to check the upper part of the breast and toward the axilla.
**Do the upright BSE in the shower.
Soapy hands glide more easily, making lumps easier to palpate!
61
BSE: Lying down
Place a pillow under the right shoulder and place the right hand behind the head.
Use the finger pads of the three middle fingers held together on the left hand to feel for lumps.
Press the breast tissue against the chest wall firmly enough to know how the breast feels. A ridge of firm tissue in the lower curve of each breast is normal.
Use circular motions systematically all the way around the breasts as many times as necessary until the entire breast is covered.
Bring the arm down to the side and feel under the axilla.
Repeat the exam on the left breast using the right finger pads of the right hand.
62
Gynecomastia
Over development of breast in males
63
Duct ecstacia
Blocking or occlusion of a breast or mammary gland
