Exam #3: Breast & Axillae

Question 1

What are the general breast cancer risk factors categories?

Answer 1

• Modifiable (cannot be changed)
• Non-modifiable ( can be changed)
• Uncertain, Controversial, or Unproven

Question 2

Tanner Stages of Breast Development

Answer 2

1) Tanner I
2) Tanner II
3) Tanner III
4) Tanner IV
5) Tanner V

Question 3

When does the onset of breast development occur?

Answer 3

• 1 year prior to the onset of pubic hair development
• 2 years prior to menarche
• Complete process usually occurs over a 4 year period

Question 4

Tanner I

Answer 4

• Prepubertal

- Elevation of papilla only

Question 5

Tanner II

Answer 5

• Breast Bud Stage
• Elevation of breast & papilla as a small mound
• Enlargement of the diameter of areola

Question 6

Tanner III

Answer 6

Further enlargement of the breast and arerola with no separation of the contours

Question 7

Tanner IV

Answer 7

Areola projected above level of breast as a secondary mound

Question 8

Tanner V

Answer 8

• Mature Stage
• Recession of areola mount to the general contour of the breast
• Projection of papilla only

Question 9

What are the 5 D’s related to nipples?

Answer 9

• Discharge
• Depression or Inversion
• Discoloration
• Dermatological changes
• Deviation (compare to the opposite side)

Question 10

What are the red flags of a breast examination?

Answer 10

• Skin changes (Peau d’orange)
• Dimpling
• Hard & immobilize mass (pebble)
• Painless lump
• “Outie nipple transitioning to Innie”

Question 11

What is the best method for a breast examination?

Answer 11

Vertical Method (like a lawn-mower)

Question 12

Colostrum

Answer 12

clear or milky fluid that is expressed from the breast before milk production

Question 13

Galactorrea

Answer 13

Lactation not associated with childbearing

Question 14

Gynecomastia

Answer 14

Abnormal large mammary glands in the male; sometimes may excrete milk

Question 15

Lactation

Answer 15

Production & secretion of milk from the breast

Question 16

Mastitis

Answer 16

Inflammation of the breast

Question 17

Mastodynia

Answer 17

Pain in the breast

Question 18

Non-modifiable Risk Factors Breast Cancer

Answer 18

• Gender, 100x more likely in women
• Age, MOST IMPORTANT, 55>
• Genetic, BRCA1/2
• Family History, first degree increases 2x, 2x first degree= 5x
• Personal History
• Race
• Dense Breast Tissue
• Previous Chest Radiation
• DES (Diethylstilbesterol) Exposure
• Menstrual Periods
• Certain Benign Breast Conditions
• Lobular Carcinoma in situ

Question 19

Modifiable Risk Factors for Breast Cancer

Answer 19

• Postmenopausal Obesity
• Exercise, lack of physical activity
• Alcohol
• Hormone Replacement
• Recent Oral Contraceptive Use
• Childbirth, breast feeding reduces risk of breast cancer

Question 20

Outline the early detection plan.

Answer 20

1) Women >40, yearly mammogram if in good health
2) Clinical Breast Examination (20-39=Q3years, 40+=annual)
3) Breast Self-Examination (20+)
4) High Risk Women (MRI & Mammogram annually)
5) Moderate Risk Women (talk w/ provider about the benefits of MRI)

Question 21

What are the signs & symptoms of a fibrocystic breast mass?

Answer 21

• 20-50 years
• Usually bilateral
• Multiple or single
• Round
• Soft to firm; usually elastic
• Mobile
• No retraction
• Often tender
• Well defined borders
• Variation w/ menses

Question 22

What are the signs & symptoms of a Fibroedenoma?

Answer 22

• 15-25 years & 55+
• Usually bilateral
• Single; may be multiple
• Round, disc like, or lobular
• Usually firm, ruberry
• Very mobile
• No retraction
• Usually nontender
• Well defined border
• No variation with menses

Question 23

What are the signs & symptoms of breast cancer?

Answer 23

• 30-90 years, most common

Question 24

What are normal changes that occur with menstruation?

Answer 24

• Enlargement
• DO NOT examine breasts at this time
• Best time to evaluate is 5-7 days after the onset of menses

Question 25

What are normal changes that occur with pregnancy?

Answer 25

• Fuller & more firm
• Nipple changes
• Colostrum in 3rd trimester

Question 26

What are important PROS questions relating to breast complaints?

Answer 26

• Presence of a mass
• Breast pain
• Nipple discharge
• Recent trauma

Question 27

Areola

Answer 27

pigmented area surrounding the nipple

Question 28

Colostrum

Answer 28

a clear or milky fluid that is expressed from the breast before milk production

Question 29

Cooper Ligaments

Answer 29

a band of subcutaneous fibrous tissue that provides support to the breast

Question 30

Duct Ectasia

Answer 30

benign condition of the subareolar ducts that can cause a nipple discharge

Question 31

Fibroadenoma

Answer 31

benign tumor of the breast

Question 32

Fibrocystic Disease

Answer 32

benign condition that presents with fluid-filled cyst due to ductal enlargement that is usually seen bilaterally & multiple

Question 33

Galactorrhea

Answer 33

lactation not associated with childbearing

Question 34

Gynecomastia

Answer 34

• abnormally large mammary glands in the male

- sometimes may secrete milk

Question 35

Intraductal papillomas

Answer 35

benign tumors of the subareolar ducts that produce a nipple discharge

Question 36

Mastitis

Answer 36

inflammation of the breast

Question 37

Mastodynia

Answer 37

pain in the breast

Question 38

Montgomery follicles

Answer 38

tiny sebaceous glands that may appear on the areola

Question 39

Paget Disease

Answer 39

skin manifestations that are indicative of ductal carcinoma

Question 40

Peau d’ orange

Answer 40

skin changes of the breast due to edema caused by blockage of the lymph drainage associated with inflammatory breast cancer

Question 41

Tail of Spence

Answer 41

area where most malignancies of the breast tissue occur

Question 42

Thelarche

Answer 42

beginning of female pubertal breast development