Exam 4: Breast and Lymphatics Flashcards
Smallest structures of mammary gland
Alveoli
Darkened area surrounding nipple
Areola
Thin, yellow fluid, precursor of milk, secreted for a few days after birth
Colostrum
Suspensory ligaments; fibrous brands extending from the inner breast surface to the chest wall muscles
Cooper’s ligaments
Benign breast mass, non tender, moveable, diagnosed with biopsy to assure its not cancer
Fibroadenoma
Excessive breast development in the male
Gynecomastia
Serosanguineous nipple discharge
Intraductal papilloma
Nipples that are depressed or invaginated
Inverted
Conveying milk
Lactiferous
Pain in the breast
Mastalgia
Inflammation of the breast
Mastitis
Sebaceous glands in the areola, screte protective lipid during lactation also called tubercles of Montgomery
Montgomery’s glands
Intraductal carcinoma in the breast, clear, yellow discharge, halo red circle around it: cancer
Paget’s disease
Orange-peel appearance of breast due to edema
Peau d’orange
Dimple or pucker on the skin
Retraction
Atrophic pink, purple, or white linear streaks on the breasts, associated with pregnancy, excessive weight gain, or rapid growth during adolescence
Striae
Minute extra nipple along the embryonic milk line, in males and females
Supernumerary nipple
Extension of breast tissue into the axilla
Tail of Spence
These are present in both males and females, but in males they are rudimentary/undeveloped throughout life
Breast/mammary glands
Accessory reproductive organs whose function is to produce milk for nourishing newborns
Female breasts
Most of the breasts lymphatic drainage (75%) drains into..
the axillary nodes
Most cancerous breast tumors are found in the …
Axillary tail of spence
Breast are composed of what 3 tissues
Adipose (fat)
Fibrous (suspensory to hold breast up)
Glandular (15-20 lobes embedded)
What are the 4 groups of axillary nodes
Lateral
Pectoral
Superaclavicular
Subscapular
Another word for tissues or muscles wasting away
Atrophy
After menopause, ovarian secretions of estrogen and progesterone decrease causing breast glandular tissue to..
Atrophy (waste away)
Why are breast lumps easier to palpate after menopause
Because the tissue atrophies/wastes away
-really any inner breast structures are going to be more prominent or easier to palpate since the tissue atrophies
While African American women have a lower breast cancer rate, they have a higher…
death rate
You should always refer a lump to a..
Physician or nurse practitioner
Its normal to have pain in the breast right before..
a period
What should the examiner ask about pain
When it first started If its localized or all over Painful to touch? Pulling sensation? Any relation to your menstrual cycle? once a month? Is it brought on by strenuous activity
Why are under-wire bras not a good idea to wear
they don’t allow for good lymphatic drainage
What should the examiner ask about lumps
Where is it Is it painful Is it thickening or changing Any relation to your menstrual cycle? Changes on the overlying skin
What should the examiner ask about discharge
Is it thick or runny
Color
Odor
What should the examiner ask about a rash
When did you notice it
Is it on nipple, areola, or surrounding skin
What should the examiner ask about swelling
Is it in one spot or all over
Is it related to menstrual cycle, pregnancy, or breastfeeding
Any change in bra size
*Hormones usually mean swelling
What should the examiner ask about trauma
Any trauma or injury to breast
Did it result in swelling, lumps, or breaks in skin
What should the examiner ask about a history of breast disease
Was it cancerous or benign What type of cancer When did it occur How is it being treated Any family history --what age was the family member
What should the examiner ask about breast surgeries
Was it a biopsy What were results Mastectomy Mammoplasty (reconstruction) Reduction Implants Augmentation (increase breast size) Mammograms Xrays --when was last xray
What should the examiner ask about the axillary region
Any rashes, tenderness, lumps, or swelling
How should you prepare for a breast examination
Have the patient sitting up, facing examiner, eye level
During palpation, she is supine, make sure to keep breast you’re not looking at covered
Teach about self breast exams
What equipment do you need for a self breast exam
Ruler with cm to measure lumps
Small pillow
Pamphlet for teaching about BSE
What should the general appearance of the breast look like
Symmetry
Smooth even color
–note redness, bulging or dimpling
A fine blue vascular network may be visible during..
Pregnancy
What is fixed inversion
When the nipple is inverted and you cant get it to come out — this is abnormal
What should the appearance of the nipple look like
Should be protruding
–if its flat or inverted can usually pull it out
Note dry scaling, fissures, ulcerations, or bleeding
What maneuvers should you use to screen for retraction of the breast
Lift arms slowly above head – breasts should move together
Put hands on hips, palms on hips, and push – both breasts should slightly lift up
How should you inspect and palpate the axilla area
Lift woman’s arm and support it
Use right hand to palpate left axilla
Move fingers down axilla in 4 directions
How should you palpate the breast
Lay her in supine position
Lift arm of the breast you arm examining over her head
Use first 3 fingers to make a circular motion while palpating — vertical strip pattern recommended
Breast tissue gets softer and looser after..
Pregnancy
What should you do for nipple discharge
Press on the areolar area from different directions and note the color and consistency
Why should you examine the unaffected breast first
To get a baseline feel of what the breast should feel like
If you do feel a lump, you should assure the pt that most lumps are not..
cancerous
What characteristics should you note on the lump during the examination
Location (like a clock) Size (cm) Consistency Shape Movable Distinctness Skin over lump Tenderness
Term for when regional lymph nodes are palpable
Lypmhadenopathy
What should you teach about BSEs
Do monthly
Right after menstrual period
You should check the male breast when you…
examine chest, thorax, heart, and lungs
Flat disk of underdeveloped breast tissue beneath the nipple
Normal male breast
What is the menopausal age..
45-50+
Points inward instead of outward and doesn’t come out with stimulation
Nipple retraction
Dimpling is always considered..
abnormal
Multiple lumps in both breasts usually due to hormonal changes in the body, its bilateral (formerly fibrocystic breast disease)
Benign breast disease
Usually just in one side, not usually painful until later stages, hard, dense, and fixed, wont move when you feel it, it has irregular borders, most common sight is upper outer quadrant
Cancer
Sticky purulent abnormal nipple discharge that is caused by an infection of the ducts
Mammary duct ectasia
A bloody abnormal nipple discharge
Carcinoma
