Exam 4 - Breast And Regional Lymphatics

Question 1

Non-modifiable risk factors for breast cancer

Answer 1

Female
Age > 50
Mutation of BRACA1 or BRACA2 genes
First degree relative with breast cancer
Previous breast biopsy with atypical hyperplasia
Previous breast radiation
Menstruation before 12 yrs or menopause after 50 yrs

Question 2

Modifiable risk factors for breast cancer

Answer 2

First child after 30 yrs old
Recent oral contraceptive use
Post menopausal hormone therapy
Not breast feeding
Alcohol intake of >1 drink per day
Obesity/high fat diet
Physical inactivity

Question 3

Explain the American Cancer Society’s recommendations for when women should have mammograms

Answer 3

40-44 yrs: choose if they want mammograms
45-54: mammogram every year
55+: mammogram every 2 years or can choose to have one every year
Mammograms continue every 2 years as long as woman is in good health with life expectancy of at least 10 years

Question 4

What should you tell your patients about doing self breast exams?

Answer 4

All women should be familiar with breast tissue and know who to contact if changes occur

Question 5

What should you document about a patient’s breasts general appearance?

Answer 5

Symmetry of size and shape

Question 6

What should you document about the skin of a pt’s breasts?

Answer 6

Normally smooth with even color
Note any localized ares of redness, bulging or dimpling
Normally no edema is present

Question 7

What should you document about a pt’s nipples?

Answer 7

Should be symmetric
Normal nipple inversion may be unilateral or bilateral
Note any dry scaling, fissures, ulcerations, bleeding, or other discharge

Question 8

What are the different areas of the breast called using the four quadrant method?

Answer 8

Upper inner quadrant
Upper outer quadrant
Lower inner quadrant
Lower outer quadrant
Axillary tail of Spence

Question 9

What is the most common area for breast cancer to start?

Answer 9

Axillary tail of Spence

Question 10

What is retraction look like, while inspecting breasts

Answer 10

Dimpling or puckering
Fibrosis of tissue
Usually best seen while pt raises arms

Question 11

What is retraction caused by?

Answer 11

Growing neoplasms

Question 12

What maneuvers should you have pt do to screen for retraction?

Answer 12

Lift arms over head
Push hands into hips
Lean forward with forearm support

Question 13

How should you palpate the breasts?

Answer 13

Use pads of first three fingers
Use gentle rotary motion 
Choose one of three patterns
Slide hands instead of lifting to move to new area
Don’t forget the nipple

Question 14

3 patterns that can be used to palpate the breasts

Answer 14

Vertical strip pattern
Spokes-on-a-wheel
Concentric circles

Question 15

What is the pendulous breast palpation method and when is it used?

Answer 15

If pt has breasts that hang down
Bimanual method
Pt is sitting and leaning forward

Question 16

What is the inflammatory ridge?

Answer 16

Firm transverse ridge of compressed tissue in the lower quadrants
Noticeable in large breasts
This is a normal finding

Question 17

If pt has a lump in their breast, which facts are we documenting?

Answer 17

Location
Size
Shape
Consistency
Movable
Distinctness
Nipple
Note skin over lump
Tenderness
Lymphadenopathy

Question 18

How do we document location of a lump in the breast?

Answer 18

Location - distance in cm from the nipple and location by clock measurement “7:00, 2 cm from the nipple”

Question 19

How do you document the size of a lump in the breast?

Answer 19

Centimeters in 3 dimensions: width x length x thickness

Question 20

How do you document shape of a lump in the breast?

Answer 20

Oval, round, lobulated, or indistinct?

Question 21

How do you document the consistency of a lump in the breast?

Answer 21

Soft, firm, or hard?

Question 22

How do you document if a lump in the breast is movable?

Answer 22

Freely movable or fixed?

Question 23

How do you document distinctness of a lump in the breast?

Answer 23

Solitary or multiple?

Question 24

How do you document the nipple if there is a lump in the breast?

Answer 24

Displaced or retracted?

Question 25

How should you document the skin over a lump in the breast?

Answer 25

Erythematous? Dimpled? Retracted?

Question 26

How should you document lymphadenopathy if a pt has a lump in their breast?

Answer 26

Are lymph nodes palpable in axilla?

Question 27

How should you teach a pt about breast self examination?

Answer 27

Tell them to schedule the self exam on a regular monthly schedule (right after cycle, or select a familiar date if no cycle)
Describe correct technique
Have them demonstrate it back

Question 28

What do lumps feel like with breast cancer?

Answer 28

• Solitary, unilateral star-shaped mass
• Often non-tender
• Firm to stony, hard, fixed mass
• Borders irregular, poorly delineated
• Grows consistently
• Skin retraction

Question 29

What is the most dangerous type of breast cancer?

Answer 29

Invasive lobular

Question 30

Was is the least dangerous type of breast cancer?

Answer 30

Ductal