Female Exam

Question 1

What are the most palpable lymph nodes that drain the breast? Where will you find them?

Answer 1

Central. Located high in the axilla, midway between the anterior and posterior axillary lines.

Question 2

What other lymph nodes drain into the central nodes?

Answer 2

Pectoral, Subscapular, and Lateral

Question 3

If you advise your female patient to do a self breast exam, what point in her cycle is the most beneficial?

Answer 3

5-7 days after the first day of her menses is when estrogen levels are lowest. This reduces unnecessary testing for lumps/masses that fluctuate with hormones

Question 4

This mass is usually smooth, rubbery, round, mobile and nontender. It is most common between 15-25 yoa.

Answer 4

fibroadenoma

Question 5

This mass is usually soft to firm, round, mobile, and often tender. It occurs most between 25-50 yoa.

Answer 5

cysts

Question 6

This mass is nodular and ropelike, common between 25-50 yoa.

Answer 6

fibrocystic changes

Question 7

This mass is irregular, firm, may be mobile or fixed.

Answer 7

Cancer.

Question 8

What is the lifetime risk of women for getting breast cancer?

Answer 8

12%

Question 9

What are the screening recommendations for mammograms per the USPSTF?

Answer 9

Age: 75: insufficient data

Recommends Clinical Breast Exams Q3Y for patients between 20-50 yoa.

Question 10

FYI

Answer 10

USPSTF recommends against self exams.

American Cancer Society advocates self exams.

Question 11

What 4 things are you inspecting during the breast exam?

Answer 11

1) skin
2) symmetry
3) contours
4) retraction

Question 12

What are the 4 positions the patient should assume for a complete breast exam?

Answer 12

1) Arms loose at the sides
2) Arms overhead
3) Hands on hips with elbows out
4) Leaning forward

Question 13

If you noticed red skin on the breast exam, what would you consider?

Answer 13

Infection or inflammatory carcinoma

Question 14

Although uncommon, Padgett’s Disease of the breast presents as _______________ on physical exam?

Answer 14

rash or ulcer of the breast

Question 15

Nipple retraction is a red flag for cancer. What position will be the most likely to elicit this change?

Answer 15

Leaning forward

Question 16

Dimpling is also a red flag for cancer. What position is the most likely to elicit this change?

Answer 16

Arms overhead or leaning forward.

Question 17

What do tender chords suggest on the breast exam?

Answer 17

mammary duct ectasia (dilated ducts that cause inflammation)

Question 18

Deeply pigmented, velvety axillary skin suggests _______________, which can be associated with internal malignancy

Answer 18

acanthosis nigricans

Question 19

Medical term for sweat gland infection

Answer 19

hidradenitis suppurativa

Question 20

Bloody nipple discharge is suggestive of _______________

Answer 20

intraductal papilloma, DCIS, Paget’s dz

Question 21

Milky discharge is suggestive of____________

Answer 21

prolactinoma, hypothyroidism

Question 22

Provide an example of a normal breast exam write up.

Answer 22

Breasts symmetric and smooth without masses. Nipples without discharge.