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gluteal muscles > H & P Breast Exam > Flashcards

H & P Breast Exam Flashcards

1
Q

Communication Skills

A

-This portion of the physical examination requires constant communication with the patient
-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

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2
Q

Breast/Axilla ROS

A

Breasts and axilla are examined together, comparing one side with the other.

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3
Q

Breast/Axilla ROS

A 
Review of Systems
Lumps
Pain or discomfort
Nipple discharge
Self-examination
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4
Q

Sexual Maturity Rating

A
  • Breast development = thelarche
  • Sign of puberty
  • Tanner stages I through V
  • Menstruation begins at stage III or IV
  • From stage II to menarche is about 2 years
  • Breasts can develop at different rates in the same individual
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5
Q

Inspection

A 
Contour
Symmetry
Vascular pattern
Nipples
Retraction
Discharge
Skin changes
Piercings
Skin characteristics
Dimpling
Edema
Retraction
Inflammation
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6
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
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7
Q

Inspection- Breast Location

A

Breast tissue can be located anywhere along milk lines, from the axilla to the groin

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8
Q

Polythelia

A

extra nipples

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9
Q

Polymastia

A

accessory breasts

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10
Q

Positions

A 
Sitting
-Arms over head
     Dimpling and retraction
-Hands pressed against hips
      Dimpling and retraction
-Leaning forward
     May reveal an asymmetry of the breast or nipple.
-Retraction of nipple and areola suggests cancer
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11
Q

Palpation

A 
-Palpation MUST be systematic and gentle, palpate men too
Note:
   Tenderness
    Nodules
    Size and Mobility
    Shape
    Consistency 
-Palpation should note 
   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
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12
Q

Palpation

A

-Palpate all four quadrants
-Several methods to use
-Do NOT omit the tail of Spence (axillary tail)
Many cancers discovered at this location
-Palpate under the areola and nipple
-Be aware of the infra-mammary ridge

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13
Q

Palpation Technique

A
  • 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
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14
Q

Lymph Nodes

A

-Pectoral nodes
-Subscapular nodes
-Supraclavicular nodes
-Infraclavicular nodes
-Lateral nodes
-Central axillary nodes
-Not all lymphatics drain to the axilla
Some may drain to infraclavicular or mediastinal lymph nodes

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15
Q

The Axilla

A

Sitting position is preferable

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16
Q

Axilla Inspection

A

Rash, infection, unusual pigmentation, or nodules

17
Q

palpation

A

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
  • You should feel 1 or more soft, small (1cm suggest malignancy
  • Check the supraclavicular, infraclavicular and epitrochlear nodes as well
18
Q

Mastectomy or Breast Augmentation

A
  • 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
19
Q

Mastectomy or Breast Augmentation

A

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
20
Q

Male Breast Examination

A

-Brief but important
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
-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

21
Q

Breast Cancer Screening

A

-Screening Mammogram
Used to look for breast disease in women who appear to have no breast problems
-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

22
Q

Breast Cancer Screening

A

-Clinical breast examination
Q3 years, ages 20-39 years
Annually after age 40 years
-Breast self examination (BSE)
Q month beginning at age 20 years
Performed 5-7 days post onset of menses
-Mammography
Baseline at age 40 years, then Q1-2 years up to age 49 years
FHx of breast cancer, or those with increased risk may need mammogram, US, or MRI sooner
Annually from age 50-70 years
-MRI
>20% lifetime risk = MRI with mammogram annually

23
Q

Breast Self Exam (BSE)

A
  • 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.
  • BSE should be performed Q month.
24
Q

Breast Self Exam (BSE)

A

-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

25
Q

Breast Self Exam (BSE): Upright

A

-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.

26
Q

Breast Self Exam (BSE): Lying Down

A
  • 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.

gluteal muscles (3 decks)

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