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Advanced Health Assessment > Midterm-Breast > Flashcards

Midterm-Breast Flashcards

1
Q

breast

A

located between 2nd and 6th ribs, from sternum to midaxillary line

divided into tail of spence + 4 quadrants

breast development begins during 5th week of gestation in utero

at birth, males and females have the same breast anatomy

estrogen drives further breast development in females (occurs between age 8-13)

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2
Q

tail of spence

A

superior lateral corner of axilla (many breast cancers are found here)

start palpation here

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3
Q

glandular tissue

A

15-20 lobes radiating from nipple

contain lobules within that produce milk

leads to milk ducts then to sinus behind nipple that is used for storage of milk

could have cyst or cancer here

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4
Q

suspensory ligaments (coopers)

A

fibrous bands extending vertically from breast surface and attach to chest wall

supports breast tissue- large/heavy breast and age stretch ligaments

become contracted in cancer, causing dimpling/pits in overlaying skin

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5
Q

adipose tissue in breast

A

lobes embedded in this tissue

layers of subcutaneous and retromammary fat provide bulk of breasts

proportion depends on women’s age, menstrual cycle, pregnancy, lactation, and nutritional state

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6
Q

lymphatic system

A

extensive lymphatic drainage from breasts

75% of drainage leads to the ipsilateral (same side) axillary nodes

important to assess these areas and know what you’re checking for

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7
Q

four different lymph nodes to check for in breast assessment

A

central axillary- high up in axilla

pectoral (anterior)- lateral edge of pectoralis muscle inside axillary fold

subscapular (posterior)- lateral edge of scapula, deep in posterior fold

lateral (brachial)- inside upper arm, along the humerus

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8
Q

male breast CA presentation

A

painless firm mass

nipple retraction- nipple involvement 40-50% as tumor usually close to nipple

ulceration of the nipple or skin, discharge (serosanguinous/bloody)

fixation of tumor to skin/underlying muscle- dimpling

tumor tenderness, palpable axillary nodes

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9
Q

painless firm mass for male breast CA

A

infiltrating ductal= most common breast CA in males

lump behind areola= most common location

fewer than 1% of cases are bilateral

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10
Q

gynecomastia

A

male development of breast tissue

may be driven by estrogen, certain meds, testosterone depletion, etc.

problematic for a man’s self esteem and image

may require surgical correction

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11
Q

infant breast inspection

A

breast engorgement/white discharge- NORMAL due to MATERNAL ESTROGEN- may last 1-2 weeks, should go away on its own

concerning if swelling is unilateral, or if REDNESS/signs of infection-mastitis

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12
Q

documentation of adolescent breast development

A

TANNER STAGING

assessing if hormonally competent

stage 1: no breast development

stage 2: breast bud

stage 5: full growth

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13
Q

nipple abnormal findings

A

deviation/pointing in different directions

scaling-paget’s disease

fissures/ulcerations

dimpling/tucking- always abnormal/concerning

fixation of tissue to chest wall

recent nipple retraction (change from normal)

MASTITIS- skin is red but still smooth (not peur d’orange)

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14
Q

mastitis

A

sx: pain, redness, swelling, fever, enlargement, changed nipple sensation, discharge, itching, tenderness, lump
tx: antibiotics

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15
Q

palpation of breast

A

concentric circles

spokes of wheel/wedge

vertical strips

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16
Q

axilla assessment

A

examine with pt sitting up

lift pt’s arm and support it so that chest/axilla muscles are loose

reach fingers high into the axilla

move firmly in 4 directions

abnormal to feel nodes- infection/cancer

TENDERNESS may be normal- menstruating/breastfeeding

if mass found document like face of a clock, distance from areola, gross size estimate, and shape/texture/movability

17
Q

pain in breast lump

A

less worrisome for breast CA

mastitis

18
Q

male breast cancer

A

average age of onset is 65 (5-10 years older than in women)

**family hx/genetics*- BRCA1 and BRCA2

HIGH MORTALITY RATE (often has already metastasized)- higher in african american men/radiation exposure to chest/ heavy alcohol intake (liver function)

ELEVATED ESTROGEN LEVELS increase risk

19
Q

elevated estrogen levels increase risk of what in men?

A

klinefelter syndrome

liver cirrhosis- changes to hormones, low androgens/high estrogen

prostate cancer treatment- androgen deprivation leaves unopposed estrogen

gynecomastia

never being married- no partner to “take care” of them

obesity- fat cells convert androgens into estrogens

hx of testicular conditions- undescended testes, mumps, testicular removal

occupation- hot environment, gasoline fume exposure

new fracture after age 45 not associated with trauma= warning sign

20
Q

klinefelter syndrome

A

pt has Y chromosome plus at least 2 X chromosomes

congenital condition, leads to higher estrogen

21
Q

breast cancer in woemn

A

RISK FACTORS present in 55% of cases

FAMILY HX present in 10% of cases (+fam hx increases risk; brca 1/brca 2)

AGE: 3/4 of women are >50 yo, 1/2>65 yo

HIGHER EDUCATION/INCOME double the risk- r/t parity

higher rates in CAUCASIANS

all related to longer periods of ESTROGEN EXPOSURE

HISTORY OF BREAST BX=atypical hyperplasia

increased ETOH consumption (2-5 drinks a day=1 1/2 times risk)

OVERWEIGHT AFTER MENOPAUSE- increased estrogen in fat tissue

BIRTH CONTROL- OC/depo have a slightly increased risk; no risk after 10 years off pill

hormone replacement therapy- may have flawed date r/t this

personal hx of breast disease

22
Q

longer periods of estrogen exposure that increase risk of breast cancer in women

A

early menarche

delayed menopause

1st live birth after 35 (when pregnant/breastfeeding, no period so no estrogen fluctuations)

23
Q

reduced risk for breast cancer in woemn

A

physical activity/recreational exercise

higher parity

breastfeeding (estrogen respite)

post-menopause BMI <23

oophorectomy at <35 yo

24
Q

american cancer society screening recommendations

A

women ages 40-44 should have the CHOICE TO START ANNUAL BREAST CANCER SCREENING WITH MAMMOGRAPHY if they wish to do so (average risk)

women ages 45-54 should get a mammogram EVERY YEAR

women ages 55 and older can switch to mammograms EVERY TWO YEARS or continue with yearly screening (depending on risk/preference)

screening should continue as long as a woman is in GOOD HEALTH and is EXPECTED TO LIVE 10 MORE YEARS OR LONGER

all women should know how their breasts normally look/feel (self breast exam) and report any changes to their health provider right away

25
Q

benign breast disease (fibrocystic)

A

6 diagnostic categories

very common- 50% of all women have some form

nodularity occurs bilaterally

regular, rope-like, firm, mobile (can move it), rubbery

pain may be dull, cyclic (with menstruation), or none

CYSTS are discrete, fluid-filled sacs- must be investigated to r/o breast cancer

26
Q

breast cancer presentation

A

solitary UNILATERAL mass

SOLID, hard, dense, NOT MOBILE, fixed to underlying tissue

BORDERS, are POORLY DELINEATED

GROWS, often PAINLESS

most commonly in UPPER OUTER QUADRANT

found in women ages 30-80 yo but MORE COMMON >50 yo

as it advances: enlargement of axillary nodes, nipple discharge/retraction, dimpling

27
Q

fibroadenoma

A

solitary, UNILATERAL, NON-TENDER mass

firm, RUBBERY, ELASTIC (less solid than cancer)

ROUND, oval, or lobulated (1-5 cm)

FREELY MOVING, slippery, slides through tissue

most common in 20-30 yo, but can occur up to age 55

GROWS QUICKLY and constantly

diagnosed by BIOPSY- must rule out malignancy

28
Q

paget’s disease

A

malignant lesion of areola and/or nipple

usually has a corresponding tumor, but not always

1-4% of breast cancers

occurs in both women and men

average age is 57 yo but can occur in young or elderly

29
Q

presentation of paget’s disease

A

flaky/crusty/scaly dermatitis to areola/nipple

can be friable

tingling, redness, itching

flattened nipple, sometimes inversion

discharge from nipple, may be yellowish or bloody

itching/crusting can eventually lead to erosion

ANY REDNESS/THICKNESS ON THE NIPPLE SHOULD BE CONSIDERED SUSPICIOUS

Advanced Health Assessment (7 decks)

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