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Physical Diagnosis > PD Breast and Axilla > Flashcards

PD Breast and Axilla Flashcards

1
Q

What muscles are superficial to the paired mammary glands on anterior chest?

A

Pectoralis major

Serratus anterior

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2
Q

What is the female breast composed of?

A

Glandular tissue
Fibrous tissue
Fat

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3
Q

How is the glandular tissue of the breast arranged?

A

15-20 lobes that radiate about the nipple

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4
Q

How are the lobes of the breast arranged?

A

Each lobe composed of 20-40 lobules

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5
Q

What do the lobules contain?

A

Milk producing cells that empty into lactiferous ducts

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6
Q

What is the function of the fibrous tissue?

A

Supports the breast

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7
Q

Where is fat located in the breast?

A

Subcutaneous, retromammary

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8
Q

What is the vascular supply to the breast?

A

Branches of internal mammary artery

Lateral thoracic artery

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9
Q

What are the five segments of the breast?

A

4 quadrants and a tail of Spence

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10
Q

Where does the greatest among of glandular tissue lie in the breast?

A

Upper outer quadrant

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11
Q

Each breast has a complex… network

A

Lymphatic

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12
Q

In the axillae, the mammary tissue is in direct contact with what structures?

A

Axillary lymph nodes

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13
Q

Montgomery tubercles

A

Small elevations on surface of areola
Sebaceous glands
Secrete lipoid material to protect nipples during nursing

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14
Q

What history questions do we ask patients about breasts?

A 
Mastalgia
Lumps/masses
Nipple discharge
Skin lesions
FHx of breast/ovarian cancer
Mammograms
Breast self exam
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15
Q

How do we prep the patient to be examined?

A 
Properly gowned patient
Unclothes from waste up
Warm, clean hands
Supine
Special maneuvers when lump or mass is detected
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16
Q

What do male practitioners need to do during a breast exam?

A

Males examining females should always have another female in the room

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17
Q

What are the positions the patient should be in for breast exam?

A

Sitting position with arms handing loosely at sides
Sitting, arms overhead/leaning forward
Sitting, hands on hips/pressed together

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18
Q

How does sitting with arms overhead or leaning forward affect the exam?

A

Position increases tension on suspensory ligaments and may help to accent any mass effect

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19
Q

How does sitting with hands on hips or pressed together affect the exam?

A

Maneuver contracts the pectorals muscles, lesions deeply adherent may manifest themselves

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20
Q

Inspection of breast

A 
Size
Skin
Texture
Symmetry
Venous patterns
Contour
Lesions
Supernumerary nipples
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21
Q

How do we need to position the breasts to examine them?

A

Make sure to lift each breast to inspect inferior aspect or folds

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22
Q

How do we compare breasts?

A

First compare left to right

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23
Q

What should we expect when comparing breasts?

A

Expect as a normal variant that one breast is slightly or even noticeably larger than the other

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24
Q

What are some breast abnormalities?

A

Dimpling
Retraction of skin surface or nipple
Peau d’orange

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25
What kinds of patients would get infections under the breast?
Elderly Obese Diabetic Immunocompromised
26
What does skin dimpling most likely indicate underneath?
Tumor
27
Nipple retraction
Common developmental anomaly results in nipple having crater-like depression Harmless
28
What does appearance of nipple retraction after maturity arouse?
Appearance after maturity should arouse suspicion of underlying neoplasm or inflammatory disease
29
Peau d'orange | Cause
Appearance of skin that indicates edema of the breast caused by blocked lymphatic drainage Often due to carcinoma Skin looks thickened with enlarged pores and accentuated skin markings
30
Supernumerary nipples
Polythelia | One or more extra nipples located along embryonic mammary ride (milk line)
31
Palpation of breast
``` Systemically palpate all 4 quadrants and tail of each breast, axillae, and supraclavicular regions Hand and fingers flat Press firmly Small rotary motion Don't lift hands off, slide ```
32
When would you use your thumbs for palpation of the breast?
Use thumbs only for discrete mass characterization
33
How firmly should you palpate the breast?
Firmly, but no so firmly that breast compressed against rib cage
34
Variety of methods of palpation of breast
Vertical Circular Wedge or radial
35
How are patients positioned for palpation of breast?
Seated initially | Supine or slight incline to distribute breast tissue over chest wall and more easily compressed
36
Palpation of areola / nipple
Make sure to palpate breast tissue deep to areola | Compress niple between thumb and index finger - inspect for drainage
37
How do we characterize drainage of the areola?
Serous Bloody Pus
38
More than 1/2 of breast cancers arise from what area of the breast?
Upper outer quadrant / Tail of Spence
39
What other regions need to be palpated, besides the breast?
Axillae Supraclavicular For nodes - 1-2% of breast cancers only present as an enlarged LN
40
Mass characterization
``` Location Size Shape Consistency Tenderness Mobility Borders Retraction Overlying skin changes Nipple discharge ```
41
Common breast lesions
``` Fibrocystic disease (mammary dysplasia) Fibroadenoma Breast carcinoma Mastitis/abscess Nipple discharge Gynecomastia ```
42
Inspection of nipple discharge
``` Nature/consistency of discharge (clear, milky, pus, blood) Association with mass or not Unilateral/bilateral Spontaneous or must be expressed Relationship to menses Any meds/estrogen ```
43
Galactorrhea
Abnormal lactation (not associated with child bearing)
44
Drug causes of galactorrhea
``` Most commonly, drugs Phenothiazines TCA Antihypertensive Estrogen ```
45
Intrinsic causes of galactorrhea
``` Prolactin secreting tumors Pituitary tumors Hypothyroidism Cushing syndrome Hypoglycemia ```
46
Gynecomastia
Enlargement of breast tissue in boys/men
47
Causes of gynecomastia
``` Puberty Hormone imbalance Testicular tumors Pituitary tumors Meds containing estrogens or steroids, antiHTN Drugs like marijuana, alcohol, heroin ```
48
What does gynecomastia feel like are where is it located?
Smooth, firm, mobile, tender disk of breast tissue located behind areola
49
What is the most frequent disorder of the breast?
Fibrocystic disease
50
Fibrocystic disease
Benign cyst formation caused by ductal enlargement Rapid fluctuation in size Lesions filled with fluid, usually bilateral and multiple
51
What part of the menstrual cycle is fibrocystic disease associated with?
Long follicular or luteal phase
52
Describe cysts of fibrocystic disease
Filled with fluid Bilateral and multiple Tender/painful with increase Sx premenstrually Round, soft to firm and tense, mobile, no retractions or dimpling No nipple discharge
53
What age do patients usually present with fibrocystic disease?
30-50
54
Fibroadenoma
Benign neoplasm accounts for majority of breast tumors in young women Generally asymptomatic and do not change premenstrually
55
Describe fibroadenomas
``` Multiple 1-5 cm Bilateral Non tender/painless Round or discoid with firm/rubbery consistency Mobile with well delineated borders No retraction Often biopsied to rule out carcinoma ```
56
Mastitis, breast abscess
Infection of the breast | Absces if pus pocket is present
57
Cause of mastitis
Staph aureus
58
Presentation of mastitis
Breast pain and redness in nursing mom
59
PE findings with mastitis
``` Erythema Edema Tenderness Induration Fluctuance Fever/chills Purulent nipple discharge ```
60
What would we consider instead of mastitis in non lactating females?
Inflammatory breast Ca
61
What is the second most common site of cancer in women?
Breast carcinoma
62
Lifetime risk of breast Ca
In white women, 1 in 8/9
63
What is the second most common cause of cancer death?
Breast carcinoma
64
Peak age of breast carcinoma
40-60
65
Most common initial symptom of breast carcinoma
Painless lump
66
How does breast carcinoma metastasize?
Occur through lymphatic and vascular systems
67
Breast carcinoma risk factors
White Increasing age Personal Hx FHx, breast, ovarian, endometrial Early menarche (before 12) Late neopause (after 50) Nulliparity Late age at birth of first child (over 30) Previous breast biopsies with benign disease Genetic mutations of BRCA1 and 2 Estrogen replacement therapy after menopause (>4 years)
68
Findings associated with breast carcinoma
``` Mass or thickening in breast Marked asymmetry Prominent unilateral veins Skin discolorations (erythema or ecchymoses) Peau d'orange Ulcerations Dimpling, puckering, retraction of skin or areola Fixed inversion or deviation of nipple Crusting or erosion of nipple/areola ```
69
What is the rationale for breast screening?
Not all breast carcinomas are palpable
70
What are the qualities of palpable breast ca?
``` Firm or hard Non tender Poorly defined borders Accompanied by skin/nipple changes Accompanied by discharge ```
71
What kind of nipple discharge is indicative of breast carcinoma?
Bloody discharge
72
Signs of advanced breast ca
``` Erythema Ulceration of skin Large primary tumor Fixation to chest wall Enlargement or shrinkage/retraction of breast Axillary or supraclavicular LAD Ipsilateral arm edema Distant mets ```
73
What do recent studies suggest about BSE?
Monthly BSE do not impart any benefit to female patients towards decreases in breast cancer mortality
74
Clinical breast examination by a health care provider should be done... over age of...
Yearly over age of 40
75
American cancer society advocates ... as a cancer screening tool in women over...
Yearly mammograms in women over 40
76
Why is BSE done monthly?
So patient becomes familiar with the usual appearance and feel of her breasts - easier to notice changes
77
When should a patient do a BSE?
2-3 days after menses, when breasts are least likely to be tender
78
How do you perform a BSE?
1. Stand before mirror and inspect both breasts for anything unusual 2. Watching closely in mirror, clasp hands behind head and press hands forward 3. Press hands firmly on hips and bow slightly toward mirror, pull shoulder elbows forward 4. Raise left arm, use right hand to explore left breast firmly 5. Gently squeeze nipple and look for discharge 6. Repeat on right breast 7. Repeat while lying down

Physical Diagnosis (10 decks)

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