Physical Examination of the Breasts and Axilla

Question 1

How do you annotate the location of masses or lumps in the breast?

Answer 1

Clock positions and distance from the nipple.

Question 2

I’m an idiot.

Answer 2

I can’t figure out how to delete this one.

Question 3

What guidance governs the screening recommendation for breast cancer?

Answer 3

US Preventative Services Task Force, NAVMED P-117 (MANMED)

Question 4

What are non-modifiable risk factors for breast cancer?

Answer 4

Age
Gender
Personal and family history of breast cancer
Previous breast biopsies
Race
Previous breast radiation
Early menarche
Late menopause
Breast density
DES therapy

Question 5

What are modifiable risk factors for breast cancer?

Answer 5

Nullparity or late childbirth
Hormone therapy
Alcohol
Obesity
High fat diets
Lack of physical activity

Question 6

Describe the location of breasts and their supporting muscles and bones.

Answer 6

Located on the anterior chest wall, superficial to the pectoralis major and serratus anterior muscles.

Extends from the second or third rib to the sixth or seventh rib, and from the sternal margin to the mid-axillary line.

Question 7

How many lobes are contained in each breast, and how many lobules are within each lobe?

What is contained within the lobules?

Answer 7

15-20 lobes per breast that radiate about the nipple.

20 to 40 lobules per lobe, each lobule consists of milk-producing acini cells that empty into lactiferous ducts during lactation.

Question 8

What are the underlying muscle fascia that form the floor of the breasts?

Answer 8

Pectoralis major and minor, serratus anterior, latissimus doors, subscapularis, external oblique, rectus abdominis.

Question 9

What are the branches that provide vascular supply to the breasts?

Answer 9

Internal mammary and lateral thoracic artery.

Question 10

Where does the greatest amount of glandular breast tissue lie?

Answer 10

The upper outer quadrant. Tissue extends from this quadrant to the axilla, forming the tail of Spence.

Question 11

What are the 5 D’s related to nipples?

Answer 11

Discharge

Depression

Discoloration

Dermatologic changes

Deviation

Question 12

In what situation should you perform nipple compression?

Answer 12

Only if the patient complains of spontaneous discharge.

Question 13

What can cause venous networks to be pronounced in the breasts of a female patient?

Answer 13

Pregnancy or obesity.

Question 14

Where do supernumerary nipples appear?

Answer 14

Along the embryonic mammary ridge.

*More common in black women.

Question 15

What are fibrocystic changes, and what causes them?

Answer 15

Benign cyst formation due to ductal enlargement. They are associated with a long follicular or luteal phase of the menstrual cycle.

The lesions are filled with fluid and are bilateral and multiple.

Question 16

These account for the majority of breast tumors in young women. What are they?

Answer 16

Fibroadenoma, which are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process.

Question 17

Malignant breast tumors have a peak increase between what ages, and typically occur at what age?

What are the signs and symptoms?

Answer 17

Peak at 40-75, typically occur in women over 50.

Mass or thickening of the breast
Marked asymmetry
Prominent unilateral veins
Discoloration
Peau d’orange
Ulcerations
Dimpling
Puckering or retraction of skin
Fixed inversion or deviation of nipple

Question 18

Fat necrosis typically occurs in response to what?

Answer 18

Local injury. It appears as a firm, irregular mass that appears as an area of discoloration.

Question 19

These are 2-3cm tumors if the subareolar ducts that occur singly or in multiples. They commonly cause serous or bloody nipple discharge.

Answer 19

Intraductal papillomas and papillomatosis.

Question 20

This is a surface manifestation of underlying ductal carcinoma. It appears as a red, scaling, crusty patch that forms on the nipple, areola, and surrounding skin.

The lesions appear eczematous and usually unilateral.

Answer 20

Paget disease

Question 21

What causes gynecomastia?

Answer 21

Hormone imbalance

Testicular, pituitary or hormone secreting tumors

Liver failure

Antihypertensives

Question 22

Retention cysts are inflammation of what breast glands?

Answer 22

Subaceous glands of the areola.

Question 23

Galactorrhea is lactation not associated to childbearing. What are its causes?

Answer 23

Pituitary tumors, Cushing’s syndrome, hypoglycemia drugs, phenothiazines, tricyclic antidepressants, estrogen.

Question 24

Mastitis is typically caused by what?

Answer 24

Staph infection, most common in lactating women.

Question 25

Mammary duct ectasia typically occurs in what patient group?

Answer 25

Menopausal women.