Physical Examination of the Breasts and Axilla Flashcards
How do you annotate the location of masses or lumps in the breast?
Clock positions and distance from the nipple.
I’m an idiot.
I can’t figure out how to delete this one.
What guidance governs the screening recommendation for breast cancer?
US Preventative Services Task Force, NAVMED P-117 (MANMED)
What are non-modifiable risk factors for breast cancer?
Age
Gender
Personal and family history of breast cancer
Previous breast biopsies
Race
Previous breast radiation
Early menarche
Late menopause
Breast density
DES therapy
What are modifiable risk factors for breast cancer?
Nullparity or late childbirth
Hormone therapy
Alcohol
Obesity
High fat diets
Lack of physical activity
Describe the location of breasts and their supporting muscles and bones.
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.
How many lobes are contained in each breast, and how many lobules are within each lobe?
What is contained within the lobules?
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.
What are the underlying muscle fascia that form the floor of the breasts?
Pectoralis major and minor, serratus anterior, latissimus doors, subscapularis, external oblique, rectus abdominis.
What are the branches that provide vascular supply to the breasts?
Internal mammary and lateral thoracic artery.
Where does the greatest amount of glandular breast tissue lie?
The upper outer quadrant. Tissue extends from this quadrant to the axilla, forming the tail of Spence.
What are the 5 D’s related to nipples?
Discharge
Depression
Discoloration
Dermatologic changes
Deviation
In what situation should you perform nipple compression?
Only if the patient complains of spontaneous discharge.
What can cause venous networks to be pronounced in the breasts of a female patient?
Pregnancy or obesity.
Where do supernumerary nipples appear?
Along the embryonic mammary ridge.
*More common in black women.
What are fibrocystic changes, and what causes them?
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.
These account for the majority of breast tumors in young women. What are they?
Fibroadenoma, which are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process.
Malignant breast tumors have a peak increase between what ages, and typically occur at what age?
What are the signs and symptoms?
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
Fat necrosis typically occurs in response to what?
Local injury. It appears as a firm, irregular mass that appears as an area of discoloration.
These are 2-3cm tumors if the subareolar ducts that occur singly or in multiples. They commonly cause serous or bloody nipple discharge.
Intraductal papillomas and papillomatosis.
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.
Paget disease
What causes gynecomastia?
Hormone imbalance
Testicular, pituitary or hormone secreting tumors
Liver failure
Antihypertensives
Retention cysts are inflammation of what breast glands?
Subaceous glands of the areola.
Galactorrhea is lactation not associated to childbearing. What are its causes?
Pituitary tumors, Cushing’s syndrome, hypoglycemia drugs, phenothiazines, tricyclic antidepressants, estrogen.
Mastitis is typically caused by what?
Staph infection, most common in lactating women.
Mammary duct ectasia typically occurs in what patient group?
Menopausal women.
