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79 Cards in this Set
- Front
- Back
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Describe the vertical boundaries of the female breast.
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between the 2nd and 6th ribs
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Describe the horizontal boundaries of the female breast.
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between the sternal edge to the mid axillary line
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Where is the nipple located on the female breast?
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Just below the center
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What is the Tail of Spence?
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The superior lateral corner of the breast that projects up and into the axilla
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Where do we see the most cancer in women?
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Tail of Spence
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Where do we see the most cancer in men?
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Just under the nipple
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What are the 3 components of breast tissue?
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1. glandular tissue
2. fibrous bands of tissue 3. fat or adipose tissue |
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Describe the glandular tissue of the breast.
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it's located inside the 15-20 lobes that surround the nipple
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Give an example of a fibrous band of breast tissue. What does it do?
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suspensory ligaments, specifically Cooper's ligament.
It supports the glandular tissue. |
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Which tissue retracts or dimples when breast cancer is present?
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fibrous tissue
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Why is fat/adipose tissue significant in the breast?
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1. It surrounds the breast
2. It predominates the breast tissue |
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What are 2 ways that you can describe clinical findings of the breast?
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1. divide the breast into 4 quadrants based on vertical or horizontal lines through the nipple
2. use the clock and describe any thing you find/feel in cm from thenipple |
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What are 4 axillary chains of nodes in the breast?
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1. Central axillary nodes
2. Pectoral nodes 3. Subscapular nodes 4. Lateral axilly nodes **you can feel these if they're enlarge |
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Which sets of nodes feed into the central nodes?
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1. Pectoral nodes
2. Subscapular nodes 3. Lateral axillary nodes |
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Where are the central axillary nodes located?
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High/mid axilla
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Where are the pectoral nodes located?
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Anterior/lateral edge of the pectoralis muscle, under the lateral fold
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Where are the subscapular nodes located?
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the lateral edge of the scapula, deep in the edge of the posterior fold
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What is the drainage pattern for all breast lymph nodes?
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All drain into the infraclavicular to the supraclavicular nodes
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What might a newly inverted nipple indicate?
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possibly cancer
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What might a naturally inverted nipple indicate?
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probably normal
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Is breast cancer usually painful?
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no
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What is Paget's disease characterized by?
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areola/ nipple scalding
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At what age should you begin to ask a woman when she had her last mammogram?
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if the person is over 40
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What are 9 types of subjective data to collect during the health history portion of the breast exam?
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1. Pain?
2. Lump? 3. Discharge [from nipples]? 4. Rash? 5. Swelling? 6. Trauma? 7. History of breast disease? 8. Surgery? 9. Self-care behaviors: -Perform breast self-examination? -Last mammogram? |
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What are 7 risk factors associated with breast cancer?
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1. family history
2. 1st degree 3. no parity 4. waiting for 30 to have 1st child 5. previous ovarian/breast cancer 6. obesity 7. alcohol use |
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Why do you need to elevate the shoulder on the side you're examining?
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So that the breast is spread out against the chest wall
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When you are about to conduct the physical exam, what do you need to prepare?
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1. position
2. draping |
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What equipment do you need during the physical exam?
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1. small pillow
2. ruler marked in cm 3. pamphlet or teaching aid for BSE |
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What are 4 pieces of objective data that you should INSPECT during the physical exam?
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1. size and symmetry (OK if 1 is larger)
2. contour (masses, dimpling, flattening) 3. Skin color, thickening, edema, venous pattern 4. Direction that nipples point (note for a change) |
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What might prominent venous flow on a breast indicate?
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possibly tumors, since they are well vascularized
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What are 2 retraction maneuvers that you should instruct your patient to do?
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1. arms held straight above the head
2. hands pressing down on the hips (to move the pectoral muscle) |
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What is the purpose of having the patient do retraction movements?
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to see if anything looks different (ie pull from a tumor)
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During inspection of the breasts, why would you tell the patient to lean forward?
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If anything is stuck to the chest wall, you'll notice
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What are 6 features you should inspect for on a nipple?
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Note:
1. size 2. shape 3. direction in which they point 4. rashes 5. ulceration 6. discharge |
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What is a milk line and why is it significant?
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We are born with a milk line
A nipple can develop anywhere along a milk line |
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What is a supernumerary nipple? Describe it.
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A little nipple that develops along the milk line
May have some breast tissue; insignificant; many people mistake it for a mole |
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What is the best position for breast palpation?
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when the tissue is flattened
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How long should a thorough breast exam take?
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3 minutes/ breast
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Describe the proper palpation technique when palpating the breasts?
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Use FINGERTIPS with light, medium, and deep pressure
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Why might you want to place a towel under the shoulder?
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to spread out the breast more along the chest wall
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Describe the area that you will palpate the breast for?
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rectangular
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How do you perform bimanual breast palpation? When would you use the technique?
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Have the patient sit up and have 1 hand under the breast
If a woman is very large breasted |
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What are 2 correct patterns of breast palpation? Which does Dr. Desjardins think is best?
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1. spokes-on-a-wheel (might miss areas in between)
2. concentric circles (less likely to miss something) |
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What are 10 features that you should note if any lumps are present?
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1. location
2. size 3. shape 4. consistency 5. mobility 6. distinctness 7. nipple retraction 8. overlying skin 9. tenderness 10. lymphadenopathy |
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How should you note the location of a lump?
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quarters or clock (better) AND
note the distance from the nipple |
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How should you note the size of a lump?
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with a ruler, measure length, width, and depth
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How could you describe the shape of the lump?
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oval, round, lobulated
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How could you describe the consistency of the lump?
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soft, hard, or firm
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How should you describe the mobility of the lump?
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Can you move the lump or is it adhering to the chest wall?
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What might a hard or firm lump indicate?
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malignancy
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What might a soft lump indicate?
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a cyst
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How would you describe the distinctness of the lump?
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solitary or multiple
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How might you note nipple retraction?
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inverted?
note change in nipple |
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What are outward signs of mastitis?
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1. tenderness
2. redness 3. induration |
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Why should you palpate the nipple?
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for discharge
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How should you palpate the nipple?
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With the 2nd and 3rd finger (peace sign)
Don't use a lot of pressure |
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What are you looking for when you palpate the nipple?
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secretions
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What do you assess while inspecting and palpating the axillae?
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1. skin
2. lymph nodes |
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Describe the palpation technique that you would use on the axillae.
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-Take the patient's hand like you're shaking it (tell them to relax that arm)
-With your other hand, palpate the 1. pectoral nodes 2. central nodes 3. subscapular nodes 4. lateral axillary nodes |
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When should you teach the breast self-examination?
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-You check one breast while describing the correct technique to your patient
-then tell the patient to demonstrate the correct technique to you -then you check |
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When is a good day for the patient to perform the self-exam? Why?
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on day 5 of menstruation
Swelling/tenderness (especially in fibrocystic breast) should go down |
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If you feel a soft mass, which test should you order?
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ultrasounds to check for fluid filled moiety
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If you feel a hard/fixed mass, which test should you order?
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mammogram
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Are fibroadenomas cancer precursors?
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no
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In which ages do you commonly see fibroadenomas?
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15-25
Usually puberty and young adulthood, but up to age 55 |
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Describe fibroadenomas
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1. usually single (may be multiple)
2. round, disclike, or lobular 3. may be soft, usually firm 4. well delineated (can put fingers around it to delineate) 5. *very mobile (not stuck to chest wall) 6. usually nontender |
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In which ages do you commonly see fibrocystic breasts?
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aka "lumpy breasts"
age 30-50, regress after menopause except with estrogen therapy |
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Describe a fibrocystic breast
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1. single or multiple
2. round 3. soft to firm, usually elastic 4. well delineated 5. mobile 6. often tender *some women have more fibrocystic breasts than others |
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What makes fibrocystic breasts get worse?
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1. coffee
2. chocolate |
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In which ages does breast cancer occur? Which is most common?
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Age 30 and older
Most common over 50 |
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Describe breast cancer
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1. usually single, although may coexist with other nodules
2. irregular or stellate 3. firm or hard 4. not clearly delineated from surrounding tissues 5. may be fixed to skin or underlying tissues 5. usually nontender (but could be) |
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What is Edema (Peau d'orange)?
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When the breast skin looks like the skin of an orange because blood flow is restricted from a tumor
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What causes retraction?
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when the suspensory ligaments pull in because they're attached to the chest wall (not a good sign)
possibility that it can be caused from scarrings from prior procedure (ie cyst removal) |
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Describe Tanner Stage 1
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Tanner Stage 1:
preadolescent elevation of nipple only (also occurs in boys going through puberty, boys may also have 1 breast larger) |
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Describe Tanner Stage 2
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Tanner Stage 2
the breast bud stage: 1. elevation of breast and nipple as a small mound 2. enlargement of areolar diameter |
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Describe Tanner Stage 3
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Tanner Stage 3
further enlargement of elevation of breast and areola |
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Describe Tanner Stage 4
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Tanner Stage 4
projection of areola and nipple to form a secondary mound above the level of the breast |
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Describe Tanner Stage 5
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Tanner Stage 5
the mature stage: 1. projection of nipple only 2. areola has receded to general contour of the breast |
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See slide 26 for example of documenting
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See slide 26 for example of documenting
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