Mosby Breast Chapter 16

Front 1

The breasts lie anterior to which muscles?

Back 1

pectoralis major and serratus anterior

Front 2

The female breasts extend from rib __ to rib__ .

Back 2

2-3 to 6-7

Front 3

How many lobes are in the female breast?

Back 3

15 to 20

Front 4

What does a breast lobule consist of?

Back 4

milk producing acini cells that empty into lactiferous ducts

Front 5

How many lobules are found in each lobe?

Back 5

20 to 40

Front 6

Cooper ligaments extend from _____ through the breast and attach to ___

Back 6

connective tissue layer; underlying muscle fascia

Front 7

What is another name for the suspensory ligaments

Back 7

Cooper ligaments

Front 8

7 muscles that form the floor of the breast

Back 8

pectoralis major and minor, serratus anterior, lat dorsi, subscapularis, external oblique and rectus abdominis

Front 9

What is the major blood supply to the breast?

Back 9

internal mammary and lateral thoracic

Front 10

What tissue makes up the majority of the breast?

Back 10

Subcutaneous tissue and retromammary fat

Front 11

Where is the tail of Spence found?

Back 11

In the axilla

Front 12

where is the greatest amount of glandular tissue found?

Back 12

upper outer quadrant

Front 13

Describe the smooth muscle arrangement under the nipple?

Back 13

Circular and longitudinal smooth muscle

Front 14

What are the stimuli that causes nipple contraction?

Back 14

sensory, tactile, or autonomic stimuli

Front 15

Def: tiny sebaceous glands on areola surface

Back 15

Montgomery tubercles/follicles

Front 16

Where can we find supernumerary nipples?

Back 16

Along the mammary ridge that extends from the axilla to the groin

Front 17

What is responsible for the lymphatic drainage of the skin

Back 17

Superficial lymphatics

Front 18

What is responsible for the lymphatic drainage of the mammary lobules?

Back 18

Deep lymphatics

Front 19

Where are the anterior axillary nodes found?

Back 19

Along the lower border of the pectoralis major inside the lateral axillary fold.

Front 20

Where are the midaxillary nodes found?

Back 20

High in the axilla close to the ribs

Front 21

Where are the posterior axillary nodes found?

Back 21

Along the lateral border of the scapula and deep in the posterior axillary fold

Front 22

What lymph nodes drain the retroareolar area?

Back 22

The interpectoral (Rotter) nodes into the axillary chain

Front 23

What is the lymph node drainage for the areola and nipple?

Back 23

Midaxillary, infraclavicular, and supraclavicular nodes

Front 24

What is the average period from breast bud to menarche?

Back 24

2 years

Front 25

When do most girls start menstruation?

Back 25

At stage 4

Front 26

After lactation has been terminated, how long does involution of breast tissue take?

Back 26

3 months

Front 27

What is the thelarche?

Back 27

Breast development

Front 28

What are the enlarging structures of the breast in the pregnant female?

Back 28

The lactiferous ducts proliferate and the alveoli increase in size and number

Front 29

Where can we find the lateral axillary nodes?

Back 29

Alond the upper humerus

Front 30

In relation to Tanner stages, when do menses begin?

Back 30

during or after stage 3

Front 31

When does the lactacting breast make colostrum?

Back 31

In the first few days after delivery

Front 32

What are some prostate cancer treatments that can result in male breast enlargement?

Back 32

Antiandrogens or gondotropin- releasing hormones

Front 33

What are some disease states that can cause gynecomastia?

Back 33

Hyperthyroidism, testicular cancer, Kleinfelter syndrome

Front 34

What are some medications that have been implicated in male gynecomastia?

Back 34

Cimetidine, Omeprazole, Spironolactone, Finasteride,

Front 35

Name some medications implicated in nipple discharge?

Back 35

Hormones, Phenothiazines, digitalis, diuretics, steroids

Front 36

When does milk replace colostrum?

Back 36

Milk production replaces colostrum in 2 to 4 days.

Front 37

compare components of colostrum with milk

Back 37

colostrum contains more protein and minerals and antibodies

Front 38

When is it recommended for a female to start monthly breast self exams?

Back 38

During age 20s

Front 39

Women with an inherited BRCA1/BRCA2 mutation have a ____ to ____ chance of developing breast cancer.

Back 39

35% to 85%

Front 40

What race has the highest risk of breast cancer?

Back 40

white women

Front 41

Having two first degree relatives increases your risk ______-

Back 41

fivefold

Front 42

When should breast changes that have been noticed on the breast self exam be reported to a health care provider?

Back 42

Any change that lasts longer than 2 weeks

Front 43

What two procedures should be done when conducting breast self exams to tighten the chest muscles?

Back 43

Clasp hands behind your head and swing elbows forward. Press hands firmly on hips and bow slightly toward the mirror and you pull your shoulders and elbows forward

Front 44

What are the 5 Ds related to nipples

Back 44

discharge, depression or inversion, discoloration, dermatologic changes, deviation - compare opposite side

Front 45

What venous pattern is concerning for carcinoma?

Back 45

Unilateral venous patterns. These can be produced by dilated superficial veins as a result of increased blood flow to a malignancy

Front 46

What type of carcinoma is indicated with peau d orange changes of the breast.

Back 46

Inflammatory or Advanced cancer. This indicates edema of the breast caused by blocked lymph drainage

Front 47

What type of breast shape should we expect to see in overweight men?

Back 47

Conical

Front 48

Where is peau d'orange skin typically seen first?

Back 48

In the areola

Front 49

When should nipple inversion be concerning on physical exam?

Back 49

If it is a recent change.

Front 50

Breast MRI is more_____ but less ____ than mammography.

Back 50

sensitive; specific

Front 51

What can lower the sensitivity of a mammogram?

Back 51

It is lower in women who are younger than 50 years of age, have dense breasts or who are taking hormone replacement therapy.

Front 52

What can increase the specificity of a mammogram?

Back 52

It is increased with a shorter screening interval and the availability of prior mammograms.

Front 53

Why is a new nipple deviation concerning?

Back 53

the fibrotic tissue of carcinoma can change the axis of the nipple, causing it to point in a direction different from that of the other nipple

Front 54

Why is a new nipple retraction concerning?

Back 54

Retraction is a flattening or pulling back of the nipple and areola, which indicated inward pulling by inflammatory or malignant tissue

Front 55

Inflammation of the sebaceous glands in the areola can result in ______ that are tender

Back 55

retention cysts

Front 56

Which group of women are more likely to have supernumerary nipples?

Back 56

black women

Front 57

What diseases can supernumerary nipples be associated with?

Back 57

Congenital renal or cardiac anomalies particulary in whites

Front 58

What palpation techniques should be performed with the patient in the seated position?

Back 58

chest wall sweep; bimanual digital palpation; lymph node palpation

Front 59

Where should lymph nodes be palpated?

Back 59

1. Deep in the axilla hollow pushing firmly against the chest wall and muscles of the axilla 2. From the apex to the bra line 3. along the inner aspect of the upper arm down to the elbow 4. Palpated the medial aspect along the rib cage and into the anterior wall along the pectoral muscles 5. The posterior wall, along the border of the scapula 6. the supraclavicular and infraclavicular areas

Front 60

How do you palpate the supraclavicular nodes?

Back 60

Have the patient turn his head toward the side being palpated and raise the same shoulder, he should also bend his his forward to relax the SCM --> then reach deeply into the fossa

Front 61

How do you palpate the infraclavicular nodes?

Back 61

Palpate along the clavicle using a rotary motion

Front 62

Which is more sensitive for palation finger tips or finger pads?

Back 62

Finger pads

Front 63

In the concentric circle technique, start at the ______ of the breast tissue and spiral your way _____ .

Back 63

outermost edge; inward toward the nipple

Front 64

In the wedge technique, palpate from _____ in a _____ fashion

Back 64

the center; radial

Front 65

Prophylactic mastectomy reduces the risk of breast cancer by __-

Back 65

90%

Front 66

When should nipple compression be performed in a breast exam?

Back 66

Only if the patient reports spontaneous nipple discharge

Front 67

When should spontaneous nipple discharge be concerning for cancer?

Back 67

Unilateral and from a single duct

Front 68

How should breast tissue feel in an older woman?

Back 68

fine, granular

Front 69

How should the inframammary ridge feel in an older woman?

Back 69

A firm transverse ridge of compressed tissue along the lower edge of the breast

Front 70

What is responsible for newborn breast enlargement?

Back 70

The passively transferred maternal estrogen

Front 71

What additional areas should you palpate in a postmastectomy breast>

Back 71

Palpate along the surgical scar; Palpate each rib for residual intercostal breast tissue

Front 72

What breast changes can be found in males at puberty?

Back 72

they can have transient unilateral or bilateral subareolar masses that will most likely disappear in a year

Front 73

What should we expect to feel upon palpation of the female pregnant breast?

Back 73

generalized coarse nodularity

Front 74

What effects do hormone therapy have on breasts of postmenopausal women?

Back 74

They can result in fluid- filled cysts, which can be painful

Front 75

Fibroadenomas are usually ____ and bilateral but fibrocystic changes are usually ____ and bilateral

Back 75

nontender; tender

Front 76

Fibrocystic changes are associated with a ____ follicular or luteal phase of the menstrual cycle.

Back 76

long

Front 77

What is the peak incidence for breast cancer?

Back 77

between ages 40 to 75 years

Front 78

What is a benign cause of unilateral single duct nipple discharge?

Back 78

intraductal papilloma and papillomatosis

Front 79

Describe the histology of intraductal papilloma and papillomatosis?

Back 79

Epithelial hyperplasia that causes a wartlike tumor in a lactiferous duct

Front 80

Fibrocystic changes are most common in women from _____to _____

Back 80

30 to 55

Front 81

Tamoxifen reduces the risk of breast cancer in women by ___-

Back 81

50%

Front 82

best time to do BSE

Back 82

2-3 days after period ends

Front 83

Dx: retractions and dimpling of skin

Back 83

contraction of fibrotic tissue secondary to carcinoma

Front 84

Dx: peau d'orange appearance

Back 84

edema due to blocked lymph drainage secondary to advanced or inflam carcinoma

Front 85

Dx: unilateral venous patterns

Back 85

dilated superficial veins from increased blood flow to malignancy

Front 86

supernumerary nipples may be associated with what?

Back 86

congenital renal or cardiac anomalies

Front 87

which part of the finger do you use for palpation of the breast?

Back 87

finger pads

Front 88

how many depths of palpation do you use for breast palpation?

Back 88

3: light, medium and deep

Front 89

when should nipple compression be performed?

Back 89

when nipple discharge is present

Front 90

expected or not? lobular feel of glandular tissue (bumpy)

Back 90

expected when dispersed throughout breast

Front 91

post-mastectomy, where is malignancy likely to reoccur?

Back 91

scar site

Front 92

gynecomastia is associated with what activities?

Back 92

illicit or prescription drug use

Front 93

what change can occur in the nipples during pregnancy?

Back 93

become flattened or inverted

Front 94

when is engorgement a signal of mastitis?

Back 94

48 hours after initial filling

Front 95

what 2 things can cause a clogged milk duct?

Back 95

inadequate emptying or tight fitting bra

Front 96

at what point in life does the inframammary ridge thicken?

Back 96

older age

Front 97

Dx: cyst formation that are tender/painful and increase premenstrually

Back 97

fibrocystic changes

Front 98

Dx: bilateral, round and firm mass that is nontender in a 15 to 55 yo woman

Back 98

fibroadenoma

Front 99

fibroadenomas represent what?

Back 99

hyperplastic or proliferative changes in single terminal ductal unit

Front 100

Dx: painless lump with thickening and asymmetry of breast, nontender

Back 100

malignant tumor

Front 101

Dx: firm irregular mass, discoloration after local injury

Back 101

fat necrosis

Front 102

Dx: serous or bloody nipple discharge

Back 102

intraductal papilloma and papillomatosis

Front 103

Dx: red scaly crusty patch on the nipple, areola and surrounding skin; unilateral

Back 103

Paget disease

Front 104

Dx: smooth firm mobile tender disk of breast tissue behind areola in males

Back 104

gynecomastia

Front 105

causes of gynecomastia (4)

Back 105

hormone imbalance, testicular/pituitary/hormone producing tumor, liver failure, antiHTN/estrogen containing meds

Front 106

Dx: tender and suppurative cysts due to inflammation of sebaceous glands

Back 106

retention cysts

Front 107

drug causes of galactorrhea (4)

Back 107

phenothiazines, TCAs, antiHTN, estrogens

Front 108

intrinsic causes of galactorrhea (5)

Back 108

prolactin secreting tumors, pituitary tumors, hypoparathyroidism, Cushing syndrome, hypoglycemia

Front 109

Dx: sudden onset of tenderness, swelling, erythema, heat plus fever, chills and increased HR

Back 109

mastitis

Front 110

most common cause of mastitis

Back 110

Staph aureus

Front 111

should you discontinue breast feeding if mastitis occurs?

Back 111

no

Front 112

Dx: bluish color, suppuration, hardened mass, erythema and heat

Back 112

abscess

Front 113

Dx: pain, tenderness, inflammation, nipple discharge (sticky, multicolored and from multiple ducts)

Back 113

mammary duct ectasia

Front 114

mammary duct ectasia is due to what?

Back 114

subareolar ducts become blocked with desquamating secretory epithelium, necrotic debris and chronic inflam cells

Front 115

mammary duct ectasia occurs in what population

Back 115

elderly

Front 116

Who are the most common group to be affected with mastitis?

Back 116

Lactating women after milk is established usually the 2nd to 3rd week after delivery