Pcom- Quiz 9 - Physical Assessment

Front 1

What is gynecomastia?

Back 1

If the breast appear enlarged, distinguish between the soft fatty enlargment of obesity and the firm disc of grandular enlargement, called gynecoastia

Front 2

What are the causes of gynecomastia?

Back 2

Arises from the imbalance of estrogen and androgens sometimes drug related.

Front 3

What are the causes of male breast cancer?

Back 3

Risks are BRCA2 mutations obsity, family hx of male or female breast cancer, testicular disorder, and work exposure to high tempertures and exhaust emission.

Front 4

What are the significance of findings on palpation of tender cords

Back 4

Tender cords suggest mammary duct ectasia, a benign but sometimes painful condition of dilated ducts with surrounding inflammtion

Front 5

What are the significance of findings on palpation of tender nodules?

Back 5

Tender nodules are hard, irregular, poorly circumscribed nodules, fixed to the skin or underlying tissues, stringly suggests breast cancer.

Front 6

What are the findings and significance of acanthosis nigrican in the axilla?

Back 6

Deeply pigmented, velvety axillary skin suggests acanthosis nigricans - one form is associated with internal malignancy.

Front 7

what are the causes of enlarged axillary lymph nodes?

Back 7

from infection of the hand or arm, recent immunizations or skin test in the arm, or part of a generalized lymphadenopathy.

Front 8

What are the features of malignant axillary lymph nodes?

Back 8

Nodes that are large ( equal to or more 1cm) and firm and hard, matted togeather, or fixed to the skin or to underlying tissues suggest malignant involvment.

Front 9

What are the 4 groups of lymph nodes in axilla?

Back 9

?Central nodes, pectoral nodes (anterior), subscapular nodes (posterior), and lateral

Front 10

Where are their 4 lymph nodes in the axilla locationed?

Back 10

Central nodes - high in the axillary and midway between the anterior and posterior axillary folds.
Pectoral nodes (anterior), - along the lower border of the pectoralis major inside the anterior axillary fold. Subscapular nodes (posterior)- located along the lateral border of the scapula;palpated deep in the axillary fold.
Lateral - located along the upper humerous.

Front 11

What are the areas of drainage for all 4 lymph nodes in the axilla

Back 11

Central nodes;drain channels from three other groups of lymph nodes, which are seldom palable.
Pectoral nodes (anterior); Drains the anterior chest wall and much of the breast.
Subscapular nodes (posterior); They drain the posterior chest wall and a portion of the arm.
Lateral node; They drain most of the arm.

Front 12

Where do the lymph nodes in the axilla empty their lymph?

Back 12

pectoral, subscapular, and lateral nodes all drain into the central nodes. Lymph then drains from the central node to the infraclavicular and supraclavicular nodes.

Front 13

What other lymph nodes the malignant cells from breast may mestastisize?

Back 13

?Not all the lympathics of the breast drain into the axilla. Malignant cells from a breast cancer may spread directly to the infraclavicular nodes or deep channels within the chest.

Front 14

Define nonpuerperal galactorrhea?

Back 14

Milky discharge unrelated to a prior pregnancy

Front 15

What are the causes of nonpuerperal galactorrhea?

Back 15

hypothyroidism, pituitary prolactinoma and drugs that are dopamine agonists, including many psychotrophic agents and phenothiazines.

Front 16

What are the causes of spontaneous unilateral bloody discharge?

Back 16

evaluate for;
intraductal papilloma
ductal carcinoma in situ
paget's disease of the breast

Front 17

What are the signs of recurrence of breast cancer after mastectomy?

Back 17

masses, nodlarity, and change in the color or inflammation, especailly in the incision line, suggest recurence of breast cancer.

Front 18

How will you instruct a pt for breast self eaxamination.Lying supine

Back 18

1. Lie down with a pillow under your right shoulder. Place your right arm behind your head.
2. use the finger pads of the three middle fingers on your left hand to feel lumps in the right breast.
3. press firmly enough to know hoe your breasts feels.A firm ridge in the lower curve of each breast is normal. If you're not sure how hard press, talk with your health provider.
4. Press firmly on the breast in an up and down or strip pattern. you can also use a circular or wedge pattern, but be sure to use the same pattern each time. Check entire breast each month.
5. Repeat on left breasts
6. Any masses lumps or skin changes, see you doc!

Front 19

How will you instruct a pt for breast self eaxamination.Standing

Back 19

Reapeat the examination of both breast while standing, with one arm behind your head. The upright position makes it easier to check the upper outer part of the breasts( towards the armpit) This is where about half of breast cancer is found, You may want do in shower! soapy hands make it easier to glide over the skin!
2. check breasts in mirror each month- note changes
3. Any masses lumps or skin changes, see you doc

Front 20

What are the three most common causes of breast nodules?

Back 20

Fibroadenoma ( benign tumor)
Cysts
Cancer

Front 21

What are the differences between them Fibroadenoma ( benign tumor),Cysts and Cancer in different aspects; Usual age

Back 21

Fibroadenoma ( benign tumor)- 15-25 usually puberty and young adulthood, but up to age 55
Cysts- 30-50 regress after menopause except with estrogen therapy.
Cancer- 30-90 most common over 50

Front 22

What are the differences between them Fibroadenoma ( benign tumor),Cysts and Cancer in different aspects; Number

Back 22

Fibroadenoma ( benign tumor)- usually single may be multiple
Cysts - single or multiple
Cancer- usually single, although may coexist with other nodule

Front 23

What are the differences between them Fibroadenoma ( benign tumor),Cysts and Cancer in different aspects; Shape

Back 23

Fibroadenoma ( benign tumor)- Round, disclike,or lobular
Cysts- Round
Cancer- irregular or stellate

Front 24

What are the differences between them Fibroadenoma ( benign tumor),Cysts and Cancer in different aspects; Consistency

Back 24

Fibroadenoma ( benign tumor)- may be soft, usually firm
Cysts- soft to firm, usually elastic
Cancer- firm or hard

Front 25

What are the differences between them Fibroadenoma ( benign tumor),Cysts and Cancer in different aspects; Delimitation

Back 25

Fibroadenoma ( benign tumor)- Well delineated
Cysts- Well delineated
Cancer- Not clearly delineated from surrounding tissue

Front 26

What are the differences between them Fibroadenoma ( benign tumor),Cysts and Cancer in different aspects; Mobility

Back 26

Fibroadenoma ( benign tumor)- very mobile
Cysts- mobile
Cancer- fixed to the skin or underlying tissues

Front 27

What are the differences between them Fibroadenoma ( benign tumor),Cysts and Cancer in different aspects; Tenderness

Back 27

Fibroadenoma ( benign tumor)- usually nontender
Cysts- often tender
Cancer- usually non tender

Front 28

What are the differences between them Fibroadenoma ( benign tumor),Cysts and Cancer in different aspects; Retraction signs

Back 28

Fibroadenoma ( benign tumor)- Absent
Cysts- Absent
Cancer- may be present

Front 29

What are the rectraction signs of breast cancer?

Back 29

As breast cancer advances it causes fibrosis( scar tissue) Shortening of this tissue produces, dimpling changes in contour and retraction deviation of the nipple.

Front 30

What are the other causes of brest rectraction?

Back 30

fat necrosis and mammary duct ectasia

Front 31

What is the Peau d' orange sign in the breast?

Back 31

Edema of the skin is produced by lymphatic blockage. It appears as thickened skin with enlarged pores. Often seen first in the lower portion of the breast or areola.

Front 32

What is the visible sign in Paget's disease of the nipple?

Back 32

Scaly, eczemalike lesion that may weep, crust or erode.

Front 33

What is the milk line?

Back 33

This is the area where occasionally one or more extra nipples are located. Only a small nipple and areola are present, often mistaken for a common mole. There is no pathologic significance.

Front 34

Lymphatic Drainage of the Breast

Back 34

- mostly drain down towards the axilla
- of the axillary nodes the central nodes are palpable most frequently.
- the pectoral anterior nodes, subscapular posterior nodes and Lateral nodes all drain into the central nodes deep within the axilla, then the lymph drains from the central axillary nodes to the infraclavicular and supraclavicular nodes.

Front 35

What is galactorrhea?

Back 35

Galactorrhea is the inappropriate discharge of milk-containing fluid.
It is abnormal if it occurs 6 or more months after childbirth or cessation of breastfeeding.

Front 36

Name the palpable masses of the breast at different ages

Back 36

15-25 Fibroadenoma, usually smooth rubbery, round, mobile, non tender.
25-50 Cysts, usually soft to firm, round mobile, often tender.
Fibrocystic changes, Nodular and rope-like.
Cancer Irregular, firm, may be mobile or fixed to surrounding tissue.
Over 50- Cancer until proven otherwise

Front 37

The relative risk factors for breast cancer and strength of the risks.

Back 37

Relative risk is > 4.0 for being female, Greater than 65, greater than 45 if you are a Black woman, certain inherited genetic mutations for breast cancer (BRCA1 and or BRCA 2) Two or more 1st degree relatives with breast cancer diagnosed at an early age. personal hx of breast cancer, high breast tissue density, biopsy confirmed atypical hyperplasia.

Relative risk is 2.1-4.0 if you have 1 first degree relative with breast cancer.
Have had high dose radiation to the chest. High bone density (postmenopausal)

Relative risk is 1.1-2.0 late age at first full term pregnancy (>30 years old). Early menarche (<12)Late menopause(>55). No full term pregnancies. Never breastfed. Recent oral contraceptive use. Recent and or long term use of hormone replacement therapy
Obesity postmenopausal

Other factors may include personal history of endometrium, ovary, or colon cancer
Alcohol consumption. height(tall) high socio economic status, Jewish heritage.

Front 38

What are the risk factors of breast cancer that can be modified?

Back 38

Modifiable risks include: postmenopausal obesity, use of HRT, alcohol ingestion, physical inactivity, choices about breastfeeding, and type of contraception.

Front 39

What is the relations of mammographic breast density with causation of breast cancer?

Back 39

Most undervalued and underused risk factor.
omen with radiologically density is more than 60 to 75% of the breast are 4 to 6 times more at risk of Breast cancer...read more!

Front 40

What is the recommendations of screening mammography, CBE,and BSE

Back 40

Mommagraphy- ages 40-50 - every 1 to 2 years
CBE ( clinical breast examination)- 20 -40 every 3 years
BSE( breast self examination)-American cancer society no longer recommends monthly BSE! should be monthly 5 to 7 days after the onset of menses.

Front 41

What are the 4 views of inspection of the breast.

Back 41

arms at side.
Arms over head
arms pressed against hips
Leaning forward.

Front 42

What are the causes of breast redness

Back 42

from local infection or inflammatory carcinoma.

Front 43

What are the causes of breast redness thickening and prominent pores in the skin of breasts

Back 43

Suggest breast cancer

Front 44

What are the causes of breast flattening of the normal convex?

Back 44

Suggest breast cancer

Front 45

What causes dimpling of the breast? What is it's significance?

Back 45

When a cancer or its associated fibrous strands are attached to both the skin and the fascia overlaying the pectoral muscle, pectoral contraction can draw the skin inwards. Suggest breast cancer-can be a benign lesion- should check!

Front 46

What is nipple retraction? What is it's significance?

Back 46

Recent of fixed flattening or depression of the nipple suggests nipple retraction. May be broadened of thickened suggesting an underlying cancer.

Front 47

What are the different findings on palpation of breasts in breast cancer?

Back 47

Hard irregular poorly circumscribed nodules, fixed to the skin or underlying tissues, cysts inflamed ares; some cancer can be tender.A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and intercostal muscles; if fixed when the hand is pressed against the hip, it is attached to the pectoral fascia. thickening of the nipple and loss of elasticity suggest underlying breast cancer.