Phys Dx Breast

Front 1

Borders of the brease?

Back 1

2nd or 3rd rib to 6th or 7th rib from sternal edge to anterior axillary line.

Front 2

Common site of the breast for malignant neoplasia?

Back 2

Upper outer quadrant

Front 3

What is the tail of spence?

Back 3

Tissue from upper outer quadrant that extends into axilla. Thicker than other breast areas.

Front 4

Number of lobes of the female breast?

Back 4

15-25

Front 5

Components of glandular tissue of the female breast?

Back 5

15-25 lobes --> excretory duct --> milk sinus/ nipple

Front 6

Components of the female breast?

Back 6

Glandular tissue, fibrous tissue, ducts, subcu and retromammary fat, supporting muscle tissue, blood vessels, nerves, lymphatics, areola, nipple

Front 7

What is the areola skin like?

Back 7

Deeply pigmented, occasional hair follicles and sebaceous glands

Front 8

What are montgomery tubercles?**

Back 8

Areolar glands around the nipple

Front 9

What are Cooper's ligaments?**

Back 9

Suspensory structures of the female breast

Front 10

Male breast components?

Back 10

Nipple, areola, thin layer of breast tissue

Front 11

Muscles of the breast? (7)

Back 11

Pectoralis major
Pectoralis minor
Serratus anterior
Latissimus dorsi
Supscapularis
External oblique
Rectus abdominus

Front 12

Blood supply of the breast (2)**

Back 12

Internal mammary artery**
Lateral thoracic artery

Front 13

Lymphatic drainage of the breast? (6)**

Back 13

Axillary nodes (central and lateral)**,
Supclavicular
Supraclavicular
Internal mammary
Pectoral
Subscapular (posterior)

Front 14

Where might you find supernumerary nipples or breast tissue?**

Back 14

Along mammary ridge (milk line) that extends from axilla during embryonic development to inguinal region

Front 15

How common are accessory breast or nipples?

Back 15

2% of white women

Front 16

Most common site for accessory breast structures?** Unilateral or bilateral?

Back 16

Axilla.**

Bilateral

Front 17

What is the significance of accessory breast structures (i.e. extra nipple)?*

Back 17

Little clinical significance; no physiologic function; rarely assoc w/ dz*

Front 18

What is the term for breast development?

Back 18

Thelarche

Front 19

Average time from appearance of breast buds (Tanner stage II) to menarche?

Back 19

2 years

Breasts develop at diff rates

Front 20

Lactiferous duct changes during pregnancy?

Back 20

Duct proliferation; alveoli increase in size and number leading to breast enlargment

Front 21

Change in breast tissue during pregnancy?

Back 21

Breasts become softer and looser from incerase in glandular tissue, displacing connective tissue

Front 22

Changes in areolae and nipples during pregnancy?

Back 22

Areolae more deeply pigmented and increase in dm,
Nipples more prominent, darker and more erectile,
Montgomery tubercles develop from sebaceous gland hypertrophy, Colostrum produced near end of preg and stored in alveoli (acini cells)

Front 23

What changes to mammary vascularization during pregnancy?

Back 23

Increases.
Engorgement of veins --> "blue" color to skin

Front 24

What is colostrum?

Back 24

Secreted from breasts for first few days post delivery.

Has antibodies, more protein and minerals than milk.

Front 25

When does milk replace colostrum?

Changes in breast once milk production begins?

Back 25

2-4 days post delivery (increased prolactin, decreasing estrogen and stimulation by sucking)

Breasts become full and tense.

Decreased size to pre-lactation size over 3 months post stopping lactation.

Front 26

Breast changes in older adults?

Back 26

Tissue: atrophy of glandular tiss and replacement of fat at menopause.

Thickening of inframammary ridge at lower edge of breast.

Nipples: smaller, flatter, lose erectile ability.

Skin: dry, thin, loss of axillary hair

Front 27

Neuroendocrine control of breasts:
Milk production?
Milk let down?

Back 27

Production: Prolactin

"Let down" - allows milk to be excreted: Oxytocin

Front 28

What are some signs to ask about in hx that could be suggestive of malignancy?**

Back 28

Nipple discharge*
Nipple inversion*
Skin changes*

Front 29

Is nipple discharge common?**

Back 29

No!*
Think cancer

Front 30

3 types of breast discharge?**

Back 30

Serous, bloody, milky

Front 31

**What does serous breast discharge look like?

Causes?

Back 31

Thin, watery, yellowish stain on bra.

Causes: intraductal papilloma, OCPs, breast cancer

Front 32

**Causes of bloody breast discharge?

Back 32

Non-malignant intraductal papilloma, malignant intraductal papillary carcinoma

Front 33

**Causes of milky discharge?

Back 33

Lactation (or just after stopping), pituitary tumor (prolactinoma), meds, mechanical stimulation or sucking

Front 34

What is a major skin change in the breast? What should you consider?**

Back 34

Peau d'orange - prominant pores (lymphatic obstruction); like skin of orange peel.

Think BREAST CANCER!!***

Other changes: dimpling, puckering, scaliness

Front 35

How should you examine the breast?*

Back 35

Divide into 5 segments: 4 quadrants and tail. When examining, refer to "clock" position.

The tail of spence is an extension of upper outer quadrant

Front 36

What are you inspecting generally about the breast?

Back 36

Size, shape, symmetry, contour, color, edema, venous patterns, lesions

Front 37

What are you inspecting about the nipple?

Back 37

Size, shape, symmetry, color, texture, contour, inversion, eversion, discharge

Front 38

5 D's of nipple and areola?

Back 38

Discharge, Depression (inversion), Discoloration, Dermatologic changes, Deviation

Front 39

2 possible causes of erythema of the breast?

Back 39

Infection, inflammatory carcinoma

Front 40

Possible cause of dimpling of the breast?

Back 40

"retraction phenomena" - malignancy.

Abnormal traction on Coopers ligaments. May have congenitally inverted nipples.

Front 41

What side of patient should you be on to examine the breasts?

Back 41

Right side

Front 42

What should normal breast tissue feel like?

Back 42

Dense, firm, elastic and may be lobular.

Inframammary ridge can be felt along the lower edge of the breast.

May feel fibrocystic changes.

Front 43

6 components of describing the findings of a mass in the breast?**

Back 43

Size of mass, shape of mass, borders of mass, consistency of mass, mobility, tenderness

Front 44

What would mobility of a mass in the breast tell you?

Back 44

Cancers are usually fixed. Benign tumors and cysts are freely mobile.

Front 45

What is the subareolar area?

Why are you palpating this area for?

Back 45

Area directly under areola. Breast tissue is less dense.

Abscess of MOntgomery's glands: tender subareolar mass.

Front 46

What are you examining the nipple for?

Back 46

Retraction, fissures, scaling,
**discharge: note character, amount

Front 47

Should men have breast exams?**

Back 47

**Yes, should be performed on all men. Inspect both breasts.

Front 48

What are you inspecting about the male breast?

Back 48

Size, shape, symmetry, surface characteristics

Nipples: swelling, discharge, ulceration

Front 49

What are you palpating in the male breast?

Back 49

Should have thin layer of fatty tissue over muscle. May look like breast enlargement in obese men. May have firm disk of glandular tissue.

Areola and subareolar tissue for masses.

Axillary lymph nodes.

Front 50

4 types of nipple discharge in males?

Back 50

Serous, bloody, milky, purulent

Front 51

Characteristics of gynecomastia?

Causes?

Back 51

Smooth, firm, mobile, tender breast tissue behind areola. Unilat or bilat.

Causes: age, drugs, ETOH, hormones

Front 52

Average age of dx of breast cancer in men?

Back 52

59

Front 53

Most common symptom of carcinoma of breast in men?***

Back 53

PAINLESS, firm, subareolar mass or mass in UOQ.

Front 54

Metastatic sites from breast? (5)

Back 54

Bone,
Lung,
Pleura,
Lymph nodes,
Skin

Front 55

Characteristics of carcinoma of breast in women?

Back 55

Usually unilateral.
Single mass.
Irregular shape, hard, stonelike, fixed.
Often retraction signs.
Usually non-tender.
Poorly delineated.
No change w/ menses.

Front 56

Associated physical findings in carcinoma of breast in women?

Back 56

Mass or thickening of breast,
Marked asymmetry,
Prominent unilateral veins,
Discolorations (erythema, ecchymosis),
Peau d' orange, ulerations, dimpling, puckering, retraction of skin or areola. fixed inversion or deviation of nipple, crusting or erosion of nipple or areola.

Front 57

Non modifiable risk factors for breast cancer in women? (7)

Back 57

Advanced age,
Female,
Fam hx breast cancer,
Increased breast density,
Genetics,
Menarche before 12 yo
Natural menopause after age 45

Front 58

Modifiable risk factors for breast cancer in women? (5)

Back 58

Hormone therapy,
Pregnancy,
ETOH,
Behavioral/ lifestyle,
Non-hormonal meds

Front 59

Possible risk factors for breast cancer in women, but unknown?

Back 59

Diet, smoking, aspirin, NSAIDs

Front 60

5 things that are do not effect risk of breast cancer in women?

Back 60

Dietary fat,
Caffeine,
Miscarriage and induced abortions,
Abx,
Hormonal contraception?

Front 61

What is Fibrocystic Breast Disease?

Back 61

Age 20-49.
Bilateral, single or multiple masses, round soft or firm, mobile.
Usually tender and well delineated. No retraction signs. Vary w/ menses.

Front 62

What are fibroadenomas?

Back 62

"mouse tumor" Age 15-55. Bilateral. Single or multiple mass. Round or discoid, firm or rubbery, mobile. Usually nontender. No retraction signs. Well delineated. No change w/ menses.

Front 63

What is galactorrhea?

Causes?

Back 63

Lactation not assoc w/ child-bearing.

MCC: drugs (TCA, phenothiazine, estrogen).
Also, tumors (prolactinoma), hypothyroidism, Cushings.

Front 64

What are retention cysts?

Back 64

Inflammation of sebaceous glands in areola. Tender and suppurative.

Front 65

What is Pagets disease?

Back 65

Ductal carcinoma of skin of breast. Red scaling, crusty patch on nipple, areola. Looks like eczematous. Usually unilateral.

Front 66

What is fat necrosis of the breast?

Back 66

Local injury of the breast. Firm irregular mass. Often discolored.

Front 67

What tissues have lymphatics?**

Back 67

Every tissue supplied by blood vessels.
Except placenta and brain.

Front 68

What is the drainage of lymph on right side of body and left side of body?**

Back 68

**Right upper body drains lymph through lymphatic trunk that empties into right subclavian vein.

Thoracic duct drains everything else into subclavian vein.

Front 69

Drainage of lymph fluid from circulation?

Back 69

Closed but porous circulation.
Moves from bloodstream to interstitial spaces. Collected by tubules/ ducts. Carried to lymph nodes. Moved to venous system.

Front 70

T cells vs B cells?**

Primary function of lymphs?**

Back 70

T cells: cellular type immunity.
B cells: humoral-type immunity

Function: fighting chronic bacterial infections and acute viral infections.

Front 71

Tissue layers location of superficial vs deep lymph nodes?

Back 71

Superficial: subcu connective tissue.
Deep: fascia of muscle w/in body cavities.

Front 72

Location of thymus?

Back 72

Superior mediastinum

Front 73

Spleen: white pulp? red pulp?

Back 73

White pulp: lymphatic nodules and tissues.
Red pulp: venous sinusoids.

Site of hematopoiesis in utero.

Front 74

What are peyer patches?

Back 74

Small, raised areas of lymph tissue on mucosa of small intestine. Consist of many clustered lymphoid nodules.

Front 75

Function of lymphatic tissue? (6)

Back 75

Movement of lymph fluid,
Production of lymphs,
Ab production,
Phagocytosis,
Fat absorption from GI tract,
Extra medullary hematopoiesis

Front 76

At what gestational age do immune system and lymphoid system begin development?

Back 76

20 weeks

Front 77

Are palantine tonsils larger in children or adults?

Back 77

Children. Doesn't always mean problem. Most lymph tissue larger in children.

Front 78

What are Virchow's nodes?**

Back 78

Supraclavicular; "sentinel node"
Not usually found/ palpated.

Presence associated w/ high incidence of malignancy (G( and breast) - cause for concern!

Front 79

Changes to lymph tissue in older adults?

Back 79

Decrease in number and size in older adults.

May become fibrotic and fatty which contributes to impaired ability to resist infection.

Front 80

Regions to examine for lymph nodes?

Back 80

Cervical (anterior and posterior),
Supraclavicular,
Axillae,
Epitrochlear (above elbow),
Inguinal,
Popliteal

Front 81

What are you inspecting lymph node areas for? (4)

Back 81

Edema,
Erythema,
Red streaks,
Skin lesions

Front 82

What are you palpating lymph nodes for? (6)***

Back 82

Enlargement,
Consistency,
Mobility (note any that are FIXED!!!),
Tenderness,
Size,
Warmth

Front 83

What are "shotty" nodes?**

Back 83

Small, movable, discrete nodes <1cm that move under the fingers

Front 84

What are "matted" nodes?**

Back 84

Enlarged, juxtaposed, feel like large mass

Front 85

Relationship of hardness of lymph node to malignancy?

Back 85

The harder the node, the more likely malignancy

Front 86

What is acute lymphangitis?

Back 86

Inflammation of 1 or more lymph vessels.
Pain, malaise, not feeling well, +/- fever.

PE: red streak, slightly indurated and palpable to touch. Look distal for sites of infection.

Front 87

What is acute suppurative lymphadenitis?

Back 87

MCC: group A strep or staph.
Firm, tender node. W/in 72 hrs, swelling, erythema.
Mycobacterial lymphadenitis, caused by TB (inflammation w/out warmth, +/- tenderness).
"Cat scratch fever" Cat scratch.
Cat or dog bite --> pasturella multocida.

Front 88

What is mono-like syndrome?

Back 88

Adolescents usually. Pharyngitis, fever, fatigue, malaise.
Splenomegaly, hepatometaly, rash.
Anterior and posterior cervical nodes. May be tender.
Causes: EBV, CMV, adenovirus, varicella, enterovirus

Front 89

What is Roseola Infantum?

Back 89

Common childhood illness. Peak age 2. Herpes virus 6.
High grade fever 3-4 days. Sometimes assoc w/ URI and lymphadenopathy.
Involved nodes: discrete and not tender in occipital and post-auricular area.
Morbilliform, maculopapular rash trunk to extremities.
Tx: sx. No aspirin!

Front 90

What is Cat Scratch Fever?

Back 90

MCC: Bartonella henselae. Papule or pustule 3-5 days, then vesicular and crusts in 2 -3 days. Lymphadenopathy in 1 -2 weeks in region that drains primary lesion. Single lymph node most common, but can be multiple. Lymphadenopathy can last 2-4 months

Front 91

Hodgkins Lymphoma?

Back 91

Malignant. Young kids, late adolescence, young adults. Males > females. Variable presentation, but common: painless enlargement of cervical nodes. Often posterior. Usually asymmetric. Nodes may be matted and firm.
Tx: chemo/ radiation. Curable

Front 92

Non-Hodgkins?

Back 92

Malignant. Nodes of chest, neck, abdomen. B-cell most.
Painless, enlarged nodes, fever, weight loss, night sweats, abd pain, fullness.
Nodes solid, well defined. May become matted.