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What is the anatomical position/location of the breast?
- extends from 2nd rib to 6th rib & sternum to mid-axillary line
- lies superficially over the pecotralis major and serratus anterior
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Bilateral thickenings at inferior border.
inframammary ridge
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Each breast has ______ lobes made up of lobules that drain into _______ ducts.
- 15-20 lobes
- lactiferous (milk)
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Lactiferous ducts drain into ______ at the nipple that stores milk until expressed.
sinuses
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What is the blood supply for the breast?
- internal mammary artery
- lateral thoracic artery
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Pigmented area surrounding nipple containing sebaceous glands, smooth muscle and an occasional hair.
areola (may be asymmetric but < 3mm, enlarge & darken with pregnancy)
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Lactiferous sinuses at the base of the nipple lead to ______ to the exterior.
terminal ducts
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Where do the lymphatics for the breast primarily drain into?
the anterior and central axillary nodes
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Where do the lymphatics for the upper arm drain into?
lateral axillary nodes
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Where do lymphatics for the retro-areolar area drain into?
central axillary nodes
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Lymphatic drainage of the breast may go deep to the internal mammary nodes & ________ nodes.
supraclavicular
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Describe the Tanner staging for the breasts.
- 1: preadolescent, nipple elevated off chest wall
- 2: breast bud
- 3: breast bud & areola elevate as a unit
- 4: areola & nipple form a secondary mound
- 5: adult breast shape
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When should self breast exams be performed? How can it be done?
- monthly after 20 yrs, 5-7 days after period starts or on the same day every month
- tell pt to inspect in the mirror, palpate lying down/standing, partner can perform exam
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What percentage of breast cancers are found solely by clinical breast exam (CBE)? How sensitive and specific is this test?
- 5%
- 54% sensitive, 94% specific
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When is the best time for breast examination?
- 5-7 days after onset of menstruation
- **always ask about risk factors for breast cancer**
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When inspecting the breast what are you looking for?
- skin changes (color, thickening)
- size & symmetry
- contour (masses, dimpling, flattening)
- nipple size & shape; retraction; rashes, ulceration, discharge
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Which lymph nodes are palpated during a breast exam?
- anterior, posterior, central & lateral axillary nodes
- supraclavicular
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What is the rectangular area you need to palpate during the breast exam while the pt lays supine?
- from clavicle to inframammary fold
- from midsternal line to posterior axillary line
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What are the three breast palpation techniques?
- wedge
- circular
- vertical strip
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What are you checking for when palpating the breasts?
- consistency
- tenderness
- nodules
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What should you note if you find nodules on the breast?
- location & size (quadrant/clock/cm from nipple)
- shape (round, disc, irregular)
- consistency (soft, firm, hard)
- delimitation (well circumscribed/not)
- tenderness
- mobility (in relation to skin, fascia, chest wall)
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Milky discharge unrelated to pregnancy is called what?
nonpuerperal galactorrhea
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What can cause unilateral bloody DC from 1-2 ducts?
- intraductal papilloma
- ductal carcinoma in situ
- Paget's disease of the breast
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What happens to the nipples during pregnancy?
- increase in size up to 2-3 times
- tissue softer & looser
- areola darkens & enlarges
- nipple becomes more prominent
- colostrum DC possible (starting in early pregnancy through early post partum)
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If a woman is breastfeeding what can you ask the patient to do before getting a breast exam to make it easier for her?
feed baby/express milk immediately before performing exam
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What happens to breast tissue as a woman ages?
- glandular & lobular tissue decrease (replaced by fatty tissue)
- atrophy & more prominent inframammary ridge
- nipple appears smaller and flattens
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What is the chance a woman in the US will develop breast cancer?
1 in 8
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What are risk factors for developing breast cancer?
- female
- age
- fam hx (1st degree relatives)
- PMHx of breast cancer/atypical hyperplasia
- H/O high dose radiation to chest
- early menarche (<12), or late menopause (>55)
- nullparity or late first child (>35)
- long term use of HRT
- obesity
- BRCA1/2
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If BRCA 1 and 2 mutations are present what is the likelihood of that woman developing breast cancer?
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In which breast quadrant is breast cancer mostly likely to develop?
- upper outer quadrant (50%)
- nipple (18%)
- upper inner (15%)
- lower outer (11%)
- lower inner (6%)
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Benign tumor, typically 15-25 yo, usually single and firm, round/disclike/lobular, very mobile and typically nontender.
fibroadenoma
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Benign, typically 30-50 yo, similar signs as fibroadenoma, often tender.
cysts
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Occurs in 30-60% of women, cobblestone texture, periodic or intermittent breast pain, sx's tend to peak just before menses.
fibrocystic changes
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Cutaneous edema of the breast is indicated by skin that is indented deeply with holes, the accentuated orifices of the sweat glands.
Peau d'Orange (gives appearance of orange skin/pig skin)
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When should women get mommography?
- <50 yo: pt dependent; risk factors, harm vs benefit, etc
- 50-74 yo: biennial (q 2 yrs)
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When should CBE be performed?
- 20-40 yo: every 3 years
- >40 yo: annually
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What does ultrasound imaging of the breast used for? Is it a cancer screening tool?
- distinguish between solid tumors & fluid filled cysts
- not a cancer screening tool
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