PE exam II (breast)
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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
Bilateral thickenings at inferior border.
Each breast has ______ lobes made up of lobules that drain into _______ ducts.
- 15-20 lobes
- lactiferous (milk)
Lactiferous ducts drain into ______ at the nipple that stores milk until expressed.
What is the blood supply for the breast?
- internal mammary artery
- lateral thoracic artery
Pigmented area surrounding nipple containing sebaceous glands, smooth muscle and an occasional hair.
areola (may be asymmetric but < 3mm, enlarge & darken with pregnancy)
Lactiferous sinuses at the base of the nipple lead to ______ to the exterior.
Where do the lymphatics for the breast primarily drain into?
the anterior and central axillary nodes
Where do the lymphatics for the upper arm drain into?
lateral axillary nodes
Where do lymphatics for the retro-areolar area drain into?
central axillary nodes
Lymphatic drainage of the breast may go deep to the internal mammary nodes & ________ nodes.
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
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
What percentage of breast cancers are found solely by clinical breast exam (CBE)? How sensitive and specific is this test?
- 54% sensitive, 94% specific
When is the best time for breast examination?
- 5-7 days after onset of menstruation
- **always ask about risk factors for breast cancer**
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
Which lymph nodes are palpated during a breast exam?
- anterior, posterior, central & lateral axillary nodes
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
What are the three breast palpation techniques?
- vertical strip
What are you checking for when palpating the breasts?
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)
- mobility (in relation to skin, fascia, chest wall)
Milky discharge unrelated to pregnancy is called what?
What can cause unilateral bloody DC from 1-2 ducts?
- intraductal papilloma
- ductal carcinoma in situ
- Paget's disease of the breast
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)
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
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
What is the chance a woman in the US will develop breast cancer?
1 in 8
What are risk factors for developing breast cancer?
- 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
If BRCA 1 and 2 mutations are present what is the likelihood of that woman developing breast cancer?
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%)
Benign tumor, typically 15-25 yo, usually single and firm, round/disclike/lobular, very mobile and typically nontender.
Benign, typically 30-50 yo, similar signs as fibroadenoma, often tender.
Occurs in 30-60% of women, cobblestone texture, periodic or intermittent breast pain, sx's tend to peak just before menses.
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)
When should women get mommography?
- <50 yo: pt dependent; risk factors, harm vs benefit, etc
- 50-74 yo: biennial (q 2 yrs)
When should CBE be performed?
- 20-40 yo: every 3 years
- >40 yo: annually
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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