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History & Physical Examination > Exam 2 - Breast Exam > Flashcards

Exam 2 - Breast Exam Flashcards

1
Q

How can you enhance your communication skills with the patient during a breast exam?

A 
Drape the patient carefully
Warm hands before touching patient
Explain each step of the exam
State what you are about to do before you do it
Keep eye contact
Watch for signs of discomfort
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2
Q

What two things are examined at once?

A

Breasts and axilla

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3
Q

What’s listed under breast exam ROS?

A 
Review of Systems
Lumps
Pain or discomfort
Nipple discharge
Self-examination
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4
Q

What is thelarche?

A

Breast development = thelarche

*Sign of puberty

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5
Q

What Tanner Stage does menstruation begin at?

A

Menstruation begins at stage III or IV

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6
Q

How long does it take to progress from stage II to menarche?

A

From stage II to menarche is about 2 years

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7
Q

T or F: Breasts can develop at different rates in the same individual

A

True

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8
Q

Describe Tanner Stage I:

A

No breast development-preadolescent girls

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9
Q

Describe Tanner Stage II:

A

Elevation of breast and areola-breast bud stage

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10
Q

Describe Tanner Stage III:

A

Areola and breast enlargement-adolescence, early adult

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11
Q

Describe Tanner Stage IV:

A

Areola elevated to above the breast-adolescence, mid adult

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12
Q

Describe Tanner Stage V:

A

Breast enlarged, areola in contour of the breast itself-late adolescence, adult

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13
Q

What’re you looking for when inspecting the breasts?

A 
Contour
Symmetry
Vascular pattern
Nipples
Skin characteristics
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14
Q

What nipple characteristics are you inspecting for?

A

Retraction
Discharge
Skin changes
Piercings

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15
Q

What skin characteristics are you inspecting for on the breasts?

A

Dimpling
Edema
Retraction
Inflammation

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16
Q

By inspection, the breasts should:

A

Be symmetrical, full, rounded, smooth in all portions, without dimpling, retractions or masses
Demonstrate a faint, even vascular pattern and striae
Demonstrate everted nipples with even areola
Demonstrate axillae with even color, without masses or rash

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17
Q

What is polythelia?

A

Polythelia = extra nipples

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18
Q

What is polymastia?

A

Polymastia = accessory breasts

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19
Q

Where is breast tissue found?

A

Breast tissue can be located anywhere along milk lines, from the axilla to the groin

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20
Q

What positions do you inspect the breasts in?

A 
Positions
1. Sitting with arms over head
>>Dimpling and retraction
2. Hands pressed against hips
>>Dimpling and retraction
3. Leaning forward
>>May reveal an asymmetry of the breast or nipple.
>>Retraction of nipple and areola suggests cancer
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21
Q

What does retraction of the nipple suggest?

A

Retraction of nipple and areola suggests cancer

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22
Q

Palpation must be systematic and gentle. What are you palpating for?

A 
Tenderness
Nodules
Size and Mobility
Shape
Consistency 
Firm tissue, without masses or lumps
Local areas without excessive warmth or tenderness
Nipples should not have discharge
Axillae should be smooth
Lymph nodes should not be palpable
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23
Q

T or F: Men should have palpation in breast exam as well as women.

A

True

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24
Q

What should not be palpable?

A

lymph nodes

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25
Q

How do you palpate the breast?

A
  1. Palpate all four quadrants
    >Several methods to use
    »Do NOT omit the tail of Spence (axillary tail)
    »>Many cancers discovered at this location
  2. Palpate under the areola and nipple
  3. Be aware of the infra-mammary ridge
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26
Q

Why is it important to palpate the tail of spence? Where is it?

A

Do NOT omit the tail of Spence (axillary tail)

Many cancers discovered at this location

27
Q

When a lesion is found on the breast, how is it described?

A

Lesions are described positionally as quadrants or as clock face numbers

28
Q

Describe the recommended palpation technique of the breasts?

A

The middle three fingers are held together with the metacarpal-phalangeal joint slightly flexed

Pads of the fingers are the examining surface

Use light, medium, and deep palpation

29
Q

What are the pectoral lymph nodes?

A 
Pectoral nodes
1. Subscapular nodes
2. Supraclavicular nodes
3. Infraclavicular nodes
4. Lateral nodes
5. Central axillary nodes
***Not all lymphatics drain to the axilla
Some may drain to infraclavicular or mediastinal lymph nodes
30
Q

How do you inspect the axilla?

A

Sitting position is preferable

Inspection
Rash, infection, unusual pigmentation, or nodules

Palpation
Use right hand to exam the left axilla and vice versa
Point fingers toward the midclavicle
Press fingers toward the chest wall and slide them downward
Check the supraclavicular, infraclavicular and epitrochlear nodes as well

31
Q

What are you looking for when inspecting axilla?

A

Rash, infection, unusual pigmentation, or nodules

32
Q

Which hand is used to examine the left axilla?

A

Right hand

33
Q

What do you expect to feel in axilla?

A

You should feel 1 or more soft, small (

34
Q

If lymph nodes of axilla feel large, hard, tender, or have lesions/drainage, what do you do?

A

If nodes feel large, hard, or tender, or if you see lesions or drainage, examine other groups of axillary lymph nodes
>Large nodes >1cm suggest malignancy

35
Q

What type of lymph node suggests malignancy?

A

Any axillary lymph node greater than 1cm

36
Q

With mastectomy and breast augmentation patients - What are you inspecting for?

A

Inspect the mastectomy scar and axilla carefully
>Note masses or unusual nodularity
>Note color or signs of inflammation
>Lymphedema may be present in axilla and upper arm

37
Q

With mastectomy and breast augmentation patients - What are you palpating for?

A

Palpate gently along the scar-sensitive
>Use circular motion with 2 or 3 fingers
>Pay attention to the upper outer quadrant and axilla
>Note any enlargement of lymph nodes and signs of inflammation or infection

38
Q

Why is it important to examine male breasts?

A

1% of breast cancer cases are male

Peak in frequency at age 71 years

Risk Factors: BRCA2 mutations, obesity, FHx, testicular conditions, work exposure to high temperatures and exhaust emissions

39
Q

How do you examine the male breast?

A

Inspect the nipple and areola
>If enlarged breast distinguish obesity vs. gynecomastia
>Note nodules, swelling, discoloration, or ulceration

Palpate the nipple and breast tissue
>Note nodules

40
Q

What is Peau d’orange?

A

a pitted or dimpled appearance of the skin, especially as characteristic of some cases of breast cancer or due to cellulite.

41
Q

What is Nipple inversion?

A

An inverted nipple (occasionally invaginated nipple) is a condition where the nipple, instead of pointing outward, is retracted into the breast.

In some cases, the nipple will be temporarily protruded if stimulated, but in others, the inversion remains regardless of stimulus.

42
Q

What is Nipple retraction?

A

A retracted nipple, unlike an inverted nipple, will not come back out when stimulated.

Nipple retraction may be caused by aging, duct ectasia, or breast cancer.

43
Q

What causes nipple retraction?

A

May be caused by aging, duct ectasia, or breast cancer.

44
Q

Left Breast Depression

A

Dimple in the breasts; usually from a tumor causing a dimple

45
Q

Right Breast Mass

A

Tumor in the breasts; has a blueish circumference and obvious protrusion

46
Q

Downward Pointing Nipple

A

Tumor takes up the space of where the nipple is causing it to point downward.

47
Q

Breast Dimpling and Inflammation

A

Another abnormality of the breast

48
Q

Examples of Breast PE Documentation

A

“Breasts symmetric and smooth without masses. Nipples without discharge. No axillary or epitrochlear adenopathy.”

“Breasts pendulous with diffuse fibrocystic changes. Single firm 1 X 1 cm mass, mobile, and nontender, with overlying peau d’orange appearance in right breast, upper outer quadrant at 11 o’clock, 2 cm distal from nipple. 1X1 cm rubbery and mobile bilateral axillary lymphadenopathy.”

49
Q

Overview Summary of the Breast Exam

A

Remember to drape the patient to optimize comfort and completeness of the examination.

Use a pattern that allows for complete coverage of all breast tissue.

Best examination patterns include vertical strips and concentric circles.

Use the middle three fingers on the dominant hand to palpate.

Examine each site with light, then moderate, then firm pressure.

Thoroughly examine the tail of Spence.

Palpate for any axillary or supraclavicular lymph nodes.

50
Q

What is a screening mammogram used for?

A

Screening Mammogram

Used to look for breast disease in women who appear to have no breast problems

51
Q

What is a diagnostic mammogram used for?

A

Diagnostic Mammogram

Used to find breast disease in women who have symptoms or who have found a lump or abnormal radiological changes

  • *A mammogram alone cannot prove that an area of concern is breast cancer
  • *May need US and/or US-guided biopsy
52
Q

What age is appropriate to start clinical breast examinations? How frequently are they done?

A

Clinical breast examination
Q3 years, ages 20-39 years
Annually after age 40 years

53
Q

What age is appropriate to start breast self examination?

A

Breast self examination (BSE)
Q month beginning at age 20 years
Performed 5-7 days post onset of menses

54
Q

What age is appropriate to start getting mammograms? How often are they done?

A

Mammography

Baseline at age 40 years, then Q1-2 years up to age 49 years

55
Q

When is it okay to start screening earlier?

A

FHx of breast cancer, or those with increased risk may need mammogram, US, or MRI sooner

Annually from age 50-70 years

56
Q

When are MRIs done to screen breast cancer?

A

MRI

Pt has >20% lifetime risk = MRI with mammogram annually

57
Q

Why are Breast Self Examinations important?

A

90% of breast cancers are found by women themselves.

When women perform BSE properly and regularly, they can note any changes in their breasts and seek further evaluation.

When women discover lumps in their breasts, and report these findings to their healthcare provider at a very early stage, surgery can save 70-80% of proven cases.

58
Q

How often should women perform breast self exams?

A

BSE should be performed Q month.

59
Q

How is a Breast Self Examination performed?

A

Inspection before a mirror
>Stand and face a mirror with arms relaxed at the sides or arms resting on hips; then turn to the right and left for a side view, looking for any flattening.
>Bend forward from the waist with arms raised overhead
>Stand straight with arms raised over head and move arms slowly up and down at the sides. Look for free movement of the breasts over the chest wall.
>Press each arm firmly together at the chin level while elbows are raised to shoulder level.

Palpate standing, sitting, or lying down

60
Q

BSE: Upright

A

Repeat the examination of both breasts while upright with one arm behind the head.
This position makes it easier to check the upper part of the breast and toward the axilla.

**Do the upright BSE in the shower.
Soapy hands glide more easily, making lumps easier to palpate!

61
Q

BSE: Lying down

A

Place a pillow under the right shoulder and place the right hand behind the head.

Use the finger pads of the three middle fingers held together on the left hand to feel for lumps.

Press the breast tissue against the chest wall firmly enough to know how the breast feels. A ridge of firm tissue in the lower curve of each breast is normal.

Use circular motions systematically all the way around the breasts as many times as necessary until the entire breast is covered.
Bring the arm down to the side and feel under the axilla.

Repeat the exam on the left breast using the right finger pads of the right hand.

62
Q

Gynecomastia

A

Over development of breast in males

63
Q

Duct ecstacia

A

Blocking or occlusion of a breast or mammary gland

History & Physical Examination (19 decks)

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