Breast and Axillae

Question 1

Breast nodules are often bilateral or unilateral?

Answer 1

bilateral and can occur throughout the breast

Question 2

when does nodularity of the breast increase?

Answer 2

possibly before menses

Question 3

is uneven breast tissue normal or abnormal

Answer 3

normal

Question 4

extra nipples along the “milk line” that present as a small nipple/areola

Answer 4

supernumerary nipples

Question 5

what node is most likely to be palpable

Answer 5

central nodes

Question 6

node that is in the center of the axilla in the axillary fat, midway between A and P axillary fold

Answer 6

Central nodes

Question 7

node located between the pectoralis minor and major muscles

Answer 7

Rotter’s nodes

Question 8

where does the central nodes drain into

Answer 8

into the infraclavicular and supraclavicular nodes

Question 9

where do most lymphatic vessels of the breast drain into?

Answer 9

the axillary nodes

Question 10

what 3 groups drain into the central nodes? are they palpable

Answer 10

1. pectoral (anterior)
2. subscapular (posterior)
3. lateral (humeral or deep)

no they are not palpable

Question 11

small nipple and areola overlaying a thin disc of undeveloped breast tissue consisting of primarily ducts

Answer 11

the male breast

Question 12

a benign breast enlargement caused by a proliferation of a palpable glandular tissue

Answer 12

gynecomastia

Question 13

how big is the glandular tissue in gynecomastia?

Answer 13

> 2cm in size

Question 14

what causes gynecomastia?

Answer 14

• increased estrogen
• decreased testosterone
• medications (spironolactone)
• Klinefelter syndrome
• antipsychotics

Question 15

common/concerning symptoms of the breast

Answer 15

• breast lump
• discomfort or pain
• nipple discharge

Question 15

accumulation of subareolar fat

Answer 15

pseudogynecomastia (man boobs)

Question 16

what should be asked for pts with breast lump or mass?

Answer 16

1. location
2. how long has it been there
3. any variation in size or with menstraution
4. any dimpling of the skin?
5. family history

Question 17

MC breast mass for age 15-25 years?

Answer 17

fibroadenoma

Question 18

smooth, rubbery, round, mobile and nontender breast mass

Answer 18

fibroadenoma

Question 19

MC breast mass in age 25-50

Answer 19

Cyst, fibrocystic changes, cancer

Question 20

mass that is soft/firm, round, mobile, tender

Answer 20

cysts

Question 21

mass that is nodular and rope like

Answer 21

fibrocystic change

Question 22

mass that is irregular, firm, mobile/fixed

Answer 22

cancer

Question 23

MC masses in pregnant/lactating patients

Answer 23

• lactating adenomas
• cysts
• mastitis
• cancer

Question 24

Breast pain that fluctuates with hormone changes from menstrual cycle

Answer 24

cyclic mastalgia

Question 25

breast pain related to an internal injury or anatomical change

Answer 25

non-cyclic mastaglia

Question 26

breast pain that is felt in the breast but originates from another location

Answer 26

Extramammary mastalgia

Question 27

what type of pain NEEDS diagnostic imaging

Answer 27

focal

Question 28

a discharge of milk containing fluid unrelated to pregnancy or lactation

Answer 28

galactorrhea

Question 29

what is the MC cause of galactorrhea

Answer 29

hyperprolactinemia

Question 30

when is nipple discharge more likely to be pathologic?

Answer 30

* blood/serous * unilateral * spontaneous * with a mass * arising from a single duct * >40yo

Question 31

When is the best time to do a breast exam in female patients that are still menstruating

Answer 31

5-7 days after onset of menstruation

Question 32

what are the 4 positions of breast exams

Answer 32

1. arms at the side 2. arms over the head 3. hands pressed against the hips 4. leaning forward

Question 33

why do we do 4 different positions for breast exam

Answer 33

b/c certain positions can bring out dimpling or retraction

Question 34

thickening of the skin and prominent pores of the breast

Answer 34

Peau d'orange

Question 35

what does peau d'orange suggest?

Answer 35

breast cancer

Question 36

Nipple that points inward and is depressed below the areolar surface but can be moved out from the sulcus

Answer 36

inverted nipple

Question 37

what is a benign variant of nipple shape that can cause difficulty with breastfeeding

Answer 37

inverted nipple

Question 38

nipple that is pulled inward and is tethered by an underlying duct

Answer 38

retracted nipple

Question 39

what can a retracted nipple suggest?

Answer 39

possible underlying cancer

Question 40

what nipple variation may be depressed, flat, broad, or thickened?

Answer 40

retracted nipple

Question 41

how should the patient be positioned for a breast exam

Answer 41

1. lying supine with their hand on their forehead

Question 42

what is the area borders of a breast exam

Answer 42

rectangular area from the clavicle to the inframammary fold and from the midsternal to the posterior axilla

Question 43

what pattern should the breast be examined in?

Answer 43

verticle strip pattern *small circles at each examining points w varying pressure*

Question 44

how to describe the location of a mass

Answer 44

by quadrant of the clock with cm from the nipple

Question 45

how should the size of a mass be described

Answer 45

cm

Question 46

how should the shape of a mass be described?

Answer 46

* round * cystic * disc-like * irregular contour

Question 47

how should the consistency of a mass be described

Answer 47

soft, firm, hard

Question 48

how should the boundary of a mass be described

Answer 48

delimitation well circumscribed or not

Question 49

what are you palpating the nipple for?

Answer 49

thickening and elasticity

Question 50

firm disc of glandular enlargement, often tender

Answer 50

gynecomastia

Question 51

soft, fatty enlargement of breast from obesity

Answer 51

pseudogynecomastia

Question 52

normal nodes are

Answer 52

soft small non tender

Question 53

how to palpate for the axillae

Answer 53

sunder the axillae

Question 54

what should you inspect a mastectomy scar for

Answer 54

* masses * unusual noduality * inflammation * infection

Question 55

should you palpate the mastectomy scar?

Answer 55

yes, gently

Question 56

where should you palpate the breast post breast reconstruction

Answer 56

* breast tissue and incision lines * pay attention to the upper/outter quadrant * note any enlarged lymph nodes

Question 58

what causes should be considered for bilateral nipple discharge?

Answer 58

* hyperthyroidism * pituitary prolactinoma * medications *not pregnancy*

Question 59

what causes should be considered for unilateral bloody discharge?

Answer 59

* intraductal papilloma * ductal carcinoma in situ * paget disease

Question 60

what type of discharge is usually benign

Answer 60

* multiductal * clear, green or black * non bloody

Question 61

what is the most common solid benign tumor?

Answer 61

Fibroadenoma

Question 62

what can cause an increase in size of fibroadenoma

Answer 62

pregnancy or estrogen therapy

Question 63

what can cause a fibroadenoma to regress

Answer 63

menopause

Question 64

a fluid filled sac within the breast that is benign

Answer 64

breast cyst (common in middle aged women)

Question 65

irregular or stellate shape with firm or hard consistency mass

Answer 65

cancer

Question 66

what causes cysts that are tender/painful and palpable as nodular rope-like densities

Answer 66

fibrocystic changes

Question 67

are fibrocystic changes benign

Answer 67

yes

Question 68

painless, well circumscribed, round, mobile mass

Answer 68

fibroadenoma

Question 69

what are the visible signs of breast cancer?

Answer 69

* retraction signs (contours, dimpling, deviation) * edema of the skin * thickened skin/enlarged pores * paget disease

Question 70

what is an uncommon form of breast cancer?

Answer 70

paget disease of the nipple

Question 71

where is edema first seen as a sign of breast cancer

Answer 71

in the lower portion of the breast

Question 72

scaly, eczema like lesion on the nipple that may weep, crust or erod with ulceration into the areola

Answer 72

paget disease of the nipple (starting)

Question 73

how often is an in situ/invasive ductal/lobular carcinoma present in pagets disease

Answer 73

60%

Question 74

what is the most important risk factor of female breast cancer

Answer 74

AGE

Question 75

what are the other risk factors of female breast cancer?

Answer 75

* BRCA mutation * dense breast tissue * personal/family history * early menarche (<12 yo) or late menopause (>55 yo) * high dose radiation at a young age

Question 76

what age should breast cancer screening be started?

Answer 76

age 40

Question 77

how often should mammograms be conducted?

Answer 77

every 2 years (Biennial) | American cancer society says q1 year

Question 78

why is dense tissue a risk factor for female breast cancer

Answer 78

* harder to detect * more common in dense

Question 79

what percentage of breast cancer is male pts

Answer 79

<1%

Question 80

what are risk factors of male breast cancer?

Answer 80

* age * radiation * BRCA mutation * Klinefelter syndrome * testicular disorders * family history * alochol use * cirrohsis * diabetes * obesity

Question 81

when is male breast cancer typically found?

Answer 81

age 60-70