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EC Physical Examination > Breasts & Axilla > Flashcards

Breasts & Axilla Flashcards

1
Q

The glandular tissue is arranged into ____ to ____ lobes per breast that radiate about the nipple

A

15-20

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2
Q

Each lobe of the breast is composed of __ to ____ lobules.

A

20-40

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3
Q

Each lobule consists of milk producing ____ cells that empty into ____ ducts.

A

acini

lactiferous

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4
Q

What extends from the connective tissue later through the breast and attach to the underlying muscle fascia providing support to the breast?

A

suspensory (Cooper) ligaments

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5
Q

What are the muscles that form the floor of the breast? (7)

A 
pectorals major and minor
serratus anterior
latassimus dorsi
subscapularis
external oblique
rectus abdominis
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6
Q

What provides vascular supply to the breast?

A

branches of the internal mammary and lateral thoracic artery

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7
Q

What constitutes most of the bulk of breast and gives it soft consistency?

A

subcutaneous and retromammary fat

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8
Q

Where does the greatest amount of glandular tissue lie in the breast?

A

upper outer quadrant which extends into axilla, forming the tail of Spence

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9
Q

What are the tiny sebaceous glands on the areola surface?

A

Montgomery tubercles or follicles

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10
Q

Which lymph nodes are more superficial and accessible to palpation when enlarged?

A

axillary nodes

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11
Q

What axillary lymph nodes are located along the lower border of the pectorals major inside the lateral axillary fold?

A

anterior axillary (pectoral)

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12
Q

What axillary LN are high in the axilla close to the ribs?

A

midaxillary (central)

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13
Q

What axillary LN lie along the lateral border of the scapula and deep in the posterior axillary fold?

A

posterior (subscapular)

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14
Q

What axillary LN can be felt along the upper humerus?

A

Lateral (brachial)

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15
Q

Where does the drainage from the deep retroareolar area go?

A

inter pectoral (rotter) nodes into the axillary chain

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16
Q

Where does the drainage go from the superficial upper outer quadrant go?

A

scapular, brachial, intermediate nodes toward axillary lymph nodes

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17
Q

Where does the drainage go from the superficial medial portion go?

A

internal mammary chain toward opposite breast and abdomen

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18
Q

What happens to the breast during pregnancy in response to luteal and placental hormones?

A

the lactiferous ducts proliferate and the alveoli increase in size and number causing the breast to enlarge 2-3x prepregnant size

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19
Q

What happens towards the end of pregnancy?

A

Epithelial secretory activity increases, colostrum is produced and accumulates in the acinus cells (alveoli)

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20
Q

What happens to the areolae during pregnancy?

A

more deeply pigmented and their diameter increases

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21
Q

What happens to vasculature during pregnancy?

A

It increases causing veins to engorge and become visible below surface of skin

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22
Q

In the first few days after delivery what is secreted from the breasts?

A

colostrum containing more protein and minerals compared to milk and also antibodies

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23
Q

When does milk production replace colostrum?

A

2-4 days after delivery

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24
Q

What stimulates milk production?

A

surging prolactin levels, declining estrogen levels and the stimulation of sucking

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25
Q

When does involution occur?

A

at the termination of lactation over a period of 3 months

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26
Q

What happens to the breast after menopause?

A

glandular tissue atrophies and is replaces by fat
inframammary ridge at the lower edge of the breast thickens
nipples become smaller and flatter and less erectile
hang more loosely as a result of tissue change and relaxation of suspensory ligaments
skin becomes dry and thin
loss of axillary hair may also occur

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27
Q

What medications are associated with nipple discharge?(6)

A 
contraceptives
hormones
phenothiazines
digitalis
diuretics
steroids
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28
Q

What medications can be associated with breast enlargement in males? (9)

A 
cimetidine
omeprazole
spirinolactone
anti androgens (finasterides)
HIV meds
some chemo
antihypertensives
some antipsychotics
estrogen
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29
Q

What genetic mutations or hereditary cancers are important in past medical history?

A

known BRCA1 or BRCA2
hereditary nonpolyposis colorectal cancer
Li-Fraumeni syndrome
Cowden syndrome

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30
Q

What are the non modifiable risk factors? (11)

A 
age
gender
genetics
personal history of breast ca
family history of breast ca
precious breast biopsies
race (whites)
Previous breast radiation
menstrual periods (menarche before 12 or menopause after 55)
Breast density
Diethylstilbestrol therapy
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31
Q

What is the % of developing breast ca with known BRCA1 or BRCA2 mutations?

A

have a 45-80% chance of developing breast ca compared to average risk of 12%

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32
Q

What is the risk if patient has one first degree relative with breast ca?

A

doubles the risk

if two first degree relatives the risk increases threefold

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33
Q

Previous biopsies of what can increase risk of developing breast ca?

A

atypical hyperplasia or lobular cancer in situ (LCIS)

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34
Q

Older women with more dense tissue are at ____ to ___ times the risk.

A

1.2 to 2 times

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35
Q

What are the modifiable risk factors of breast ca? (5)

A 
childbirth
hormone therapy
alcohol
obesity and high fat diets
lack of physical activity
36
Q

How does hormone therapy affect breast cancer risk?

A

use of combined estrogen and progesterone hormone replacement therapy (HRT) after menopause for more than 4 years increases the risk

Transgender women taking hormones for 5-10 years is uncertain

37
Q

How does having more fat tissue affect breast ca risk?

A

Having more fat tissue can increase estrogen levels and increase likelihood

38
Q

What are some medications that can cross the milk-blood barrier?

A

cometidine
clemastine
thiouracil

39
Q

What do retractions and dimpling signify?

A

contraction of fibrotic tissue that may occur with carcinoma

40
Q

What is the appearance of skin that indicates edema of the breast caused by blocked lymph drainage in advances or inflammatory breast cancer?

A

peau d’orange (orange skin)

41
Q

Unilateral venous patterns can be the result of what?

A

increased blood flow to a malignancy

42
Q

What is a common expected finding of the areolae?

A

peppering of contender, non suppurative Montgomery tubercles

43
Q

The peau d’orange skin associated with cancer is often seen where first?

A

the areola

44
Q

What change in the nipple may suggest malignancy?

A

recent unilateral inversion of a previously everted nipple

45
Q

Supernumery nipples which are more common in blacks are associated with what in white patients?

A

congenital renal or cardiac anomalies

46
Q

Most of the benefit of mammography results from screening ages ____ to _____

A

50-74

47
Q

What are the ways to describe a breast mass shape? (6)

A 
round
discoid
lobular
stellate
regular
irregular
48
Q

When should nipple compression be performed?

A

When patient reports spontaneous discharge

49
Q

What is the firm transverse ridge of compressed tissue along the lower edge of the breast that is sometimes confused with a mass?

A

the inframammary ridge

50
Q

If malignancy were to reoccur post mastectomy where is it important to examine on exam?

A

at the site of the scar

51
Q

What is a common exam finding during the second trimester?

A

telangiectasias on upper chest, arms neck and face that DO NOT blanch

52
Q

What is the common age to see fibrotic changes in breast tissue?

A

20-49

53
Q

What is the common age range to see a fibroadenoma?

A

15-55

54
Q

What is the common age range to see cancer?

A

30-80

55
Q

What breast changes are usually bilateral?

A

fibrocystic changes and fibroadenoma

56
Q

What is usually the shape of a breast cancer mass?

A

irregular or stellate

57
Q

What is a common consistency of fibrocystic changes?

A

soft to firm; tense

58
Q

What is the common shape of a fibroadenoma?

A

round or discoid

59
Q

What is the common consistency of a cancer mass?

A

hard, stone like

60
Q

What breast masses are usually mobile?

A

fibrocystic changes and fibroadenoma

61
Q

What breast mass is usually tender?

A

fibrocystic changes

62
Q

What type of breast mass does not vary with menses?

A

fibroadenoma and cancer

63
Q

What is a benign fluid filled cyst formation caused by ductal enlargement?

A

fibrocystic changes

64
Q

What are fibrocystic changes associated with?

A

long follicular or luteal phase of the menstrual cycle

65
Q

When are fibrocystic changes the worst?

A

premenstrually

66
Q

What are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit?

A

fibroadenoma

67
Q

What can a fibroadenoma occur?

A

may occur at any age during the reproductive years

68
Q

When does a fibroadenoma regress?

A

after menopause

69
Q

Do fibroadenomas fluctuate with the menstrual cycle?

A

NO

70
Q

benign breast lump occurs as inflammatory response to local injury

A

fat necrosis

71
Q

What is epithelial hyperplasia producing a warlike tumor in a lactiferous duct causing spontaneous nipple discharge?

A

intraductal papillomas and papillomatosis

72
Q

What is a benign condition of the subareolar ducts that produce nipple discharge

A

duct ectasia

73
Q

Subareolar ducts become dilated and blocked with desquamating secretory epithelium, necrotic debris and chronic inflammatory cells

A

duct ectasia

74
Q

What does duct ectasia occur most commonly?

A

menopausal women

75
Q

What is the characteristic of the nipple discharge in duct ectasia?

A

spontaneous unilateral or bilateral that is often green or brown in color and may be sticky

76
Q

What is elevated levels of prolactin, resulting in milk production, occur as a result of disruption of the communication between the pituitary and hypothalamus glands?

A

galactorrhea

77
Q

What are the common causes of galactorrhea? (7)

A 
pituitary- secreting tumors
hypothalamic-pituitary disorders
systemic diseases
numerous medications
herbs
physiologic conditions 
local factors
78
Q

What are the possible medical conditions associated with galactorrhea?

A 
amenorrhea
pregnancy
post abortion
hypothyroidism
Cushing syndrome
chronic renal failure
79
Q

What are the possible medications associated with galactorrhea?

A 
phenothazines
tricyclic antidepressants
some htn meds
estrogens
H2 receptor blockers
marijuana
amphetamines
opiates
80
Q

What is migration of malignant epithelial cells from the underling intraductal carcinoma chia the lactiferous sinuses into nipple skin?

A

Paget disease

81
Q

What is commonly seen with Paget disease?

A

red, scaling, crusty patches on nipple, areola and surrounding skin that may be unilateral or bilateral that does not respond to steroids

82
Q

What is the most common infectious agent causing mastitis?

A

staph aureus

83
Q

When is mastitis most common?

A

in lactating patients after milk is established usually the second to third week after delivery however it can occur at any time

84
Q

What is characterized by sudden breast swelling, tenderness, redness and hear often accompanied by chills and fever

A

mastitis

85
Q

What is the presentation of mastitis?

A

tender, hard breast mass with an area of fluctuation, erythema and heat
may have discharge of pus (suppuration)
underlying put filled abscess may given bluish tint to skin

86
Q

What is the result of increased body fat; hormone imbalance from puberty or aging, by testicular, pituitary or hormone secreting tumors, by liver failure or by a variety of medications in males?

A

gynecomastia

EC Physical Examination (9 decks)

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