PE of the Breast

Question 1

Location of Breasts

Answer 1

2nd to 6th rib and from sternal margin to mid-axillary line

Question 2

Where are the Glands of Montgomery located?

Answer 2

Areola

Question 3

[Glands of Montgomery]

Function

Answer 3

Produce lipoid fluid that protects nipple during suckling

Question 4

Lobes per Breast

Answer 4

15-20

Question 5

Lobules per Lobe

Answer 5

20-40

Question 6

What contains acinar cells for milk production?

Answer 6

Lobules

Question 7

Pathway of Milk

Answer 7

Lobe -> Lactiferous Duct -> Lactiferous Sinus -> Nipple Surface

Question 8

[T/F]

Females have similar amounts of glandular tissue

Answer 8

T

Question 9

[Cooper’s Ligament]

Function

Answer 9

Provides support for the breast

Fibrous tissue separating lobules

Question 10

What do silicon implants do to the breasts?

Answer 10

Renders it impalpable

Question 11

[PE of Breast]

Two main maneuvers

Answer 11

Inspection

Palpation

Question 12

Proper Position for Breast Inspection

Why?

Answer 12

Sitting with arms at sides

Relaxes breasts and minimizes tension

Question 13

[PE of Breast]

Inspect for? (4)

Answer 13

Size
Symmetry
Contour
Color and Texture

Question 14

Dimpling in Breasts occur when?

Answer 14

Cooper’s Ligaments pull the skin and tissue inward due to malignant growth

Question 15

Define: Peau d’orange

Answer 15

Enlarged pores due to edema caused by invasion of tumor in lymphatics of the breasts

Indicative of advanced malignancy

Question 16

Define: Normal Venous Pattern

Answer 16

Bilaterally similar

Not usually visible

Question 17

What could cause unilateral visible venous network?

Answer 17

Dilated superficial veins as a result of increased blood flow to malignant masses

Question 18

[Nipple]

How should the color be?

Answer 18

Homogenous and matching that of the areola

Pregnancy may cause it to darken

Question 19

[Nipple]

Normally everted or inverted?

Answer 19

Everted

Question 20

What are the 5 D’s in Nipple Examination?

Answer 20

Discharge
Depression
Discoloration
Dermatologic Changes
Deviation

Question 21

What could cause deviation of nipples?

Answer 21

Carcinoma pulling Cooper’s Ligaments

Question 22

What could cause retraction?

Answer 22

Could be normal

Inward pulling by an inflammatory/malignant mass

Question 23

What are supernumerary nipples?

Answer 23

Extra nipples that develop along the milk line

Question 24

When could supernumerary nipples have a risk for malignancy?

Answer 24

If they have glandular tissue

Question 25

Paget's Disease

Answer 25

Crusting and Eczema of the Nipple

Question 26

Peau d'orange is first seen in?

Answer 26

The Areola

Question 27

[Different Positions of Breast PE] Name 3

Answer 27

Arms over head Hands hard against hips Seated and leaning forward from waist

Question 28

Why Arms Over Head?

Answer 28

Adds tension to upper and lower suspensory ligaments Accentuates dimpling if present May reveal variation in color and symmetry

Question 29

Why Hands Pushed Together/Against Hips

Answer 29

Contracts pectoralis muscle, allows examiner to determine if breast mass is invading muscle Mass that has invaded muscle cannot be moved in this portion

Question 30

Why Seated and Leaning Forward from Waist

Answer 30

Helpful for large breasts | May reveal variation in contour and symmetry

Question 31

In all positions, breasts should be? | 7

Answer 31

``` Bilaterally equal Evenly contoured Smooth No dimpling No nipple retraction No deviation No visible discharge ```

Question 32

[Techniques for Breast Palpitation] Which parts of the hand to use?

Answer 32

2nd, 3rd and 4th finger pads | Never the palm

Question 33

Techniques for Breast Palpation (3)

Answer 33

Back and Forth Concentric Circles Wedge Technique

Question 34

Position of the Patient for Breast Palpation

Answer 34

Patient supine with one arm raised behind the head Place a small pillow under the shoulder Repeat with arms at the side

Question 35

How to palpate large breasts?

Answer 35

Immobilize the inferior surface with one hand while examining the superior surface with the other hand

Question 36

How to palpate the Tail of Spence

Answer 36

Patient should be seated with arms raised | Palpate between thumb and fingers

Question 37

Documenting Breast Masses (8)

Answer 37

``` Location Size Shape Consistency Tenderness Mobility Borders Retraction ```

Question 38

Characteristic of Cancer (5)

Answer 38

``` Irregular Shape Hard Consistency Non-Tender Movable/Fixed Irregular Borders ```

Question 39

Where do most cancers occur?

Answer 39

Upper Outer Quadrant

Question 40

How to palpate the nipple?

Answer 40

Compress gently between thumb and index finger

Question 41

Is a spontaneous or non-spontaneous nipple discharge more dangerous?

Answer 41

Spontaneous

Question 42

What color of fluid would be pathologic? What is not pathologic?

Answer 42

Serious/Yellowish fluid: No pathologic Bloody: Pathologic, could be caused by a tumor

Question 43

How do you determine the origin of a duct producing a discharge

Answer 43

Press the areola with one digit in a radial manner and observe, change position with every press

Question 44

Name of the Test for Nipple Discharge

Answer 44

Cytologic Smear

Question 45

[Patient Position] Axilla Palpation

Answer 45

Seated with arms flexed at elbow

Question 46

[Patient Position] Supraclavicular Area

Answer 46

Seated

Question 47

[Supraclavicular Area Palpation] What do you palpate? What is it bounded by?

Answer 47

Supraclavicular Triangle 1. Clavicle 2. SCM 3. Omohyoid

Question 48

[Lymph Node Enlargement] Stage IV Cancers are Found? Stage III Cancers are Found?

Answer 48

1. In the Neck (Cervical Lymph Nodes) | 2. Supraclavicular Area

Question 49

[T/F] Axillary and supraclavicular lymph nodes are normally palpable

Answer 49

F