Final Study Guide
WEEK 5
Chapter 10
Breast/Axillae Assessment
Any lumps, discomfort, pain- lumps may be physiologic or pathologic ranging from cysts
and fibroadenomas to breast CA
Breast pain (Mastalgia) alone is not considered CA risk factor. CBE is warranted. Focal
breast pain more likely to merit DI. Medical issues assoc w breast pain are hormones,
SSRIs, spironolactone and digoxin
Any discharge from nipples and when it occurs? Discharge of fluid unrelated to
pregnancy or lactation is more likely to be pathologic when it is bloody or serous,
unilateral, spontaneous, assoc w a mass and occur in women over 40
Normal VS. Abnormal Findings and Interpretation
Age 15-25- common mass is fibroadenoma- smooth, rubbery, round, mobile. Nontender
Age 25-50- cysts- usually soft to form, round, mobile, often tender
o Fibrocystic changes- nodular, ropelike
o Cancer- irregular, firm, may be mobile or fixed to surrounding tissue
Over 50- cancer until proven otherwise
Pregnancy- lactating adenomas, cysts, mastitis, cancer
Arms at side inspection- note color, thickening, size and symmetry, contour,
characteristics of nipple. (redness suggests local infection or inflammatory carcinoma,
thickening suggest CA, flattening of normally convex breast suggests CA, asymmetry
due to change in nipple direction suggests CA(inverted)).
Have pt put arms over head, on hips and lean forward to bring out dimpling or retraction
that may be invisible
Palpation best performed when breast tissue is flattened- from midsternal line to posterior
axillary line into tail (vertical strip pattern)
Breast Cancer
2nd leading cause of cancer death in women
Most important risk factor is age
Non modifiable risk factors family history of breast and ovarian CA, inherited genetic
mutations, personal hx breast CA, high levels of endogenous hormones, breast tissue
density, lesions on breast biopsy
Modifiable risk factors- breastfeeding less than 1 year, postmenopausal obesity, use of
HRT, smoking, alcohol, physical inactivity, contraception
Risk factors for male breast CA- radiation exposure, BRCA1 AND 2 mutations,
Klinefelter syndrome, testicular disorders, fam hx, etoh or cirrhosis and obesity
Gail and Claus model estimate absolute lifetime risk of breast CA
, Gail-incorporates age, race, 1st degree relatives w breast ca, previous biopsies,
hyperplasia, age of period, age 1st delivery. Shouldn’t be used to women w hx breast CA
or radiation exposure or those under 35.
Claus- incorportates family hx male and female, age
Also ask about fam hx ovarian CA
Screening recommendations
Mammogram CBE BSE
US Preventative 50-74-biennially >40 not enough Recommends
Services <50 based on pt evidence to assess against teaching
specific factors harm or benefit of BSE
CBE
American CA 40-45 optional Not recommended Not recommended
Society annual
45-54-annual
>55-biennial
American college >40 annually 20-39 every 1-3 yrs Encourage BSE
of OBGYN >40 annually
Mammogram- low sensitivity and specificity- high false positives. Perform better in
younger women and with higher breast density
Self-Breast Examination
Because breasts tend to swell and become more nodular before menses from increasing
estrogen stimulation, the best time for examination is 5 to 7 days after the onset of
menstruation
Chapter 11 and Chapter 15
Abdominal/Peritoneal/Rectal Assessment and Modification for Age
Abdominal assessment:
Sequence: Inspection, auscultation, percussion, palpation
Auscultation: for bowel sounds, bruit, and friction rub. Possible abnormal sounds: increased or
decreased motility, bruit of renal artery stenosis, liver tumor, splenic infarct. .
Percuss the abdomen for patterns of tympany and dullness. Possible abnormalities: Ascites, GI
obstruction, pregnant uterus, ovarian tumor
Palpate all quadrants of the abdomen for abdominal tenderness. Light palpation for guarding,
rebound, and tenderness. Possible abnormalities: Firm, board like abdominal wall—
suggests peritoneal inflammation. Guarding if the patient flinches, grimaces, or reports
pain during palpation. Rebound tenderness from peritoneal inflammation; pain is greater
, when you withdraw your hand than when you press down. Press slowly on a tender area,
then quickly “let go. If you feel a mass, examine with the abdominal muscles tensed,
usually, abdominal wall masses can be observed, whereas intra-abdominal masses are
more concerning.
A left upper quadrant mass is more likely to be a kidney if there is no palpable “notch,” you can
push your fingers between the mass and the costal margin, there is normal tympany over
this area, and you cannot push your fingers medial and deep to the mass
Rectal assessment: Rectal assessment is a part of regular GI assessment over age of 40.
Inspection: Check for fissures, lesions, scars, inflammation, discharge, rectal prolapse, skin tags,
and external hemorrhoids.
Palpation: The rectal walls should feel soft and smooth, without masses, fecal impaction, or
tenderness.
Peritoneal assessment:
Check for ascites, a large accumulation of fluid in the peritoneal cavity caused by advanced liver
disease, heart failure, pancreatitis, or cancer.
Do not palpate a rigid abdomen. Peritoneal inflammation may be present, in which case
palpation could cause pain or rupture an inflamed organ
Normal VS. Abnormal Findings and Interpretation
Visceral pain- occurs when hollow abd organs are distended or stretched- in RUQ
suggests liver distention
Visceral pain may be gnawing, burning, cramping or aching- visceral periumbilical pain
suggests early acute appendicitis
WEEK 5
Chapter 10
Breast/Axillae Assessment
Any lumps, discomfort, pain- lumps may be physiologic or pathologic ranging from cysts
and fibroadenomas to breast CA
Breast pain (Mastalgia) alone is not considered CA risk factor. CBE is warranted. Focal
breast pain more likely to merit DI. Medical issues assoc w breast pain are hormones,
SSRIs, spironolactone and digoxin
Any discharge from nipples and when it occurs? Discharge of fluid unrelated to
pregnancy or lactation is more likely to be pathologic when it is bloody or serous,
unilateral, spontaneous, assoc w a mass and occur in women over 40
Normal VS. Abnormal Findings and Interpretation
Age 15-25- common mass is fibroadenoma- smooth, rubbery, round, mobile. Nontender
Age 25-50- cysts- usually soft to form, round, mobile, often tender
o Fibrocystic changes- nodular, ropelike
o Cancer- irregular, firm, may be mobile or fixed to surrounding tissue
Over 50- cancer until proven otherwise
Pregnancy- lactating adenomas, cysts, mastitis, cancer
Arms at side inspection- note color, thickening, size and symmetry, contour,
characteristics of nipple. (redness suggests local infection or inflammatory carcinoma,
thickening suggest CA, flattening of normally convex breast suggests CA, asymmetry
due to change in nipple direction suggests CA(inverted)).
Have pt put arms over head, on hips and lean forward to bring out dimpling or retraction
that may be invisible
Palpation best performed when breast tissue is flattened- from midsternal line to posterior
axillary line into tail (vertical strip pattern)
Breast Cancer
2nd leading cause of cancer death in women
Most important risk factor is age
Non modifiable risk factors family history of breast and ovarian CA, inherited genetic
mutations, personal hx breast CA, high levels of endogenous hormones, breast tissue
density, lesions on breast biopsy
Modifiable risk factors- breastfeeding less than 1 year, postmenopausal obesity, use of
HRT, smoking, alcohol, physical inactivity, contraception
Risk factors for male breast CA- radiation exposure, BRCA1 AND 2 mutations,
Klinefelter syndrome, testicular disorders, fam hx, etoh or cirrhosis and obesity
Gail and Claus model estimate absolute lifetime risk of breast CA
, Gail-incorporates age, race, 1st degree relatives w breast ca, previous biopsies,
hyperplasia, age of period, age 1st delivery. Shouldn’t be used to women w hx breast CA
or radiation exposure or those under 35.
Claus- incorportates family hx male and female, age
Also ask about fam hx ovarian CA
Screening recommendations
Mammogram CBE BSE
US Preventative 50-74-biennially >40 not enough Recommends
Services <50 based on pt evidence to assess against teaching
specific factors harm or benefit of BSE
CBE
American CA 40-45 optional Not recommended Not recommended
Society annual
45-54-annual
>55-biennial
American college >40 annually 20-39 every 1-3 yrs Encourage BSE
of OBGYN >40 annually
Mammogram- low sensitivity and specificity- high false positives. Perform better in
younger women and with higher breast density
Self-Breast Examination
Because breasts tend to swell and become more nodular before menses from increasing
estrogen stimulation, the best time for examination is 5 to 7 days after the onset of
menstruation
Chapter 11 and Chapter 15
Abdominal/Peritoneal/Rectal Assessment and Modification for Age
Abdominal assessment:
Sequence: Inspection, auscultation, percussion, palpation
Auscultation: for bowel sounds, bruit, and friction rub. Possible abnormal sounds: increased or
decreased motility, bruit of renal artery stenosis, liver tumor, splenic infarct. .
Percuss the abdomen for patterns of tympany and dullness. Possible abnormalities: Ascites, GI
obstruction, pregnant uterus, ovarian tumor
Palpate all quadrants of the abdomen for abdominal tenderness. Light palpation for guarding,
rebound, and tenderness. Possible abnormalities: Firm, board like abdominal wall—
suggests peritoneal inflammation. Guarding if the patient flinches, grimaces, or reports
pain during palpation. Rebound tenderness from peritoneal inflammation; pain is greater
, when you withdraw your hand than when you press down. Press slowly on a tender area,
then quickly “let go. If you feel a mass, examine with the abdominal muscles tensed,
usually, abdominal wall masses can be observed, whereas intra-abdominal masses are
more concerning.
A left upper quadrant mass is more likely to be a kidney if there is no palpable “notch,” you can
push your fingers between the mass and the costal margin, there is normal tympany over
this area, and you cannot push your fingers medial and deep to the mass
Rectal assessment: Rectal assessment is a part of regular GI assessment over age of 40.
Inspection: Check for fissures, lesions, scars, inflammation, discharge, rectal prolapse, skin tags,
and external hemorrhoids.
Palpation: The rectal walls should feel soft and smooth, without masses, fecal impaction, or
tenderness.
Peritoneal assessment:
Check for ascites, a large accumulation of fluid in the peritoneal cavity caused by advanced liver
disease, heart failure, pancreatitis, or cancer.
Do not palpate a rigid abdomen. Peritoneal inflammation may be present, in which case
palpation could cause pain or rupture an inflamed organ
Normal VS. Abnormal Findings and Interpretation
Visceral pain- occurs when hollow abd organs are distended or stretched- in RUQ
suggests liver distention
Visceral pain may be gnawing, burning, cramping or aching- visceral periumbilical pain
suggests early acute appendicitis
