Chapter 18- Breasts, Axillae, and Regional Lympathics Exam 2022

Chapter 18- Breasts, Axillae, and Regional Lympathics Exam 2022 Breasts - Answer- -lie anterior to the pectoralis major and serrated anterior muscles -accessory reproductive organs -located between the 2nd and 6th ribs, extending from the side of the sternum to the midaxillary line What is the function of the breasts? - Answer- -produce milk for nourishing newborn What is the superior lateral corner of the breast tissue called? - Answer- -tail of spence -note: pay special attention here when looking for breast cancer Nipple - Answer- -just below center of breast -rough, round, and usually protuberant Areola - Answer- -surrounds the nipple for a 1-2cm radius -has smooth muscle fibers that cause nipple erection when stimulated -more darkly pigmented than the rest of the breast -varies from pink to brown Internal anatomy of the breast what does it consist of? - Answer- (1) glandular tissue (2) fibrous tissue, including the suspension ligament (3) adipose tissue Glandular tissue - Answer- -contains 15-20 lobes radiating from the nipple, composed of lobules Suspensory ligaments (Cooper Ligaments) - Answer- -fibrous connective tissue extending vertically from the skin surface to attach on the chest wall muscles Tail of spence - Answer- -cone shaped breast tissue that projects up into the axilla, close to the pectoral group of axillary lymph nodes -upper outer quadrant is the site of most breast tumors The aging woman - Answer- -After menopause ovarian secretion of estrogen and progesterone decreases, which causes the breast glandular tissue to atrophy. This is replaced with fibrous connective tissue. -Fat envelope also atrophies. -These changes decreased breast size and elasticity do the breasts droop and sag, looking flattened and flabby. The male breast - Answer- -rudimentary structure consisting of a thin disk of undeveloped tissue underlying the nipple -during adolescence it is common for the breast tissue to enlarge temporarily, producing gynecomastia Mammography - Answer- -can discover small, potentially curable breast cancers, and the American Cancer Society recommends beginning optional annual screening for those at average risk at ages 40-44 years and definite annual mammography beginning at 45 -if it runs in family can start at 35 Lifestyle factors that affect breast cancer risk - Answer- -alcohol drinking -smoking -post menopausal breast cancer is 1.5 times higher in overweight women and 2 times higher in obese women Subjective data - Answer- -pain -lump -discharge -rash -swelling -trauma -history of breast disease -surgery or radiation -medications -patient centered care What is mastalgia? - Answer- -breast pain -occurs with trauma, inflammation, infection, and benign breast disease What is cyclic pain? - Answer- -comes and goes -common with normal breasts, oral contraceptives, benign breast (fibrocystic) disease What is galactorrhea? - Answer- -clear nipple discharge -medications that may cause it: oral contraceptives, phenothizines, diuretics, digitalis steroids, methyldopa, calcium channel blockers Breast-Self Examination - Answer- -no longer recommended but should be taught -with good BSE practice, a woman knows how her breasts normally feel and can detect any change more easily What is the best way to detect a person's risk for breast CA? - Answer- -by asking the right history questions -most breast cancers occur in women with no identifiable risk factors except sex and age General Appearance of Breasts - Answer- -note symmetry, size, and shape -a sudden increase in the size of one breast signifies inflammation or new growth -NOTE: left is slightly larger than right Retraction Signs - Answer- -caused by fibrosis in the breast tissue -usually caused by growing neoplasms -shortens with time, causing contrasting signs with the normally loose breast tissue What to do when examining someone with large, pendulous breasts? - Answer- -ask to lean forward while you support her forearms -note fixation to chest wall or skin retraction Inspect and Palpate the Axillae - Answer- -examine while woman is sitting -note rash or infection Palpating the Breast - Answer- -use pads of your first three fingers and make a gentle rotary motion on the breast -vary your pressure so you are palpating light, medium, and deep tissue in each location -vertical strip pattern is best way to detect a breast mass (start high in the axilla and palpate down the midaxillary line just lateral to the breast down to the bra line) -can palpate from nipple out to periphery (like wheel) -can palpate in concentric circles out the the periphery -heat, redness, and swelling in nonlactating and postpartum breasts indicate inflammation -large boobies use two hands (bimanual technique) -sitting position leaning forward, support inferior part of boobie with one hand, use other to palpate What to do if a woman mentions she found a lump on the titty? - Answer- -examine the unaffected side first to get a baseline If you feel a lump or mass, note which characteristics? - Answer- -location: using clock describe distance in cm -size: judge in centimeters (width X length X thickness) -shape: oval, round, lobulated, or indistinct -consistency; soft, firm, or hard -movable: freely movable or fixed -distinctness: solitary or multiple -nipple: displaced or retracted -note skin over lump: erythematous, dimpled, or retracted -tenderness: tender on palpation -lymphadenopathy: any regional lymph nodes palpable When is the best time to perform BSE? - Answer- -after period (day 4-7 of cycle) -or if postmenopausal pick the same day each month What is gynocomastia? - Answer- -benign growth of this breast tissue, making it distinguishable from other tissues on chest wall -feels smooth, firm, movable subareolar fibrous mass -occurs in about one half of adolescent boys at 13 or 14 -also occurs with use of anabolic steroids, some medications, cirrhosis The Aging Woman - Answer- -increasing age is primary risk factor for developing breast CA, annual CBE is important CONTINUES.......