Chapter 17-Breast and Regional Lymphatics – Flashcards

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Identify appropriate history questions to ask regarding the breast examination
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- Any hx of breast disease/ What type? how was it dx? when? treated? -Family hx of breast disease? What ages?
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Correlate changes in the female breast with normal developmental stages
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Stage 1: Preadolescenct: only small, elevated nipple Stage 2: Breast bud stage: small mound of breast and nipple develops; areola widens Stage 3: Breast and areola enlarge; nipple is flush with breast surface Stage 4: the areola and nipple form a secondary mound over the breast Stage 5: Mature breast: only nipple protrudes; the areola is flush with breast contour
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Describe the components of the breast examination
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Subjective: -Breast: Pain, Lump, Discharge, Rash, Swelling, Trauma, Hx of breast dx, srugery or radiation, medications, pt-centered -Axilla: tenderness, lump, swelling, rash Objective: -Inspection: General appearance, skin, lymphatic drainage areas, nipple, maneuvers for screen retration -Inspect and Palpate the Axilla -Palpate breasts -Teach breast self-examination
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List points to include in teaching the breast self-examination
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-Early detection of breast cancer is important, if cancer isn't invasive, survival rate is 98% -Explain correct techniques and rationales and expected findings -Perform in front of mirror while disrobed -Palpate in shower, then while laying supine *Perform right after menstrual period (or familiar date once a month after menopause)
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Explain significance of a supernumerary nipple or breast
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-minute extra nipple along embryonic milk line
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Differentiate bt the female and male examination procedures and findings
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Male: can have abbreviate exam, but do not omit. -can just combine with anterior thorax -Gynecomastia--> benign breast growth in adolescent male
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Discuss pathologic changes that may occur in the breast: Benign breast disease abscess acute mastitis fibroadenoma cancer paget disease
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Benign breast disease: bilateral nodules; pain (dull, heavy and cyclic) Can make detecting cancerous lumps difficult abscess: Packet of puss that feels hard, looks red, and is tender acute mastitis: Inflammatory mass before abscess. Usually single quadrant, red, swollen, tender, hot and hard. *usually with lactation bc of stasis or plugged duct* fibroadenoma: solitary nontender mass that is solid, firm, rubbery, and elastic; round, oval, or lobulated; detected in late adolescence. Benign! cancer: solitary, unilateral, nontender. solid, hard, dense, and fixed. Grows constantly paget disease: -early lesion has unilateral, clear, yellow discharge and dry, scaling crusts, friable @ nipple axex. Erythmatous halo on areola -later lesions show nipple reddened, excoriated and ulcerated with bloody discharge and erythematous plaque surrounding nipple
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List and describe the characteristics to consider when a mass is noted in the breast
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Location: clock face Size: width x length x thickness Shape: oval, round, lobulated, or indistinct Consistency: soft, firm, hard Movable: freely or fixed? Distinctness: solitary or multiple Nipple: displaced or retracted Note skin over lump: erythematous, dimpled, or retracted Tenderness: tender on palpation Lymphadenopathy: regional lymph nodes palpable?
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Gynecomastia
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benign growth of breast tissue, making it distinguishable from other tissues on chest wall. Smooth, firm, movable disk Temporary *Adolescent boys
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High-risk and moderate risk factors that increase the usual risk for breast cancer
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Alcohol, physical exercise reduces, low income, lack of health insurance, geographic, culture and language barriers, racial bias -Alcohol/western diet increases -Mediterranean diet protective against
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alveoli
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smallest structures in the mammary gland
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areola
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darkened area surrounding the nipple
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colostrum
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thin, yellow fluid, precursor of milk, secreted for a few days after birth
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cooper ligaments
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syspensory ligaments; fibrous bands extending from the inner breast surface to the chest wall muscles
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fibroadenoma
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benign breast mass
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galactorrhea
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persistent white discharge of milk between nursing sessions or after weaning
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intraductal papilloma
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serosanguineous nipple discharge
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inverted
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nipples that are depressed or invaginated
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lactiferous
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conveying milk
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mastalgia
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pain in breast
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mastitis
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inflammation of the breast
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montgomery glands
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sebaceous glands in the areola that secrete protective lipid duringn lactation -also called tubercles of Montgomery
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paget disease
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intraductal carcinoma in the breast
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peau d'orange
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orange peel appearance of breast due to edema
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retraction
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dimple or pucker on the skin
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striae
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atrophic pink, purple, or white linear streaks on the breasts, associated with pregnancy, excessive weight gain, or rapid growth during adolescence
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supernumerary nipple
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minute extra nipple along the embryonic milk line
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tail of spence
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extension of breast tissue into the axilla
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thelarche
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beginning of prepubertal breast development
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