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PD- Ch 10- Breast and Axilla
Terms in this set (33)
What is the location of breast tissue?
Extends from clavicle and 2nd rib down to 6th rib and from sternum to midaxillary line
What lymph nodes drain the anterior chest and much of the breast?
Pectoral nodes (anterior)
What lymph nodes drain the posterior chest wall and portion of the arm?
Sub scapular nodes (posterior)
What lymph nodes drain the upper humerus and most of the arm?
What are the central nodes
Infraclavicular and supraclavicular
When is the best time for breast self exam?
After menses when estrogen stimulation is lowest (5-7 days after onset of menses)
If woman admits to lump in her breast what should you ask about?
Location, duration, any change in size or variation with menstrual cycle
What is inappropriate discharge of milk-containing fluid?
What mass presents in 15-25 y.o. as smooth, rubbery, round, mobile and non-tender?
What mass presents in 25-50 y.o. as soft to firm, round, mobile and often tender?
What masses present in 25-50 y.o. as nodular or roselike?
What assess presents in 25 + as irregular, firm, may be mobile or fixed to surrounding tissue?
What amount of breast cancer occurs after age 40?
What group of women should have increased breast cancer screening before the age of 40?
African American women (Due to coexisting illness, lack of health insurance, unequal access to care, differences in treatment, and more aggressive tumor characteristics )
What are the modifiable risk factors of breast cancer?
1. Postmenopausal obesity
2. Use of HRT
3. Alcohol ingestion
4. Physical inactivity
5. Choices on breast-feeding and type of contraception
What is the most important risk factor for breast cancer?
What are the non-modifiable risk factors for breast cancer?
1. Family history- mother or sister with breast cancer
2. Breast tissue density
3. Proliferative lesions with atypia on breast biopsy
4. Duration of unopposed estrogen exposure related to:
a. Early menarche
b. Late or no pregnancy
c. Late menopause
5. Radiation to the chest is also a risk factor
6. Increasing Age
What are risk factors for male breast cancer?
a. BRCA2 mutations
c. Family history male or female
d. Testicular disorders
e. Work exposure to high temperatures and exhaust emission
Who should have BRCA 1 and BRCA2 gene screening?
a. Positive family history
b. Age 50 years or younger at diagnosis
c. Breast cancer in 2 or more individuals in the same lineage
d. Multiple primary ovarian tumors in one person
e. Breast cancer in a male relative
f. Ashkenazi Jewish ancestry
g. Family member with a known predisposing gene
When should clinical breast examination be performed?
1. Every 3 years in women ages 20-39
2. Annually beginning at age 40
Who should have contrast-enhanced MRI for screening?
a. Lifetime risk 20-25%
b. Known BRCA1 or 2 mutation
c. First degree relative with gene mutation
d. History of chest radiation between ages 10 and 30
e. History of breast cancer, ductal or lobular carcinoma in situ, or atypical ductal or lobular hyperplasia
f. Dense breasts
What are chemoprevention of breast cancer?
1. Selective Estrogen Receptor Modulators (SERMs)
a. Tamoxifen and Raloxifene
b. Used to reduce risk of invasive breast cancer in breast cancer-free women at high risk
What does thickening and prominent pores suggest?
What does flattening of the normal convex breast suggest?
Dimpling or Retracted nipple suggest
Breast cancer, occasionally associated with benign lesions such as post-traumatic fat necrosis or mammary duct ectasia
Rashes or ulcerations of nipple region
Tender cords suggest
Mammary duct ectasia- dilated ducts with surrounding inflammation
Mobile mass that comes fixed when arm relaxes is attached to...
ribs and intercostal muscles
Mobile mass that is fixed when the hand is pressed against the hip
Attached to pectoral fascia
Cause of gynecomastia
Imbalance of estrogens and androgens
Deeply pigmented, velvety axillary skin suggests
What size of enlarged firm nodes suggest malignancy?
> 1 cm
Causes of enlarged axillary nodes
1. Infection of the hand or arm
2. Recent immunizations or skin tests in the arm
3. Generalized lymphadenopathy
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