Question 1

Why might a woman have one breast larger than another?

Accepted Answer

Pectoral muscle enlargement on the a dominant side.

Question 2

What nodes are present in the upper outer quadrent and where do they drain?

Accepted Answer

1.Scapular.
2.Brachial. 
3.Intermediate.

**They drain into axillary nodes.

Question 3

What is Thelarche? when does it occur?

Accepted Answer

The begging of breast development, (Tanner 0).


It occurs 1-2yrs before menarche around 9.8 yrs old. 

**Breast buds can sometimes be confused with cancerous lumps in MEN and women.

Question 4

Changes to the breast in Pregnancy

Accepted Answer

1.Increased Duct size & number (lactation).
2.Vascular Engorgement.
3.Tissue becomes softer and looser.

**Increase in cup size may lead to shoulder/back pain.

Question 5

Changes to the breast Post-Menopause

Accepted Answer

1.Glandular tissue atrophies and thins.
2.Fat replaces parenchyma/ duct tissue.
3.less support.

**All of these lead to a sagging of the breast

Question 6

Nipple Abnormalities

Accepted Answer

1.Inversion (difficulty breast feeding).
2.Retraction & Dimpling (Pathological, tightening of suspensory ligaments. Look at breasts from different angles).
3.Flattening.
4.Deviation.
5.Discharge/galactorrhea.

Question 7

Normal variants of breast/nipples

Accepted Answer

1.Color.
2.Shape (Conus, Convex, Pendelous).

Question 8

3 causes of axillary Lymphadenopathy

Accepted Answer

1.Infection.
2.Systemic disease.
3.Breast cancer (mammary neoplasm).

Question 9

Are breast masses always cancerous?

Accepted Answer

NO

Question 10

Mastitis

Accepted Answer

Infection that leads to an inflammation of the breast. 

**Often from a backup of milk during feeding.

Question 11

Fat Necrosis

Accepted Answer

painless, benign breast lump that occurs as an inflammatory response to trauma/ local injury.

**Will see the nipple inverted with bruising.

Question 12

Gynecomastia

Accepted Answer

Breast enlargement in males.

**Most often seen in adolescent boys due to smoking weed and eating.

Question 13

Most common breast mass?

Accepted Answer

Benign Cyst. 

**There will be no dimpling or retraction, the mass will be freely mobile with premenstral tenderness.

Question 14

Firboadenoma

Accepted Answer

Benign, solid round mass. Feels rubbery or firm and is freely mobile. NONTENDER with no retraction or fixation.

Question 15

Breast cancer Risk Factors

Accepted Answer

1.Age > 40 (mammogram 2X yr).**
2.Gender.
3.Personal history (previous cancer).
4.Family hx of breast cancer.
5.Early (<12) menarche or late (>55) menapause.
6.Nulliparity or 1st child after 30yrs.
7.Hormone replacement therapy.

Question 16

Does risk of breast cancer increase with age after 40?

Accepted Answer

YES

Question 17

Cancerous tumors

Accepted Answer

Irregular contoured mass. Firm/hard consistancy that is difficult to delineate from surrounding tissue (non-mobile). NONTENDER with dimpling/retraction/fixation of the nipple.

Question 18

Is breast cancer usually bilateral?

Accepted Answer

NO, only one sided.

Question 19

What is Mastalgia?

Accepted Answer

Breast pain/tenderness.

Question 20

Breast Cancer Inspection

Accepted Answer

EYES ONLY!! look for:
1.retraction,
2.dimpling,
3.peau d' orange,
4.Unilateral venous engorgment.

**Remember to inspect at all 4 positions

Question 21

Breast Cancer Inspection positions

Accepted Answer

1.Low (arms at side).
2.High (arms raised).
3.Hips (hands pushing on hips).
4.Fly (leaning forward with Dr holding arms).

Question 22

Breast Cancer palpation

Accepted Answer

Palpating light to deep with pads of the fingers:
1.All 4 quadrants (vertical strip method while supine).
2.nipple and areola.
3.Tail of spence (extension of breast tissue into the axilla).

Question 23

Additional tests for Breast Cancer

Accepted Answer

1.Mammogram.
2.Observation of mass.
3.ultrasound.
4.biopsy.

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CS1 Breasts