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40 Cards in this Set
- Front
- Back
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Define:
tail of Spence Cooper’s ligaments supernumerary nipple gynecomastia inframammary ridge |
tail of Spence = part of breast that extends in triangle from upper outer quadrant into axilla
Cooper’s ligaments = fibrous bands extending vertically on breast securing it to chest wall (in cancer they get contracted and cause pits & dimples) supernumerary nipple = an extra nipple, somewhere along mammary ridge gynecomastia = breast tissue enlargement in men; in puberty it’s usually unilateral & temporary; in older men it is bilateral due to testosterone deficiency inframammary ridge = transverse ridge of compressed tissue across lower breast quadrants; it’s normal |
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Where do most breast cancers occur?
When is best time to do BSE? What symptoms do you see with Paget’s disease in the breast? |
most breast cancers occur in upper outer quadrant
BSE best done on day 4 -7 of cycle, when breasts are smallest; should do BSE standing up, and also lying supine Paget’s disease of the breast—looks like eczema, but is malignancy. Small crust on nipple apex, then spreads to areola |
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Explain the Tanner staging scale.
How long does process take? |
Tanner staging scale—for rating sexual maturity of girls
1) preadolescent: only a small elevated nipple 2) breast bud stage: small mound of breast and nipple develops and areola widens 3) breast and areola enlarge; nipple flush w/ breast surface 4) areola and nipple form secondary mound over breast 5) mature: only nipple protrudes; areola is flush with breast process takes on average 3 years |
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What are the lymph nodes that drain the breasts?
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75% of breast lymph drains to ipsilateral (same) side in one of these node groups:
pectoral nodes = along lateral margin of breast in anterior axillary fold subscapular = long lateral edge of scapula, deep in posterior axillary fold lateral nodes = along humorous inside upper arm central axillary nodes = high in middle of armpit (get lymph from other 3 groups the rest of drainage goes up to infraclavicular nodes or into chest 75% of breast lymph drains to ipsilateral (same) side in one of these node groups: pectoral nodes = along lateral margin of breast in anterior axillary fold subscapular = long lateral edge of scapula, deep in posterior axillary fold lateral nodes = along humorous inside upper arm central axillary nodes = high in middle of armpit (get lymph from other 3 groups the rest of drainage goes up to infraclavicular nodes or into chest |
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Describe changes that take in breast through menstrual cycle Describe changes that take place in breasts of pregnant females.
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2nd month: changes start
--enlargement, expansion of ductal system, development of true secretory alveoli --nipples larger, darker, more erectile --can get blue vascular pattern visible on breasts 4 mon: colostrum can be expressed (precursor to milk)—lot of protein and lactose but no fat 1-3 days postpartum: milk comes in |
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Describe changes that take in breast through menstrual cycle
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nodularity increases starting midcycle
tenderness 3-4 days before menstruation breast volume smallest on days 4 to 7 |
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What are risk factors for breast cancer?
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Breast Cancer Risk Factors:
female, > age 50 person history, or 1st degree relative history of breast cancer BRCA 1 or BRCA 2 mutation weird previous biopsies menstruation before age 12, or menopause after 50 nulliparity or first child after age 30 recent oral contraceptive use not breast-feeding alcohol intake ≥ 1 drink/day obesity & high fat diet physical inactivity |
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Define:
mastalgia galactorrhea retraction fixation premature thelarche |
mastalgia = breast pain
galactorrhea = nipple discharge; spontaneous flow unrelated to childbirth (can be caused by some meds) retraction= like dimpling and an area where the breast tissue pulls inward fixation = breast tissue gets “stuck to” chest wall and doesn’t move outward premature thelarche = early breast development with no other hormone-dependent signs like hair |
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How do you palpate the axilla and breast during the exam?
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to palpate axilla:
use right hand to palpate left axilla, vice versa; hold her arm with other hand 1) move down chest wall in a line from middle axilla 2) along anterior border of axilla 3) along posterior border 4) along inner aspect of arm breast is best don w/ woman laying down, arms above head; use 3 fingers in vertical strip pattern palpate nipple and gently depress to see if there is discharge |
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How do you screen for breast retraction?
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Breast retractions—have women do some moves with arms:
hold arms up over head (breads should move up) put hands on hips clasp hands together and push palms together (slight lifting) w/ large breasts, lean forward slightly and see that breasts move freely away from body |
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What could be some causes of early breast development before age 8?
What could cause delayed breast development? |
early breast development caused by:
thyroid dysfunction stilbestrol ingestiuon ovarian or adrenal tumor delayed breast development caused by: anorexia nervosa severe malnutrition |
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If you find a breast lump, what do you document?
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for a breast lump, document:
location—use clock location & cm from nipple size—width, length, thickness shape – oval, round, lobulated or indistinct consistency –soft, firm or hard movable or fixed distinctness – solitary or multiple nipple—displaced or retracted? what is skin over lump like? tenderness? lymphademopathy? |
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What is Peau d’Orange?
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Peau d’Orange = thinkened skin due to edema/lymph blockage that exaggerates hair follicles and has pig-skin/orange peel look
suggests cancer |
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What is difference b/t nipple retraction and nipple inversion?
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nipple retraction: nipple looks flatter and broader lik an underlying crater
nipple inversion: no broadening, and is not fixed—you can pull nipple out |
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What are the characteristics/signs of breast cancer?
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breast cancer
solitary, unilateral nontender mass solid, hard, dense, fixed to underlying tissue borders = irregular, poorly delineated usually painless most common in upper, outer quadrant other signs = axillary node involvement, skin dimpling, nipple retraction, elevation, and discharge |
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What are the characteristics of a fibroadenoma in breast?
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fibroadenoma = solitary, nontender mass;
solid, firm, rubbery, elastic round, oval or lobulated 1 – 5cm moves freely; is slipper common b/t 15- 30 years grows quickly and constantly benign, but required biopsy |
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What is benign breast disease? What are symptoms/types?
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benign breast disease
multiple tender masses; includes 6 categories: --swelling and tenderness --mastlgia --nodularity --dominant lumps (cysts and fibroadenomas) --nipple discharge (intraductal papilloma and duct ectasia) --infections and inflammations nodularity is bilateral; regular, firm nodules that are mobile, well demarcated, feel like rubbery small water balloons |
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Describe: mammary duct ectasia
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mammary duct ectasia – obstruction of lactiferous duct
pastelike matter in subareolar ducts produces sticky, purulent discharge that can be white, gray, brown, green or bloody itching, burning, or drawing pain around nipple ducts are palpable as rubbery, twisted tubules under areola not malignant |
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Describe: intraductal papillomasigns of a breast carcinoma
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intraductal papilloma = tiny tumors 2-3 mm in ducts
spontaneous serous or serosanguineous discharge unilateral or from single duct often is palpable nodule in the duct affect women age 40-60 usually benign |
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Describe: intraductal papilloma
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breast carcinoma:
bloody nipple discharge, unilateral, from single duct can include hard, irregular, nontender mass often under the areola, fixed to the area and with nipple retraction |
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Describe Paget’s disease (intraductal carcinoma)—mention changes over time
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Paget’s disease of the breast:
early on: lesion is unilateral, w/ clear yellow discharge and dry, scaling crusts, friable at nipple apex little later spreads outward to areola w/ erythematous halo on areola and crusted, eczematous, retracted nipple later: nipple reddened, excoriated, ulcerated and bloody discharge when surface is eroded, and erythematous plaque around nipple tingling, burning, itching |
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What are the symptoms of a plugged duct?
How to treat? |
plugged duct—occurs during breast feeding
one section of breast is tender, maybe reddened but no infection keep breast as empty as possible—nurse baby on effected side first |
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What are the symptoms of mastitis?
How to treat? |
mastitis = uncommon complication of breast feeding; inflammation before abcess formation
occurs in single quadrant area= red, swollen, tender, hot, hard headache, malaise, fever, chills, sweating, increased pulse, flulike symptoms occurs first 4 months of lactation as result of infection treat w/ rest, local heat to area, antibiotics, and frequent nursing to keep breast empty |
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What is a breast abcess and how do you treat it?
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breast abcess—rare complication of breast feeding
pocket of pus in one local area must discontinue nursing on affected side temoporarily—manually express milk and discard treat with antibiotics, surgical incision and drainage |
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Where is the following?
angle of Louis costal angle vertebra prominens |
angle of Louis: on sternum: notch at T2
costal angle: angle that lower ribs intersect at; should be <90° vertebrae prominens = spinous process of C7 (if there are 2 prominent bumps, the upper one is C7, lower one is T1) |
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How are intercostals spaces numbered?
What is relationship b/t spinous processes on vertebra and the ribs? How many vertebra are there?—C & T? How many ribs? |
intercostals spaces numbered for the rib above them
spinous processes align w/ the same number rib onty to T4; after that spiunous processes angle downward and alighn more with rib below 7 cervical, 12 thoracic vertebrae 12 ribs; ribs 11 & 12 float |
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What are the reference lines for the anterior thoracic cage?
Posterior thorax? side? |
Reference lines
anterior: midsternal (middle of chest) midclavicular—center of each clavicle anterior axillary—along sid of thorax posterior: vertebral line scapular line—goes through inferior angle of scapula lateral references: (with arms over head) anterior axillary—goes thru anterior axil fold midaxillary—from apex of axilla down posterior axillary—from posterior axillary fold |
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Where are the borders of a normal lung?
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lung borders:
apex = 3-4 cm above inner third of clavicle; at C7 on back base = about 6 rib midclavicularly, 7 or 8 rib on lateral sid posteriorly, lungs go down to T10, but can drop as low as T12 on inspiration |
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Describe positions of lobes of right lung
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right lung: 3 lobes
right upper lobe --anterior: goes down to 5th rib ish medially --posteriorly goes to T3 right middle lobe --anteriorly seen b/t 5th rib and 6th rib laterally --not seen from back right lower lobe —anteriorly: from 6th rib laterally to six rib ?? --posteriorly dominates from T3-T10 |
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diatribe
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n. bitter scolding; invective,fulmination
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Define:
costodiaphragmatic recess acinus hypercapnia |
costodiaphragmatic recess = where the pleura extend ≈ 3cm below level of lungs; it’s potential space
acinus = functional respiratory unit of lungs; consists of bronchioles, alveolar ducts, alveolar sacs, and alveoli hypercapnia = increase of CO2 in blood |
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What are the 4 major functions of respiratory system?
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4 functions of respiratory system:
1) supply O2 to body 2) remove CO2 3) maintain homeostasis of acid-base balance 4) maintain heat exchange ( \not as critical in humans) |
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What changes occur to the thorax/lungs of pregnant women?
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calcification of costal cartilages; less mobile thorax
lung is more rigid, harder to inflate decreased vital capacity increased residual volume loss of intra-alveolar septa, less gas-exchange surface area lung bases less ventilated |
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What changes occur in respiratory system of older adults?
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uterus elevates diaphragm 4 cm (decreased vertical diameter)
increased horizontal diameter chest ligaments relax, so transverse diameter can increase 2 cm costal angle widens total circumference increases 6 cm increased O2 demand, so deeper breathing increases tidal volume resp rate stays the same |
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Define:
vital capacity residual volume hemoptysis orthopnea paroxysmal nocturnal dyspnea What conditions are suggested by the following types of coughs? continuous thru day afternoon/evening coughs night coughs early morning cough productive cough 3 months of the year for 2 yrs straight |
vital capacity = maximum amt of air that a person can expel from lungs after first filling lungs to maximum
residual volume = amt of air remaining in lungs after most forceful expiration hemotysis = coughing up blood orthopnea = difficulty breathing when supine paroxysmal nocturnal dyspnea = awakening from sleep w/ SOB and needing to be upright to get comfortable |
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Define:
vital capacity residual volume hemoptysis orthopnea paroxysmal nocturnal dyspnea |
continuous thru day = acute infection
afternoon/evening coughs = irritant exposure at wk night coughs = postnasal drip, sinusitis early morning cough = chronic bronchial inflammation of smokers productive cough 3 months of the year for 2 yrs straight = chronic bronchitis |
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What do the following sputum colors suggest?
white/clear yellow/green rust colored pink, frothy |
white/clear = mucoid; colds, bronchitis, viruses
yellow/green = bacterial infection rust colored = TB, pneumococcal pneumonia pink, frothy = pulmonary edema or side effect of sympathomimentic meds |
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What types of cough are common with these conditions:
mycoplasma pneumonia early heart failure croup colds, bronchitis, pneumonia |
mycoplasma pneumonia = hacking
early heart failure = dry croup = barking colds, bronchitis, pneumonia = congested white/clear = mucoid; colds, bronchitis, viruses yellow/green = bacterial infection rust colored = TB, pneumococcal pneumonia pink, frothy = pulmonary edema or side effect of sympathomimentic meds |
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What populations are at risk for the following environmental hazards?
grain & pesticide inhalation histoplasmosis coccidioidomycosis pneumoconiosis silicosis |
grain & pesticide inhalation = farmers
histoplasmosis = ppl in Midwest coccidioidomycosis = Southwest & Mexico pneumoconiosis = coal miners silicosis = stone cutters, miners, potters |
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Define:
kyphosis scoliosis barrel chest |
kyphosis = exaggerated posterior curvature of thoracic spine (humpback); can be painful, limit mobility and affect breathing
scoliosis = S-curvature; severe scoliosis involves >45° deviation and can reduce lung volume barrel chest = anteroposterior aspect is as wide as transverse (back)( diameter; ribs horizontal and chest looks like its in continuous inspiration occurs from chronic emphysema and hyperinflation of lungs |
