N202 exam 2

not all information from google docs are on here. look back at the google docs if needed

landmarks of the breast

nipple, areola, sebaceous glands

tail of spence

part of the breast tissue that extends into the axillae, also a common site for malignancy

the breast is divided into

four quadrants

breast tissue contains

adipose tissue, glandular tissue (milk production), suspensory/cooper’s ligaments

pectoral node

behind anterior axillary fold

lateral node

inside upper arm along humerus

central axillary node

high middle axillae

mastitis

red, swollen, hot, tender breasts

gynecomastia

formation of breast tissue under the areola, typically in aging men, but may occur during adolescence due to excess testosterone being converted to estrogen

cyclic breast pain

comes and goes with menstrual cycle

fibrocystic lump

non-cancerous, could enlarge or thicken prior to menstrual cycle, tender

single isolated lump

cancerous, fibroedenoma

skin changes in the breasts

redness, warmth, dimpling, swelling - could be cancer associated

clear nipple discharge

might be caused by meds (oral meds, psychiatric meds, diuretic)

galactorrhea

milky discharge (not from lactation), often associated with a pituitary tumor

bloody nipple discharge OR thick yellow with blood is associated with?

associated with a lump, sign of ductal cancer

if lumps are found

oldcart or coldspa

age range a woman should consider starting annual breast cancer screening via mammogram

40-44

age range a woman has to get an annual mammogram

45-54

what age can women decide to have mammograms every 2 years, or still continue with yearly screening

55 and older

women should consider getting screened for breast cancer earlier if what?

family hx, high risk, or other reasons

the second major cause of death in women behind lung cancer

breast cancer

when is the recommended time to self assess the breast

4-7 days after the 1st day of menses (menstrual cycle)

what to do during a breast exam

inspect breasts, inspect nipples, palpate breast, palpate axilla

inspecting the breast

asymmetry normal, smooth skin, even color

redness with heat

common sign for mastitis

peau d’ orange

orange peel skin, seen with breast cancer; caused by blocked lymph ducts and/or edema

retraction maneuver

hands above head, prayer postion while hunching over

when inspecting nipples

look for symmetry, countour, inverted nipples, and abnormalities

if inverted nipples observed

can be suspected of malignancy if recent change and unilateral; tumors could pull on the underlying tissue, causing retraction

abnormalities in the nipples may include:

scaling, fissures, ulceration, bleeding or discharge (these may indicate disease processes)

paget’s disease

starts as a small crust on the nipple with surrounding erythema (advanced ductal cancer)

palpating breasts

palpate using 3 fingers and with 3 levels of pressure in an up/down motion from the mid axillary line to the sternal border

palpating the axilla for lumps

may indicate a metastatic process since breast cancer may metastasize here via the lymphatic drainage system

if a breast lump found upon self examination

follow up with a clinical exam

during a clinical breast exam, what will the provider note about the lump

location, size, shape, consistency (hard, soft, firm), tenderness (could be fibrocystic or later cancer), border (defined or irregular; irregular could be cancer), retraction (present or absent; indicator for cancer), mobility (mobile generally fibrocystic, fixed may be cancer)

breast cancer characteristics

painless irregular fixed lump, ulcerated skin, retraction of skin, nipple discharge

some risk factors for breast cancer (refer to google doc for more)

female (male could have breast cancer, but in rare cases), age, family hx, BRCA 1 or BRCA 2 gene mutation, use of oral contraceptives, alcohol, abnormal breast cells in previous biopsy, no children/breastfeeding

some subjective data of the skin, hair, nails include? (refer to google doc for more

previous hx of skin disease, pigmentation changes, mole changes, xerosis (excessive skin dryness), alopecia, pruritus

xerosis

excessive skin dryness, common in the elderly; can also increase risk of heat stroke in older adults

seborrhea

dandruff

pruritus

itching; common with age or kidney/liver disease, may be due to xerosisa

alopecia

patchy or total hair loss caused from chemo, familial, trauma/burns, stress

trichotollomania

pulling out hairt

two things to do to assess the skin

inspect and palpate

vitiligo

absence of melanin pigment in patchy areas (common with people with darker skin)

pallor

white/light appearance of the skin; ashen grey with brown/dark skin; could be caused by anxiety, cold, shock, or arterial insufficiency

erythema

skin appears red or “flushed”

cyanosis

bluish appearance, gray appearance in darker skin; caused by decreased perfusion of tissues

central cyanosis

secondary to cardiopulmonary problems; inspect lips, tongue, oral mucosa, and conjunctiva

peripheral cyanosis

caused by vasoconstriction such as cold exposure (inspect nailbeds and extremities)

jaundice

yellow skin appearance due to increased bilirubin in the blood and gets reabsorbed into the skin. can also be caused by biliary obstruction (gallstones), ineffective breakdown of bilirubin

skin temperature can be noted by

hypothermia (decreased circulation) and hyperthermia (can be generalized or localized)

perspiration

normal sweating

disaphoresis

lots of sweating and seen with MI (myocardial infarction)

turgor

how quickly the skin can snap back after being pinched; test for turgor below the clavicle; poor turgor can indicate dehydration

cherry angioma

genetic, bright red papular lesions 1-5mm, increases with age

spider angioma

central arteriole (fiery red) with capillary radiations; blanches (turns white) with pressure

venous star

bluish spider angioma; non-blanching

petechiae

1-3mm, deep red color, rounded, result from superficial capillary bleeding; can be caused by sepsis or bleeding disorders (thrombocytopenia)hem

hematoma

localized collection of blood

characteristics of lesions

color, elevation, configuration, size, number, location/distribution, discharge

primary lesion

the initial lesion

secondary lesion

changes from a primary lesion such as scratching, infection, popping a blister, etc

types of primary lesions

flat, raised, fluid filled

macule

flat, circumscribed, discolored, <1 cm (freckles, solar lentigines flat nevi, petechiae)

patch

flat, irregular, >1 cm (vitiligo)

papule

solid, elevated, circumscribed, < 1 cm (raised nevus, wart [verruca])

plaques

coalesced papules, > 1 cm (psoriasis)

nodule

solid, elevated, 1-2 cm (lipoma = fatty growth)

tumor

larger than a few centimeters, firm or soft (lipoma)

wheal

superficial, raised, erythematous, irregular (allergic reaction, PPD, mosquito bite) - causes interstitial edema

urticaria

also known as hives; wheals coalesce to form extensive reaction; intensely pruritic

vesicle

elevated cavity with clear fluid, <1 cm (herpes simplex, varicella [chickenpox], herpes zoster [shingles], contact dermatitis [e.g., poison ivy])

bulla

elevated cavity with fluid >1cm (blister, burns)

pustule

contains pus; filled with leukocytes, not necessarily infected (acne)

cyst

encapsulated fluid filled cavity in dermis or sub-q (sebaceous cyst); if deep, may be hard to differentiate from a nodule or tumor (e.g., breast cyst versus tumor)

crust

thickened dried exudate (dried serum/blood/pus) on top of primary lesion

scale

compact flakes of skin (psoriasis [white-silvery], seborrheic dermatitis [yellow-greasy], seborrhea (dandruff)

fissure

linear crack (cheilosis [corners of mouth], callused heels, tinea pedis [athletes foot] –between toes,)

erosion

shallow depression, moist, no bleeding (affects epidermis; e.g., varicella after rupture)

ulcer

deep depression into dermis; leaves scar (stasis ulcer, pressure sore)

excoriation

superficial abrasion (dermatitis) – red, open sores

scar

connective tissue replacing normal tissue

hypertrophic scar (keloid)

excess scar tissue secondary to increased collagen formation

lichenification

thickening of skin (eczema [atopic dermatitis]; chronic sun exposure)

annular

ring; clear center (tinea corporus [ring worm], pityriasis rosea)

discrete

isolated (bug bite)

confluent

lesions run together (urticaria)

grouped

clusters of lesions- (contact dermatitis)

linear

scratch

zosteriform

linear vesicles along a nerve route s/p Shingles [herpes zoster]

stage 1 pressure ulcer

non-blanchable erythema of intact skin

stage 2 pressure ulcer

partial thickness loss of skin with exposed dermis. Pink bed of skin, top layer of skin may look like it peeled off

stage 3 pressure ulcer

full thickness skin loss; adipose is visible

stage 4 pressure ulcer

full thickness skin and tissue loss with exposed fascia, muscle, tendon, ligament, or bone

unstageable pressure ulcer

full thickness skin and tissue loss, obscured by slough or eschar.

ABCDE of melanoma

a: asymmetry

b: border (irregular)

c: color

d: diameter >6mm

e: elevation or evolving

hair texture characteristics

fine/coarse, shiny/dull, straight and curly, brittle

when inspecting scalp, look for

seborrhea, lice, or nits