assesment exam 3-HW

common signs/symptoms of breast cancer

firm or hard irregular axillary nodes, skin dimpling, nipple retraction, elevation, and discharge

when should menstruating women do self-breast exams

right after menstrual period

describe how to correctly examine the male breast

inspect chest wall, noting skin surface and any lumps or swelling. Palpate nipple area for any lump or tissue enlargement

describe correct steps to properly palpate breast tissue

use the pads of your first 3 fingers and make a gentle rotary motion on the breast

Significance and changes of Breast tissue in Infants/Children

Neonate: breasts may be enlarged and visible from maternal estrogen crossing placenta.
Prepubertal child: nipples should be symmetric, lateral to midclavicular between 4th and 5th ribs. Nipple is flat, areola is darker pigmented

Significance and changes of Breast tissue in Adolescence

asymmetry during growth, firm and uniform. Breast budding begins

Significance and changes of Breast tissue in Lactating Women

colostrum changes to milk on 3rd postpartum day. Breasts may be engorged, appearing enlarged, reddened and shiny. Feeling warm and hard

Significance and changes of Breast tissue in Aging Women

pendulous, flattened, and sagging. Nipples may be retracted or pulled outward. Breasts feel more granular and terminal ducts around nipple feel prominent and stringy. Thickening of inframammary ridge at lower breast normal

Significance and changes of Breast tissue in Pregnant Women

delicate blue vascular pattern, breasts increase in size as do nipples. Striae may develop. Nipples become darker and more erectile. Areolae widen, grow darker, contain small, scattered, elevated Montgomery glands. Breasts feel nodular and colostrum can be expressed after 1st trimester

vertigo

sensation of you or environment moving/spinning. Often from labyrinthine-vestibular disorder in inner ear

goiter

irregular growth of the thyroid gland.
Pathologies: simple diffuse, multinodular
Causes: lack of iodine in diet

dysphagia

difficulty swallowing
Common causes: stroke, head injury, multiple sclerosis, cancer, dementia, gastro-oesophageal reflex disease (GORD)

lymphadenopathy

abnormal size/consistency of lymph nodes. Usually occurs as a result of infection from bacteria or viruses
Causes: infection, allergy, neoplasm, and mononucleosis

Major Neck muscles and location

sternomastoid and trapezius. Located by cranial nerve XI, the spinal accessory

list structures that should appear symmetrical when inspecting the head and face

eyebrows, ears, nose, mouth, palpebral fissures, nasolabial folds

hyperthyroidism facial characteristics

eyelid retraction, bulging eyes, warm moist skin, infrequent blinking, staring appearance

hypothyroidism facial characteristics

puffy, edematous face (especially around eyes). Coarse hair/eyebrows. Thick speech

Palpating thyroid gland-Posterior approach

Ask patient to sit up very straight and then bend head slightly forward and to the right. Use fingers of left hand to push trachea to the right. Curve fingers between trachea and sternomastoid muscle, retracting slightly and have patient take a sip of water. Reverse for left side

anatomic difference that place infant at greater risk for middle ear infections

eustachian tube shorter/wider and the position more horizontal than adults. This makes it easier for pathogens from nasopharynx to go to middle ear. The lumen is also easily occluded. Their external ear canals are shorter and slope opposite to adults

otosclerosis

cause of conductive hearing loss in young adults 20-40 years. Gradual bone formation causing footplate of stapes to become fixed in oval window, impeding transmission of sound and causing progressive deafness

presbycusis

age related hearing loss. prevelant in 2/3 of adults over 70. Sensorineural loss affecting middle ear structures or causing damage to nerve cells in inner ear or cranial nerve VIII. 1st loses high frequency tone, difficult to hear consonants. Ability to localize sound impaired. Hearing loss accentuated w/ competing background noise

How to straighten ear canal when using the otoscope: infant vs adult

Adult: pull pinna up and back
Infant/Child younger than 3: pull pinna straight down

darwin's tubercle

small, painless nodule at helix

tophi

small, whitish yellow, hard, nontender nodules in or near helix or antihelix

chondrodermatitis

small, indurated red, poorly defined, very painful

carcinoma

ulcerated, crusted nodule with indurated base that fails to heal, bleeds intermittently. shows chronic discharge that is serosanguineous or bloody

otitis externa

aka swimmers ear. Infection of outer ear. S&S: severe painful movement of pinna and tragus, redness/swelling of pinna and canal, scanty purulent discharge, scaling, itching, fever, enlarged tendor regional lymph nodes

What should you expect to observe when inspecting external nose

triangle shaped, leading edge superior part is the bridge, free corner is the tip. Oval openings at the base are nares. Inside widens to vestibule. Columella divides the two nares and its continuous inside with the nasal septum. Upper third of nose is made of bone, lower part is cartilage. Should be symmetric in the midline and in proportion to other facial features

How do you test patency of nostrils? What might an abnormal finding indicate?

Patency tested by pushing each nasal wing shut with your finger while asking person to sniff through other nare. Absence of sniff indicates obstruction

appearance of deviated septum

hump or shelf in one nasal cavity

appearance of perforated septum

seen as a spot of light from a penlight shining in the other naris. Occurs with cocaine use

Appearance of nasal turbinates

appear the same light red color as nasal mucosa. Vascular and tender if touched

appearance of nasal polyps

smooth, pale gray, avascular, mobile, and nontender

what is the most common site for a nose bleed

most common site for a nose bleed is in the anterior of the nasal passage

how to stop a nose bleed

sit with head tilted forward, pinching soft part of nose above nostrils for 10-15 min

Leukoedema

benign, milky, bluish white opaque area. Always bilateral

candidiasis

white, cheesy, curdlike patch on buccal mucosa and tongue. Scrapes off leaving raw, red surface that bleeds easily. Called thrush in newborn. Opportunistic infection that occurs after use of antibiotics and corticosteroids and in immunosuppressed people

leukoplakia

chalky white, thick, raised patch with well-defined borders. Lesion firmly attached and does not scrape off. May occur on lateral edges of tongue. Caused by chronic irritation of smoking and alcohol use. Precancerous

Fordyce's granules

small isolated white or yellow papules on the mucosa of cheek, tongue, and lips. Cysts are painless and not significant

4-point grading scale for the size of tonsils

1+ visible, 2+ halfway between tonsillar pillars and uvula, 3+ touching the uvula, 4+ touching one another