Health Assessment - Class 8 (Part 1)

where is the breast and mammary glands located

between 2nd and 6th rib, from sternum to mid-axillary line

Montgomery glands secrete protective lipid during ___

lactation

75% of the lymph drains to the ___ on the same side of the body (ipsilateral)

axillary nodes

Because lymphatic vessels can carry cancer cells, breast cancer can ___ through this system

spread (metasized)

the ___ are close to the top of armpit (axillary nodes)

central axillary nodes (CAN)

what are the other axillary nodes called?

pectorol (anterior), subscapular (posterior), and lateral

CAN receives lymph nodes from the other ___ groups

3

Lymph flows up to the ___ nodes from CAN

infraclavicular and supraclavicular

Gynecomastia → temporarily unilateral breast tissue ___ in males during adolescence

enlargement

this may reappear in older males because of ___ deficiency

testosterone

Gynecomastia can occur with which substance

anabolic steroids

Galactorrhea → Secretion of ___ from one or both breast, not breast milk, can occur in male or female, not related to pregnancy of breastfeeding

milky white discharge

Any ___ discharge or any discharge with a lump needs to be investigated

bloody or blood tinged

Paget’s Disease/Intraductal Carcinoma is a rare type of breast cancer that starts at the nipple apex and spreads to the __-

areole

in Paget’s, the nipple appears ___ at the centre with white or yellow discharge

crusted

Cancer causes fibrosis, which contracts the suspensory ligaments that normally cause breast to go outwards and causes something called ___

dimpling

Dimple may be apparent at rest with ___ or with lifting of the arms

compression

Edema (peau d’orange) is caused when there is ___

lymphatic obstruction

edema in the breast suggests __

cancer

___ is a non cancerous breast condition

Mammary Duct Extasia

what is mammary duct extasia? it is a stagnation of cellular debris and secretion in the ducts, leading to…

obstruction, inflammation and infection

mammary duct extasia occurs usually in women who are lactating and usually during ___ period

perimenopausal

in mammary duct extasia, there is ___, burning, pulling pain around nipple

itching

the ducts are ___ as rubbery, twisted tubules under areola

palpable

it may have palpable soft or firm __ which is poorly delineated

mass

Uncommon inflammatory mass before abscess formation

mastitis

mastitis is often seen during the first ___ of lactation

4 months

mastitis results from infection or ___ from plugged duct

milk stasis

mastitis usually ___ in a few days if treated early

resolves

what age group is at risk for breast ca

50-69 yrs

what kind of breast tissue is at risk for breast ca

dense

which gene mutation is at risk for breast ca

BRCA

which ethnicity is at risk for breast ca

ashkenazi jew

what type of period is at risk for breast ca

early menarche or late menopause

exposure to ___ is at risk for breast ca

ionizing radiation

atypical hyperplasia and ___ adult height is at risk for breast ca

tallthew

these are all examples of ___ risk factors

unmodifiable

Hormonal contraceptive use and ___ are risks for breast cancer

hormone replacement therapy

Alcohol intake of 1 or more drinks daily and __ are also risks

obesity

__ or first child after 30 are also risks for breast ca

Nulliparrity

High socioeconomic status is a risk because they ___ symptoms of breast cancer more = get it checked out more

are more aware of

However, most breast cancers occur in women ___ identifiable risk factors aside from age and hormone exposure

without

Ages 40-74 should get a ___ every 2 years

mammography

Age 75 and older discuss with healthcare provider whether this is ___

appropriate

A ___ is a solid breast lump. This breast lump is not cancer.

fibroadenoma

fibroadenoma can occur in which group

15-30 years, up to 55

what is the shape of fibroadenoma and other benign breast diseases

round and lobular

benign breast disease happens in which age group

30-55

fibroadenoma and benign breast conditions are both firm and rubbery, tho benign conditions can also be more ___

soft

fibroadenoma and benign conditions are both ___ (demarcated)

well defined

fibroadenoma and benign breast conditions can both single lumps tho benign condition are more likely to have ___

mutiple

the lumps are both ___, may be slippery in fibroadrenoma

mobile

breast cancer likely age is 30 to 80, and the shape is…

irregular, star shaped

the consistency of cancer is firm to stony ___

hard

the borders are poorly defined and there is usually one, ___ bump

fixed

___ (skin colour) → 0 (blue, pale), 1 (pink body, blue extremities), 2 (pink)

(APGAR)

appearance

___ → 0 (absent), 1 (below 100bpm), 2 (over 100bpm) 

(apgar)

pulse

___ (reflex irritability) → 0 (floppy), 1 (minimal response to stimulation), 2 (prompt response)

grimace

___ (muscle tone) → 0 (absent), 1 (flexed arms and legs), 2 (active)

activity

___ → 0 (absent), 1 (slow and irregular), 2 (vigorous cry)

respiration

___ is front of armpit going down

anterior axillary

the ___ line is going straight down the chest

midsternal

the ___ line is in the middle of the breast

midclavicular

the vertebral line goes straight down your ___ (back)

spine

the ___ goes straight down your scapulae (middle of lobe on the back)

scapular line

The right lung is larger and divided into three lobes

• superior (upper) lobe

• middle lobe

• inferior (lower) lobe

The ___ lung is smaller because it shares space with the heart

left

the left lung has two lobes

• superior (upper)

• inferior (lower)

The ___ lies in front of the esophagus and is 10-11cm long in adults

trachea

the trachea starts at the ___ in the neck and bifurcates just below the sternal angle into the right and left main bronchi

cricoid cartilage

Posteriorly it ___ (divide into two branches) at the level of T4 or T5

bifurcates

The right main bronchus is ___, wider and more vertical than the left main bronchus

shorter

Infectious disease caused by bacteria, and is the top infectious killer globally

TB

TB is ___ and curable

preventable

Indigenous population also affected by TB more due to ___ to health services

barriers

TB requires ___ of treatment → CXR follow up to ensure it is gone, making it difficult to treat for some individuals without access to these services

9 months

breathing is managed by respiratory centre in brain stem → the ___

pons and medulla

___ regulation → responds to CO2 and O2 levels in blood and regulate respiration

humoral

Increase in Co2 in blood, called ___ signals the body to breathe and remove excess Co2

hypercapnia

Decrease in O2 (hypoxemia) also ___ respirations but is less effective than hypercapnia

increases

to feel for tactile fremitus you use the ___ of hand

palmar base or ulnar edge

then you have the patient repeat the words  “ninety-nine” or ___

blue moon

Normally, the larynx helps ___ lungs to chest well, it should be prominent

vibrates

Normal tactile fremitus is ___ and equally palpable on both sides of the chest when a person speaks

symmetrical

Increased fremitus → ___ of lung tissue (pneumonia), lots of fluids and inflammation

consolidation

Decreased fremitus (decreased vibration) → ___, pleural effusion, pneumothorax

air

___ is a low-pitched, hollow, percussion sound heard over normal lungs

resonance

tympanicity is drum-like, heard over ___ organs like the stomach and bowel

air-filled

dullness is muffled, short, heard over ___ organs like the liver or heart

solid or fluid-filled

___ sounds are heard only at anterior chest, over the trachea/neck area

Bronchial

___ can be heard on both sides

Bronchovesicular and vesicular

where are bronchovesicular sounds

middle of chest, at sides of sternum

where are vesicular sounds heard

across lung fields