Chapter 17&18 Flashcards
Starting at 45 which ethnic group has a higher incidence of breast cancer?
White Woman
The beginning of breast development precedes…..
Menarche (beginning of menstruation) by age 2
Women who inherit a mutation on one or both have a significantly increased risk of…..
developing breast or ovarian cancer
What type of therapy increased the risk of developing breast cancer?
combined estrogen and progesterone therapy
How often should a woman perform a self breast exam?
Monthly
What is the best time to perform a breast self-examination
Right after a menstrual period, when the breasts are the smallest, palpate while in shower
How many quadrants is the breast divided into
4
What is located in the upper outer quadrant
tail of Spence (cone shaped breast tissue that projects up into the axilla)
What is the most common site for breast tumors?
Upper outer quadrant
Which lung has 3 lobes?
Right
Posteriorly the location of C7 marks what?
apex of the lungs
Which lung is shorter?
Right (due to the liver being below it)
Which lung is more narrow?
The left( because the heart is part of this lung)
What are the lungs separated by?
fissures that run obliquely through the chest
What fissure crosses the 5th rib in the mid-axillary line and terminates at the 6th rib in midclavicular line?
oblique (major or diagonal)
What divides the upper, middle, and lower lobes of the right lung?
horizontal (minor) fissure
The total volume of air exhaled is known as?
Forced Vital Capacity (FVC)
Normal time for full expiration is……
4 seconds or less
What measures lung health in chronic conditions such as asthma
spirometer
The number of seconds it takes for the person to exhale from total lung capacity to residual volume
Forced expiratory time
What is the normal outcome of FEV1/FVC ratio?
75% or grater (no obstruction of airflow is present)
Noninvasive method to assess arterial oxygen saturation
pulse oximeter
Is used as an outcome measure for people in pulmonary rehab because it mirrors conditions that are used in everyday life. Measures functional status in aging adults.
6 minute walk test
FEV1/FCF ratio of 60-70% is
mild obstruction
How many points do you auscultate on the posterior chest?
9(18)
What lung areas are we to listen to when doing an examination?
posterior from the apices at C7 to the base are T10 and laterally from the axilla down to the 7th or 8th rib
What is the goal of monthly breast examination
For the woman to become familiar with the look and feel of her breasts
What is a common sequela after having a mastectomy?
Lymphedema of the upper arms
Clear nipple discharge is called what?
Galactorrhea
What medications may cause clear nipple discharge?
oral contraceptives, phenothiazines, diuretics, digitalis, steroids, methyldopa, and calcium channel blockers
Occurs with trauma, inflammation, infection, and benign breast disease?
Mastalgia
What disease starts with a small crust on the nipple apex and spreads to areola?
Paget disease
What factor do we need to consider when doing breast exams?
Age
What type of tissue composes most of the breast?
adipose tissue
Contains 15-20 lobes radiating from the nipple, and these are composed of lobules. Within each lobule are clusters of alveoli that produce milk
Glandular tissue
What are the reservoirs for storing milk in the breast?
ampullae or lactiferous sinuses
Fibrous connective tissue extending vertically from the skin surface to attach on chest wall muscles. These support the breast tissue
suspensory ligaments or Cooper ligaments
The relative proportion of glandular, fibrous and fatty tissues varies depending on….
age, cycle, pregnancy, lactation, and general nutritional state
After menopause, what 2 hormones decrease causing tissue to atrophy?
Estrogen and Progesterone
What is this dead tissue replaced with?
fibrous connective tissue
Drooping of the breast in aging adults is accentuated by….
kyphosis in some older women
On the breast, a shallow dimple is also called______
skin teather
Looks flatter and broader, like an underlying crater. Can suggest cancer, which causes fibrosis of the whole duct system and pulls in the nipple
Nipple Retraction
What can produce edema (Peau d’ Orange) of the breast?
lymphatic obstruction
Asymmetry, distortion, or decreased mobility with the elevated arm maneuver.
Fixation
Underlying cancer causes fibrosis in the mammary ducts, which pulls the nipple angle toward it. Swelling behind the nipple, and the nipple tilts laterally.
Deviation in Nipple Pinting
A sudden increase in the size of one breast can signify what?
Inflammation or new growth
During a breast exam, symmetric free-forward movement of both breasts should be seen while the patient is in what position?
leaning forward
What indicates skin retraction
dimpling or a pucker
Where should the patients hands be to contract the pectoralis major muscle?
hands onto hips and her to palms together
______ is a benign growth of male breast tissue?
Gynecomastia
What male breast cancer usually present with?
painless, firm, retroareolar lump
When ausculating vesicular sounds should the examiner expect high or low pitched sounds?
Low
What are the 3 types of normal breath sounds heard in the adult and older child?
- Bronchial (high pitched normally hear in trachea and larynx)
- Bronchovesicular (moderate pitched and over major bronchi)
- Vesicualr (low pitched and over peripheral lung fields)
Result of loss of elasticity in the lung fibers and decreased force of inspired air; the lungs are also hyperinflated, so the inhaled air does not make much noise
emphysema
A silent chest means that no is moving in or out; a ______
ominous sign
What part of the hand is used to palpate tactile fremitus?
Palmar base or ulnar edge of one hand and touch the person’s chest
Occurs with obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema.
Decreased fremitus
Occurs with compression or consolidation of lung tissues. Present only when the bronchus is patent and the consolidation extends to the lungs surface..
Increased fremitus
Palpable with thick bronchial secretions.
Ronchal fremitus
Palpable with inflammation of the pleura.
Pleural friction fremitus
In patient with emphysema, which sound is present with percussion
Hyperresonance (lower pitched, booming sound found when to much air is present)
A coarse, crackling sensation palpable over the skin surface. Occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue.
crepitus
Low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult.
Resonance
Signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor
dull note
When the examiner is placing their hands on the posterolateral chest wall at the level of T9 or T10, what are they checking for?
Symmetric Chest Expansion
What occurs with tissue hypoxia?
cyanosis
These muscles lift the sternum and elevate the ribs
Intercostal Muscles
The normal stimulus to breathe for most of us is an increase of CO2 in the blood
hypercapnia
What respiratory pattern is characterized by respiration that gradually wax an wane in a regular patter
Cheyne-Stokes
Rapid, shallow breathing, Increased rate, greater than 24 per minute. Normal response to fever, fear, or exercise
Tachypnea
Increase in both rate and depth. Normally occurs with exertion, fear, or anxiety.
Hyperventilation
Slow breathing. A decreased but regular rate, as in drug-induced depression of the respiratory center in the medulla, increased intracranial pressure, and diabetic coma.
Bradypnea
Similar to Cheyne-Stokes respiration, except that the patter is irregular. A series of normal respiration’s (3-4) is followed by apnea.
Biot Respiration
Normal inspiration and prolonged expiration to overcome increased airway resistance.
Chronic Obstructive Breathing
A pleural rub is auscultated with what condition
Pleural effusion
An allergic hypersensitivity to certain inhaled allergens, irritants, microbes, stress, or exercise that produces a complex response characterized by bronchospasm and inflammation, edema in walls airway
Asthma (Reactive Airway Disease
Proliferation of mucus glands in the passageways, resulting in excessive mucus secretion. Inflammation of bronchi with partial obstruction of bronchi by secretions or constrictions.
Chronic Bronchitis
What is the medical term for shortness of breath?
Dyspnea
Difficulty breathing when supine.
Orthopnea
Awakening from sleep with SOB and needing to be upright to achieve comfort
Paroxysmal nocturnal dyspnea
Green/yellow sputum is seen with what type of infection
Bacterial
White or clear mucoid is what type of infection
colds, bronchitis, viral infections
rust colored sputum is what type of infection
TB, pneumococcal pneumonia
Pink, frothy sputum could be what disease?
pulmonary edema
In a child with croup, what lung sound might you hear?
Stridor
Low-pitched; monophonic single note, musical snoring, moaning. More prominent on expiration
Wheeze (sonorous ronchi)
Discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing; stimulate sound by rolling a strand of hair between your fingers near your ear.
Fine crackles (aka rales)
Sound like fine crackles but do not last and are not pathologic; disappear after the first few breaths; heard in axillae and bases of lungs
Atelectatic crackles
Example of obstruction of airflow
COPD
Pump failure with increasing pressure of cardiac overload cause pulmonary congestion or an increased amount of blood present in pulmonary capillaries. Dependent air sac deflated
Heart Failure
Undissolved materials originating in legs or pelvis detach and travel through venous system, returning blood to right heart, and lodge to occlude pulmonary vessels
Pulmonary Embolism
What scoring system is used for newborns
Apgar Scoring System
What are the 5 A’s for smoking history
Ask, Advise, Assess, Assist, Arrange
4 major functions of the respiratory system
- Supplying O2 to body
- Removing CO2 as a waste product of energy reactions
- maintaining homeostasis
- maintaining heat exchange
An inflammatory mass before abscess formation. Usually occurs in single quadrant. Area is red, swollen, tender, very hot, and hard, here forming outward from areola upper edge in right breast.
Mastitis
A pocket pus that feels hard, looks red, and is quite tender accumulates in one local area
Breast Abscess
Common when milk is not removed completely because of poor latching, ineffective sucking, infrequent nursing, or switching to second breast to soon
Plugged Duct
Pastelike matter in subareolar ducts produces sticky, purulent discharge that maybe white, gray, brown, green, or bloody.
Mammary Duct Ectasia
Stages of Sexual Maturity Rating in Girls
- Preadolescent (small elevated nipples)
- Breast bud stage (small mound of breast and nipple develops)
- The breast and areola enlarge; nipple is flush with the breast surface
- Areola and nipple form a secondary mound over the breast
- Mature breast (only nipple protrudes)
Discrete benign tumors that arise in a single or multiple papillary ducts. May have serous or serosanguineous discharge.
Intraductal Papilloma
Best way to detect a breast mass
vertical strip pattern
higher incedence of breast cancer before age 45 and more likely to die at every age
African American women
pain with deep breathing
inflamed pleurae
starts across tops of shoulders; make a side to side comparison all the way down the lung region
predominant note over lung fields
