Exam 2- Module 5 Flashcards by Ashley Shores

Breasts location

Between 2nd and 6th ribs

Nipple below center of breast

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Montgomerys glands

Secrete protective lipid material during lactation

elevated sebaceous glands on areola

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Breast composed of

Glandular tissue (15-20 lobes)

Fibrous tissue , suspensory ligaments

Adipose tissues

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Suspensory/coopers ligaments

Fibrous bands extending vertically from surface to attach on chest wall muscles

Support breast tissue

Contracted when cancer

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Breasts: 4 quadrants

Horizontal and vertical line through nipple

Map for clinical findings

Upper outer: usually site of breast tumors

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Breasts: axillary nodes

Central

Pectoral (anterior)

Sub-scapular (posterior)

Lateral

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Breast development

Embryonic: “milk lines” present and curve down from axilla groin bilaterally

Birth: only breast structure present are lactiferous ducts within nipple

Puberty: estrogen stimulates, normal to have temporary asymmetry

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Tanner staging

5 stages breast development

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Breast changes: pregnant

2nd month of pregnancy

4th month: colostrum expressed- thick yellow fluid, 1st few days after delivery

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Lactation

1-3 days postpartum

White color is emulsified fat and calcium caseinate

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Breast: Aging woman

Ovarian secretion of estrogen and progesterone decrease, causing glandular tissue atrophy

Decreased breast size

Breast lump now suddenly palpable

Fibrosis and calcification make breast feel firm and stringy

Axillary hair decrease

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Make breast: gynecomastia

During adolescence breast tissue temporarily enlarges

Reassurance important to body image

May reappear in aging male due to deficiency in testosterone

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**Breast cancer nonmodifiable risk factors

BRCA1 and BRACA2 mutations increase risk for breast or ovarian cancer

Age and ethnicity

Screening mammography recommended at age 40

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Factors related to breast health care

Low income

Lack of health insurance

Geographic

Cultural and language barriers

Racial bias

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Supernumerary nipple

Normal variation

Extra nipple on thorax or abdomen

Congenital finding

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Breasts: nulliparous women

Firm, smooth, elastic

Breasts: after pregnancy

Tissue is softer and looser

Breasts: premenstrual

Slight enlargement, tenderness

Increase progesterone

Breast lump characteristics

Location

Size (width, length, thickness)

Shape (oval, round, lobulated, indistinct)

Consistency (soft, firm, hard)

Movability (freely moveable or fixed)

Distinctness (solitary or multiple)

Nipple (displaced or retracted)

Tenderness

Lymphadenopathy (any regional lymph nodes palpable)

Breast development: adolescent girl

8-10yrs

Palpate as would with adult

Teach BSE now so technique will become natural

*Tactile fremitus

Palpable vibration

Use palmar (ball) of fingers or ulnar edge of hand

Touch persons chest while repeating words

Rhonchi lung sounds

Low pitched

Resemble “snoring”

Heard when patients have chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, cystic bronchitis, chaotic fibrosis

Wheezing

Narrowed airways or inflammation

High pitches whistling sound

Heard more during exhalation

Stridor lung sound

High pitched

Wheezing

Airflow disrupted by larnyx (voice box) blockage or trachea (windpipe) blockage

Crackles

Excessive fluid in airways Caused by pneumonia or congestive heart failure

Pleural friction rub

Freaking/grating sounds Inflamed surfaces sliding over one another Pleurisy Similar sounds to walking on snow or leather on leather sound

Egophony

Voice sounds heard when ausculating lungs Lung consolidation and fibrosis High frequency sound across fluid Saying the vowel "e"

Brochophony

Abnormal transmission of sounds from lungs say 99 in normal voice

Pneumonia

Infection inflames air saves in lungs Air sacs filled with fluid or pus Cough, fever, chills, difficulty breathing

Emphysema

Shortness of breath Air sac (alveoli) damage

Asthma

Chronic long term lung disease Inflames and narrows airways Wheezing, chest tightness, shortness of breath, coughing

Acute bronchitis

Chest cold Inflammation of bronchi Cough Some wheezing, shortness of breath, fever & chest discomfort Few-10 days

Barrel chest

Lungs inflated with air Rib cages stays partially expanded Chronic obstructive pulmonary disease -emphysema

Pectus excavatum

Sternum and rib cage grow abnormally *Caved-in, sunken appearance of chest Present at birth or develops at puberty

Pectus carinatum

"Pigeon chest" Protrusion of sternum and ribs

Kyphosis

Outward curvature in thoracic vertebra Spine is bent forward "Hunchback" Osteoporosis

Hypertension

Increased blood pressure Blacks 41% experience earlier in life

Characteristics of lump or mass in breast

``` Location Size Shape Consistency (soft, firm, hard) Movability Distinctness (solitary or multiple) Nipple (displaced or retracted?) Skin over lump (erythematous, dimpled, retracted) Tenderness Lymphadenopathy (regional lymph nodes palpable) ```

**breast cancer modifiable risk factors

Alcohol Physical exercise Postmenopausal weight gain