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Where is the tail of spence?
in the upper lateral of the breast
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What types of tissue are breast made up of?
- glandular tissue: 15-20 lobes
- Fibrous bands, including suspensory ligaments
- Adipose Tissue
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What lymph nodes drain the breasts?
- central axxillary nodes
- pectoral nodes
- subscapular nodes
- lateral axxillary nodes
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What are the Tanner Stages?
the 5 stages of maturation in a woman
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What is gynecomastia?
swelling of breast tissue in men
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What is breast tissue swelling in men called?
gynecomastia
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What are some unchangeable risk factors for breast cancer?
- Female
- >50 y/o
- Hx of breast cancer
- BRCA 1 or 2 mutation
- 1st degree relative with breast cancer
- prior radiation
- menarch <12
- menopause >50
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What is mastalgia?
pain in the breast
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What is pain in the breast called?
mastalgia
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when is a mammogram recommended?
after 40 or 60
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What is one of the first things you do during a breast examination
ensure pt's privacy
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What is masstitis?
Swelling of the breast
-
What is swelling of the breast called?
masstitis
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What is dimpling?
anything that sticks to the chest wall
-
What is inframammoryridge?
tissue under the breast that gets compressed
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When is discharge from the breast normal?
pregnancy, lactating
-
How do you describe a lump?*
- Location
- Size
- Shape
- Consistency
- Movility
- Distinctness-solitary, multiple
- Nipple-displace, retracted
- overlying skin
- tenderness
- lymphadenopathy (tender lymph nodes
-
Where do males tend to get breast cancer
under the nipple
-
What is fibroadenobas?
- a firm lobule, mobile, usually non-tender, shows on US, needs biopsy
- usually aged 15-25
-
What is a firm lobule that is mobile, non tender and shows in an US in younger women called?
Feibroadenombas
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Describe Fibrocystic breast disease
- soft to firm, mobile, often tender, single or multiple
- Age 30-50
- Too much caffeine can aggravate it
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What is a soft to firm lump that is mobile, often tender, single or multiple and occurs between 30-50 y/o called?
Fibrocystic breast disease
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When is breast cancer most common?
women >50 y/o
-
What is invasive breast cancer?
spread from lobule of milk duct to other tissue
-
What is non-invasive breast cancer?
Still inside the lobule or milk duct (INSITO)
-
What is peau d'orange?
- breast looks like an orange
- not a good sign
- can be localized or the whole breast
-
What are the 3 parts of the sternum?
manubrium, body, xiphoid process
-
What is the angle of louis?
The manubriosternum angle
-
Where is the costal angle?
At the bottom of the xiphoid process where the fibs dissect
-
What are the two different types of pleurae and where are they?
- Lungs
- parietal:outer
- Visceral: inner
-
What is the pleural sac?
surrounds the lungs
-
What does clear stringy sputum indicate?
viral infection
-
What does yellow/green sputum indicate?
bacterial infection
-
What does rust colored sputum indicate?
TB, Pneumococcal Pneumonia
-
What does frothy pink sputum indicate**
pulmonary edema
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What is dyspnea?
difficulty breathing
-
What is orthopnea?
- difficulty lying down
- symptom of emphysema
-
What is hemoptysis?
coughing up blood
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What is tactile fremitus?
resonance
-
What do you do during a PE of the lungs?
- inspect
- check respiratory excursion
- palpate tactile fremitus
- percuss for symmetry
- diaphragmatic excursion
- auscultate post chest
- repeat on the anterior
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What is the AP to transverse ratio?
2:1
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What is the angle of the costal angle?
<or = to 90
-
What is an adult RR
10-20
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Describe barrel chested?
A:P to transverse ratio is 1:1
-
What is pectus excavatum?
breast bone is depressed, only an issue if it interferes with breathing
-
What is pectus corinatum?
breast bone protrudes
-
What is kyphosis?
hump on back
-
What is a hump on the back called?
kyphosis
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What is a pink puffer?
pink complextion, SOB, COPD pt(emphysema, chronic bronchitis)
-
What is a blue bloater?
- cyanosis, decreased lung capacity, can be RIGHT side heart failure
- COPD
-
What is tachypnea?
RR >20 per min
-
What is bradypnea?
RR < 10 per min
-
What is Kussmaul?
Tachypnea with deep breaths
-
What is Cheyne-Stokes?
regular breathing w. long pauses
-
-
Increased tactile fremitius is an indication of what
pneumonia
-
decreased tactile fremitus is an indication of what
obstructed bronchus
-
What does dullness in the lungs indicate?
fluid or blockage
-
What is thorocentisis?
Dr drains excess fluid from dull area
-
Where should resonsance be heard till?
T 10
-
What is louder with vesicular sounds?
inspiration > expiration
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What is greater with bronchovesicular?
inspiration = expiration
-
What is louder in bronchial?
inspiration < expiration
-
Where are vesicular sounds heard?
most of the lung
-
What are bronchovesicular sounds heard?
mid chest anteriorly and between scapula
-
Where are bronchial sounds heard?
over trachea
-
What does rhonca sounds like?
snoring
-
What are sibilant wheezes associated with?
asthma
-
What is bronchophony?
hear 99 through stethescope clearly, pneumonia
-
What is egophony
E turns to A indicates fluid
-
Whispered pectoriloquy
hear whisper distinctly, indicates fluid
-
What is different about infants?
- barrel chested until 6 y/o
- breath through nose mainly until 3 months
- RR 30-40
-
Describe normal lung
- trach- midline
- tactile fremitus- normal
- percussion- resonant
- breath sounds- vesicular except for lg bronchi or tachea
- adventitiou sounds- non
-
Describe Atelectasis
- Trahcea: shifted toward side
- TM : usually absent
- Percussion: dull over affected area
- Breath sounds: absent over obstruction
- Adventitious sounds: none
-
Describe Consolidation-Pneumonia
- trach: midline
- TM: increased over area with fluid
- Percussion: dull over airless areas
- Breath sounds: bronchial over involved area
- Adventitious sounds: crackles over involved area during late inspiration
-
Bronchitis
- Trac: Midline
- TF: Normal
- Percussion: Resonant
- Breath Sounds: Vesicular except over lg bronchi or trach
- Adventitious sounds: may hear crackles or wheezes or rhoncha
-
Emphysema (alveoli are distended so pt cannot get air out
- trach: midline
- TF: Decreased
- Percussion: Hyperressonant
- Breath Sounds: decreased or absent
- Adventitious sounds: none or scatter crackling during early inspirations or sounds associated with bronchitis
-
Ashthma
- Trac: Midline
- TF: Decreased
- Percussion: Resonant to Hyper resonant
- Sounds: wheezes
- Adventitious Sounds: Wheezes
-
Pleural Effusion (too much liquid in pleurae)
- Trach: shifts away from involved side
- TF: Decreased to absent
- Percussion: dull over fluid
- Breath Sounds: decreased to absent over affected area
- Adventitious Sounds: None, except for possible rub
-
Pneumothorax (air leaks out of lung into chest)
- Trach: Shifted away
- TF: decreased or absent over pleural air
- Percussion: hyperressonant over pleural air
- Sounds: decreased to absent over pleural air
- Adventitious sounds: none
-
CHF
- Trach: Midline
- TF: Decreased
- Percussion: Resonant
- Sounds: Vesicular
- Adventitious Sounds: late inspiratory crackles in dependent portion of lung, maybe wheezes
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