Advanced health assessment part 2
correct answers
1. What lung sounds would you expect in an emphysemic patient? - correct-
answers-diminished, distant or absent breath sounds in affected area
2. Differentiate between hyperventilation, orthopnea, dyspnea, tachypnea,
stridor, wheezing and cheyne-stokes breathing, and know the common
conditions that are associated with each symptom. - correct-answers-
Wheezing is a continuous high pitch, musical sound almost a whistle
heard during inspiration or expiration seen in asthma or bronchitis.
Cheyne-stokes breathing a regular periodic pattern of breathing with
intervals of apnea followed by crescendo/decrescendo sequence of
respiration also called periodic breathing seen in children and older
adults during sleep, and in seriously ill patients particularly with brain
damage or drug associated respiratory compromise. Hyperventilation is
breathing faster than 20 breaths per minute can be due to breathing
rapidly (tachypnea), breathing deeply (hyperpnea) or both, seen in
exercise or anxiety. Orthopnea is shortness of breath that begins or
increases when the patient lies down seen in congestive heart failure.
Dyspnea is difficult and labored breathing with shortness of breath and
commonly observed with pulmonary or cardiac compromise, also in
obesity and sedentary lifestyle. Stridor is a high pitch, piercing sound
most often heard during inspiration and is the result of an obstruction
high in respiratory tree and can be seen in epiglottis, congenital defects,
and or croup when accompanied by a cough, hoarseness, or retraction.
3. Know about normal and abnormal voice sounds (egophony,
bronchophony, whispered pictoriloquy), pleural friction rubs, and tactile
fremitus. - correct-answers-Egophony e's becomes stuffy a's, the
intensity of the spoken voice is increased and there is a nasal quality
, with condition that consolidate lung tissue. Bronchophony in the
presence of consolidation, there is greater clarity and increased loudness
of spoken sound. Whispered pectoriloquy a whisper can be heard clearly
and intelligibly through the stethoscope in the presence of consolidation
of the lungs. Pleural friction rub is a palpable coarse grating vibration
usually on inspiration caused by inflammation of the pleural surfaces.
Tactile fremitus is a palpable vibration of the chest wall that result from
speech or verbalization.
4. What are the major risk factors for breast cancer? - correct-answers-1)
Age (75% of all cases occur after age 50.
5. 2) Personal Hx of Breast Cancer or Caner in Situ (DCIS is a precursor of
cancer and increases the risk for invasive breast cancer usually in the
same breast.
6. 3)Previous hx of breast biopsies for non-malignant breast disease.
7. 4) Laboratory evidence of specific genetic mutation (mutation in BRCA 1
or BRCA 2).
8. 5) Personal hx of cancer including ovarian, endometrial, colon, or thyroid
cancers.
9. 6) Family Hx of breast cancer in first-degree relatives (mother, sister or
daughter) OR two or more close relatives
10. How does breast cancer typically present in males and females? -
correct-answers-Male breast cancer is rare and represents 1% of all
breast cancers. It presents as painless, induration, retraction of the
nipple, and an attached mass. As it progresses, it includes
lymphadenopathy and skin and chest wall lesions. Physical findings of
male breast cancer disease include induration, retraction of nipple or
mass in nipple well, masses are fixed and nontender.
11. In females, it occurs most frequently in the upper outer quadrant of
the breast, is a single lump that is hard, nontender and immobile with
borders that are not clearly delineated from the rest of the breast tissue.
They are infrequently painful or tender on palpation. They often increase
, in size and do not come and go. Signs of breast cancer include nipple
inversion, nipple retraction, dimpling of the breast, bloody nipple
discharge and axillary lymphadenopathy. Unilater breast pain in a post-
menopausal woman suggests cancer. On mammogram, a non-palpable
mass or preinvasive lesion associated with macrocalcifications could also
be evidence of a malignant breast mass.
12. What is the significance of nipple inversion, fibrocystic breast disease,
and nipple discharge? - correct-answers-*All three can present s/s of and
suggest breast cancer. However, breast cancer may not exist.
13. Fibrocystic breast disease- fibrocystic breast changes usually occur as
multiple, bilateral painful masses, which frequently intensify
premenstrually during the luteal phase of the menstral cycle. They are
cyclic changes that worsen at the times of menses.
14. Nipple discharge- nipple discharge with inflammation suggests a
breast abscess (Dains pg 68); Nipple discharge with a lump suggests a
ductal cancer (Dains pg 62); unilateral discharge= associated with
intraductal papilloma or cancer (Dains pg 65); Bilateral discharge seldom
represents cancer and are usually caused by hyperprolactinemia or duct
ectasia (Dains pg 65)
15. Nipple discharge is common amoung postmenarchal females and is
related to pregnancy, recent breastfeeding, or estrogenic medications. In
non-lactating women, it is related to intraductal papilloma, duct ectasia
or cancer. Commonly, it is caused by benign lesions than by cancerous
ones. Physiological stimulation and trauma may also produce discharge.
Nipple Inversion- Lifelong inversion either unilateral or bilateral is normal
but a new inversion is suspicious, although normal nipples are everted
and point in like directions.
16. What normal variations may be observed during the breast exam? -
correct-answers-The best way to id an abnormality is to be aware of and
know what is normal. Supernumary nipples are congenital defects and
are normal. It is also normal for breasts to slightly differ in size although
correct answers
1. What lung sounds would you expect in an emphysemic patient? - correct-
answers-diminished, distant or absent breath sounds in affected area
2. Differentiate between hyperventilation, orthopnea, dyspnea, tachypnea,
stridor, wheezing and cheyne-stokes breathing, and know the common
conditions that are associated with each symptom. - correct-answers-
Wheezing is a continuous high pitch, musical sound almost a whistle
heard during inspiration or expiration seen in asthma or bronchitis.
Cheyne-stokes breathing a regular periodic pattern of breathing with
intervals of apnea followed by crescendo/decrescendo sequence of
respiration also called periodic breathing seen in children and older
adults during sleep, and in seriously ill patients particularly with brain
damage or drug associated respiratory compromise. Hyperventilation is
breathing faster than 20 breaths per minute can be due to breathing
rapidly (tachypnea), breathing deeply (hyperpnea) or both, seen in
exercise or anxiety. Orthopnea is shortness of breath that begins or
increases when the patient lies down seen in congestive heart failure.
Dyspnea is difficult and labored breathing with shortness of breath and
commonly observed with pulmonary or cardiac compromise, also in
obesity and sedentary lifestyle. Stridor is a high pitch, piercing sound
most often heard during inspiration and is the result of an obstruction
high in respiratory tree and can be seen in epiglottis, congenital defects,
and or croup when accompanied by a cough, hoarseness, or retraction.
3. Know about normal and abnormal voice sounds (egophony,
bronchophony, whispered pictoriloquy), pleural friction rubs, and tactile
fremitus. - correct-answers-Egophony e's becomes stuffy a's, the
intensity of the spoken voice is increased and there is a nasal quality
, with condition that consolidate lung tissue. Bronchophony in the
presence of consolidation, there is greater clarity and increased loudness
of spoken sound. Whispered pectoriloquy a whisper can be heard clearly
and intelligibly through the stethoscope in the presence of consolidation
of the lungs. Pleural friction rub is a palpable coarse grating vibration
usually on inspiration caused by inflammation of the pleural surfaces.
Tactile fremitus is a palpable vibration of the chest wall that result from
speech or verbalization.
4. What are the major risk factors for breast cancer? - correct-answers-1)
Age (75% of all cases occur after age 50.
5. 2) Personal Hx of Breast Cancer or Caner in Situ (DCIS is a precursor of
cancer and increases the risk for invasive breast cancer usually in the
same breast.
6. 3)Previous hx of breast biopsies for non-malignant breast disease.
7. 4) Laboratory evidence of specific genetic mutation (mutation in BRCA 1
or BRCA 2).
8. 5) Personal hx of cancer including ovarian, endometrial, colon, or thyroid
cancers.
9. 6) Family Hx of breast cancer in first-degree relatives (mother, sister or
daughter) OR two or more close relatives
10. How does breast cancer typically present in males and females? -
correct-answers-Male breast cancer is rare and represents 1% of all
breast cancers. It presents as painless, induration, retraction of the
nipple, and an attached mass. As it progresses, it includes
lymphadenopathy and skin and chest wall lesions. Physical findings of
male breast cancer disease include induration, retraction of nipple or
mass in nipple well, masses are fixed and nontender.
11. In females, it occurs most frequently in the upper outer quadrant of
the breast, is a single lump that is hard, nontender and immobile with
borders that are not clearly delineated from the rest of the breast tissue.
They are infrequently painful or tender on palpation. They often increase
, in size and do not come and go. Signs of breast cancer include nipple
inversion, nipple retraction, dimpling of the breast, bloody nipple
discharge and axillary lymphadenopathy. Unilater breast pain in a post-
menopausal woman suggests cancer. On mammogram, a non-palpable
mass or preinvasive lesion associated with macrocalcifications could also
be evidence of a malignant breast mass.
12. What is the significance of nipple inversion, fibrocystic breast disease,
and nipple discharge? - correct-answers-*All three can present s/s of and
suggest breast cancer. However, breast cancer may not exist.
13. Fibrocystic breast disease- fibrocystic breast changes usually occur as
multiple, bilateral painful masses, which frequently intensify
premenstrually during the luteal phase of the menstral cycle. They are
cyclic changes that worsen at the times of menses.
14. Nipple discharge- nipple discharge with inflammation suggests a
breast abscess (Dains pg 68); Nipple discharge with a lump suggests a
ductal cancer (Dains pg 62); unilateral discharge= associated with
intraductal papilloma or cancer (Dains pg 65); Bilateral discharge seldom
represents cancer and are usually caused by hyperprolactinemia or duct
ectasia (Dains pg 65)
15. Nipple discharge is common amoung postmenarchal females and is
related to pregnancy, recent breastfeeding, or estrogenic medications. In
non-lactating women, it is related to intraductal papilloma, duct ectasia
or cancer. Commonly, it is caused by benign lesions than by cancerous
ones. Physiological stimulation and trauma may also produce discharge.
Nipple Inversion- Lifelong inversion either unilateral or bilateral is normal
but a new inversion is suspicious, although normal nipples are everted
and point in like directions.
16. What normal variations may be observed during the breast exam? -
correct-answers-The best way to id an abnormality is to be aware of and
know what is normal. Supernumary nipples are congenital defects and
are normal. It is also normal for breasts to slightly differ in size although
