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92 Cards in this Set
- Front
- Back
Borders of the brease?
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2nd or 3rd rib to 6th or 7th rib from sternal edge to anterior axillary line.
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Common site of the breast for malignant neoplasia?
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Upper outer quadrant
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What is the tail of spence?
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Tissue from upper outer quadrant that extends into axilla. Thicker than other breast areas.
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Number of lobes of the female breast?
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15-25
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Components of glandular tissue of the female breast?
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15-25 lobes --> excretory duct --> milk sinus/ nipple
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Components of the female breast?
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Glandular tissue, fibrous tissue, ducts, subcu and retromammary fat, supporting muscle tissue, blood vessels, nerves, lymphatics, areola, nipple
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What is the areola skin like?
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Deeply pigmented, occasional hair follicles and sebaceous glands
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What are montgomery tubercles?**
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Areolar glands around the nipple
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What are Cooper's ligaments?**
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Suspensory structures of the female breast
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Male breast components?
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Nipple, areola, thin layer of breast tissue
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Muscles of the breast? (7)
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Pectoralis major
Pectoralis minor Serratus anterior Latissimus dorsi Supscapularis External oblique Rectus abdominus |
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Blood supply of the breast (2)**
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Internal mammary artery**
Lateral thoracic artery |
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Lymphatic drainage of the breast? (6)**
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Axillary nodes (central and lateral)**,
Supclavicular Supraclavicular Internal mammary Pectoral Subscapular (posterior) |
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Where might you find supernumerary nipples or breast tissue?**
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Along mammary ridge (milk line) that extends from axilla during embryonic development to inguinal region
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How common are accessory breast or nipples?
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2% of white women
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Most common site for accessory breast structures?** Unilateral or bilateral?
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Axilla.**
Bilateral |
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What is the significance of accessory breast structures (i.e. extra nipple)?*
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Little clinical significance; no physiologic function; rarely assoc w/ dz*
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What is the term for breast development?
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Thelarche
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Average time from appearance of breast buds (Tanner stage II) to menarche?
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2 years
Breasts develop at diff rates |
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Lactiferous duct changes during pregnancy?
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Duct proliferation; alveoli increase in size and number leading to breast enlargment
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Change in breast tissue during pregnancy?
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Breasts become softer and looser from incerase in glandular tissue, displacing connective tissue
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Changes in areolae and nipples during pregnancy?
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Areolae more deeply pigmented and increase in dm,
Nipples more prominent, darker and more erectile, Montgomery tubercles develop from sebaceous gland hypertrophy, Colostrum produced near end of preg and stored in alveoli (acini cells) |
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What changes to mammary vascularization during pregnancy?
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Increases.
Engorgement of veins --> "blue" color to skin |
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What is colostrum?
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Secreted from breasts for first few days post delivery.
Has antibodies, more protein and minerals than milk. |
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When does milk replace colostrum?
Changes in breast once milk production begins? |
2-4 days post delivery (increased prolactin, decreasing estrogen and stimulation by sucking)
Breasts become full and tense. Decreased size to pre-lactation size over 3 months post stopping lactation. |
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Breast changes in older adults?
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Tissue: atrophy of glandular tiss and replacement of fat at menopause.
Thickening of inframammary ridge at lower edge of breast. Nipples: smaller, flatter, lose erectile ability. Skin: dry, thin, loss of axillary hair |
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Neuroendocrine control of breasts:
Milk production? Milk let down? |
Production: Prolactin
"Let down" - allows milk to be excreted: Oxytocin |
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What are some signs to ask about in hx that could be suggestive of malignancy?**
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Nipple discharge*
Nipple inversion* Skin changes* |
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Is nipple discharge common?**
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No!*
Think cancer |
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3 types of breast discharge?**
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Serous, bloody, milky
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**What does serous breast discharge look like?
Causes? |
Thin, watery, yellowish stain on bra.
Causes: intraductal papilloma, OCPs, breast cancer |
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**Causes of bloody breast discharge?
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Non-malignant intraductal papilloma, malignant intraductal papillary carcinoma
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**Causes of milky discharge?
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Lactation (or just after stopping), pituitary tumor (prolactinoma), meds, mechanical stimulation or sucking
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What is a major skin change in the breast? What should you consider?**
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Peau d'orange - prominant pores (lymphatic obstruction); like skin of orange peel.
Think BREAST CANCER!!*** Other changes: dimpling, puckering, scaliness |
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How should you examine the breast?*
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Divide into 5 segments: 4 quadrants and tail. When examining, refer to "clock" position.
The tail of spence is an extension of upper outer quadrant |
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What are you inspecting generally about the breast?
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Size, shape, symmetry, contour, color, edema, venous patterns, lesions
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What are you inspecting about the nipple?
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Size, shape, symmetry, color, texture, contour, inversion, eversion, discharge
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5 D's of nipple and areola?
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Discharge, Depression (inversion), Discoloration, Dermatologic changes, Deviation
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2 possible causes of erythema of the breast?
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Infection, inflammatory carcinoma
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Possible cause of dimpling of the breast?
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"retraction phenomena" - malignancy.
Abnormal traction on Coopers ligaments. May have congenitally inverted nipples. |
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What side of patient should you be on to examine the breasts?
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Right side
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What should normal breast tissue feel like?
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Dense, firm, elastic and may be lobular.
Inframammary ridge can be felt along the lower edge of the breast. May feel fibrocystic changes. |
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6 components of describing the findings of a mass in the breast?**
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Size of mass, shape of mass, borders of mass, consistency of mass, mobility, tenderness
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What would mobility of a mass in the breast tell you?
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Cancers are usually fixed. Benign tumors and cysts are freely mobile.
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What is the subareolar area?
Why are you palpating this area for? |
Area directly under areola. Breast tissue is less dense.
Abscess of MOntgomery's glands: tender subareolar mass. |
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What are you examining the nipple for?
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Retraction, fissures, scaling,
**discharge: note character, amount |
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Should men have breast exams?**
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**Yes, should be performed on all men. Inspect both breasts.
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What are you inspecting about the male breast?
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Size, shape, symmetry, surface characteristics
Nipples: swelling, discharge, ulceration |
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What are you palpating in the male breast?
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Should have thin layer of fatty tissue over muscle. May look like breast enlargement in obese men. May have firm disk of glandular tissue.
Areola and subareolar tissue for masses. Axillary lymph nodes. |
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4 types of nipple discharge in males?
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Serous, bloody, milky, purulent
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Characteristics of gynecomastia?
Causes? |
Smooth, firm, mobile, tender breast tissue behind areola. Unilat or bilat.
Causes: age, drugs, ETOH, hormones |
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Average age of dx of breast cancer in men?
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59
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Most common symptom of carcinoma of breast in men?***
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PAINLESS, firm, subareolar mass or mass in UOQ.
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Metastatic sites from breast? (5)
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Bone,
Lung, Pleura, Lymph nodes, Skin |
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Characteristics of carcinoma of breast in women?
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Usually unilateral.
Single mass. Irregular shape, hard, stonelike, fixed. Often retraction signs. Usually non-tender. Poorly delineated. No change w/ menses. |
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Associated physical findings in carcinoma of breast in women?
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Mass or thickening of breast,
Marked asymmetry, Prominent unilateral veins, Discolorations (erythema, ecchymosis), Peau d' orange, ulerations, dimpling, puckering, retraction of skin or areola. fixed inversion or deviation of nipple, crusting or erosion of nipple or areola. |
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Non modifiable risk factors for breast cancer in women? (7)
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Advanced age,
Female, Fam hx breast cancer, Increased breast density, Genetics, Menarche before 12 yo Natural menopause after age 45 |
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Modifiable risk factors for breast cancer in women? (5)
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Hormone therapy,
Pregnancy, ETOH, Behavioral/ lifestyle, Non-hormonal meds |
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Possible risk factors for breast cancer in women, but unknown?
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Diet, smoking, aspirin, NSAIDs
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5 things that are do not effect risk of breast cancer in women?
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Dietary fat,
Caffeine, Miscarriage and induced abortions, Abx, Hormonal contraception? |
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What is Fibrocystic Breast Disease?
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Age 20-49.
Bilateral, single or multiple masses, round soft or firm, mobile. Usually tender and well delineated. No retraction signs. Vary w/ menses. |
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What are fibroadenomas?
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"mouse tumor" Age 15-55. Bilateral. Single or multiple mass. Round or discoid, firm or rubbery, mobile. Usually nontender. No retraction signs. Well delineated. No change w/ menses.
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What is galactorrhea?
Causes? |
Lactation not assoc w/ child-bearing.
MCC: drugs (TCA, phenothiazine, estrogen). Also, tumors (prolactinoma), hypothyroidism, Cushings. |
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What are retention cysts?
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Inflammation of sebaceous glands in areola. Tender and suppurative.
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What is Pagets disease?
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Ductal carcinoma of skin of breast. Red scaling, crusty patch on nipple, areola. Looks like eczematous. Usually unilateral.
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What is fat necrosis of the breast?
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Local injury of the breast. Firm irregular mass. Often discolored.
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What tissues have lymphatics?**
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Every tissue supplied by blood vessels.
Except placenta and brain. |
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What is the drainage of lymph on right side of body and left side of body?**
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**Right upper body drains lymph through lymphatic trunk that empties into right subclavian vein.
Thoracic duct drains everything else into subclavian vein. |
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Drainage of lymph fluid from circulation?
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Closed but porous circulation.
Moves from bloodstream to interstitial spaces. Collected by tubules/ ducts. Carried to lymph nodes. Moved to venous system. |
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T cells vs B cells?**
Primary function of lymphs?** |
T cells: cellular type immunity.
B cells: humoral-type immunity Function: fighting chronic bacterial infections and acute viral infections. |
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Tissue layers location of superficial vs deep lymph nodes?
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Superficial: subcu connective tissue.
Deep: fascia of muscle w/in body cavities. |
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Location of thymus?
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Superior mediastinum
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Spleen: white pulp? red pulp?
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White pulp: lymphatic nodules and tissues.
Red pulp: venous sinusoids. Site of hematopoiesis in utero. |
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What are peyer patches?
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Small, raised areas of lymph tissue on mucosa of small intestine. Consist of many clustered lymphoid nodules.
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Function of lymphatic tissue? (6)
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Movement of lymph fluid,
Production of lymphs, Ab production, Phagocytosis, Fat absorption from GI tract, Extra medullary hematopoiesis |
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At what gestational age do immune system and lymphoid system begin development?
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20 weeks
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Are palantine tonsils larger in children or adults?
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Children. Doesn't always mean problem. Most lymph tissue larger in children.
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What are Virchow's nodes?**
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Supraclavicular; "sentinel node"
Not usually found/ palpated. Presence associated w/ high incidence of malignancy (G( and breast) - cause for concern! |
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Changes to lymph tissue in older adults?
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Decrease in number and size in older adults.
May become fibrotic and fatty which contributes to impaired ability to resist infection. |
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Regions to examine for lymph nodes?
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Cervical (anterior and posterior),
Supraclavicular, Axillae, Epitrochlear (above elbow), Inguinal, Popliteal |
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What are you inspecting lymph node areas for? (4)
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Edema,
Erythema, Red streaks, Skin lesions |
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What are you palpating lymph nodes for? (6)***
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Enlargement,
Consistency, Mobility (note any that are FIXED!!!), Tenderness, Size, Warmth |
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What are "shotty" nodes?**
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Small, movable, discrete nodes <1cm that move under the fingers
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What are "matted" nodes?**
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Enlarged, juxtaposed, feel like large mass
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Relationship of hardness of lymph node to malignancy?
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The harder the node, the more likely malignancy
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What is acute lymphangitis?
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Inflammation of 1 or more lymph vessels.
Pain, malaise, not feeling well, +/- fever. PE: red streak, slightly indurated and palpable to touch. Look distal for sites of infection. |
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What is acute suppurative lymphadenitis?
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MCC: group A strep or staph.
Firm, tender node. W/in 72 hrs, swelling, erythema. Mycobacterial lymphadenitis, caused by TB (inflammation w/out warmth, +/- tenderness). "Cat scratch fever" Cat scratch. Cat or dog bite --> pasturella multocida. |
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What is mono-like syndrome?
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Adolescents usually. Pharyngitis, fever, fatigue, malaise.
Splenomegaly, hepatometaly, rash. Anterior and posterior cervical nodes. May be tender. Causes: EBV, CMV, adenovirus, varicella, enterovirus |
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What is Roseola Infantum?
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Common childhood illness. Peak age 2. Herpes virus 6.
High grade fever 3-4 days. Sometimes assoc w/ URI and lymphadenopathy. Involved nodes: discrete and not tender in occipital and post-auricular area. Morbilliform, maculopapular rash trunk to extremities. Tx: sx. No aspirin! |
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What is Cat Scratch Fever?
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MCC: Bartonella henselae. Papule or pustule 3-5 days, then vesicular and crusts in 2 -3 days. Lymphadenopathy in 1 -2 weeks in region that drains primary lesion. Single lymph node most common, but can be multiple. Lymphadenopathy can last 2-4 months
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Hodgkins Lymphoma?
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Malignant. Young kids, late adolescence, young adults. Males > females. Variable presentation, but common: painless enlargement of cervical nodes. Often posterior. Usually asymmetric. Nodes may be matted and firm.
Tx: chemo/ radiation. Curable |
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Non-Hodgkins?
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Malignant. Nodes of chest, neck, abdomen. B-cell most.
Painless, enlarged nodes, fever, weight loss, night sweats, abd pain, fullness. Nodes solid, well defined. May become matted. |