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Questions and Answers
What should be evaluated during the inspection of the head, face, and neck?
Which of the following describes the correct method to assess the trachea?
Which neck range of motion movement involves tilting the head to one side?
What is an expected finding when assessing the strength of neck muscles?
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Which lymph nodes are located in the neck region for inspection during an assessment?
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Which respiratory condition is characterized by a rate of less than 10 breaths per minute?
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What thoracic cage shape is described as an exaggerated posterior curvature of the thoracic spine?
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What type of breath sound is described as having a louder inspiration compared to expiration and is typically heard in peripheral lung fields?
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Which percussion note is expected over healthy lung tissue?
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What technique is recommended to promote accurate auscultation of breath sounds?
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What is the characteristic sound described as a coarse and low-pitched, grating quality that can be heard during both inspiration and expiration?
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In which condition is an irregular shallow breathing pattern observed?
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Which of the following best describes bronchial breath sounds?
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Which of the following is a non-modifiable risk factor for breast cancer?
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What type of wheezing is characterized by high-pitched sounds and is primarily observed in expiration?
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What is a recommended preparation tip before a mammogram?
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Where is the heart and great vessels located in the thoracic cage?
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Which symptom is NOT typically associated with subjective data for breast health?
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Which of the following observations should be noted during the initial inspection of breasts?
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During which phase of the cardiac cycle do the atrioventricular valves remain open and the ventricles are passively filled with blood?
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What is the primary function of breast exams?
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Which event marks the beginning of systole in the cardiac cycle?
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What sound is created when the semilunar valves close?
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During a clinical breast exam, which position is recommended for the client first?
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What occurs during the ventricular isovolumetric contraction phase?
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What is an important factor to consider in the preparation for a clinical breast exam (CBE)?
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Which of the following could indicate an abnormal finding during a breast exam?
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Which of the following describes the blood flow starting from the body to the right atrium?
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What is the main action occurring during the pre systole phase of the cardiac cycle?
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What is the primary benefit of the bimanual palpation technique?
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Which strategy is recommended for effective education on self-breast exams?
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What characteristic should be observed in a lump or mass during breast examination?
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Which of the following is NOT a recommended health promotion strategy for optimal breast health?
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For which condition is the concentric circles pattern of palpation primarily recommended?
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What position should a client be in for effective bimanual palpation?
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What should a woman do during a self-breast exam while in the shower?
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Which question is pertinent to assess a patient's head, face, and neck health history?
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Study Notes
Respiratory Assessment
- Bradypnea: Respiratory rate less than 10 breaths per minute.
- Hyperventilation: Increased rate and depth of breaths.
- Hypoventilation: Irregular, shallow breathing.
- Cheyne-Stokes: Increasing rate and depth followed by decreasing, alternating cycle.
- Chronic Obstructive Breathing: Normal inspiration and prolonged expiration.
Thoracic Cage Shapes
- Normal Adult Thorax: Elliptical shape with an anteroposterior to transverse diameter ratio of 1:2.
- Kyphosis: Exaggerated posterior curvature of the thoracic spine, resulting in a humpback.
- Scoliosis: Lateral S-shaped curvature of the thoracic and lumbar spine, leading to unequal shoulder and scapular height, and unequal hip levels.
Percussion Notes
- Resonance: Low-pitched, clear, hollow sound indicating healthy lung tissue.
- Flat: Sound over muscles or bones.
- Dullness: Sound over organs.
Auscultation Strategies
- Ensure the patient is relaxed, leaning forward slightly in a sitting position, or lying on their side.
- Listen to at least one full respiration (inhalation and exhalation) in each location.
- Perform side-to-side comparisons, moving the stethoscope from side to side and then down.
- Begin auscultation over large airways in the anterior chest.
Breath Sounds
- Bronchial: Heard over the trachea and larynx. Expiration is longer than inspiration and is not heard posteriorly.
- Bronchovesicular: Heard over the main bronchi. Inspiration and expiration are approximately equal.
- Vesicular: Heard over peripheral lung fields. Inspiration is louder and longer than expiration.
Adventitious Breath Sounds
- Crackles: Discontinuous popping sounds heard during inspiration due to fluid in the lungs.
- Pleural Friction Rub: Coarse and low-pitched, grating quality sound on inspiration and expiration, indicating roughened pleural surfaces.
- Wheezing: High-pitched wheezing prominent during exhalation (airway obstruction, like acute asthma or chronic emphysema). Low-pitched wheezing prominent during exhalation (bronchitis).
- Stridor: High-pitched inspiratory crowing sound louder in the neck than over the chest wall (airway obstruction).
Heart and Great Vessels
- Location: The heart and great vessels are situated between the lungs in the middle third of the thoracic cage, known as the mediastinum.
Blood Flow
- Systemic Circulation: Body --> Superior and Inferior Vena Cava --> Right Atrium --> Tricuspid Valve --> Right Ventricle --> Pulmonic Valve --> Pulmonary Arteries --> Lungs --> Pulmonary Veins --> Left Atrium --> Mitral Valve --> Left Ventricle --> Aortic Valve --> Aorta --> Body
Cardiac Cycle
- Protodiastolic Phase: All chambers are relaxed. Blood passively fills ventricles. AV valves are open, semilunar valves are closed.
- Presystole Phase: Atria contract, actively filling ventricles. AV valves are open, semilunar valves are closed.
- Systole: Ventricular pressure exceeds atrial pressure, closing AV valves (S1 sound).
- Ventricular Isovolumetric Contraction: All four valves are closed. Ventricle contracts and pressure rises.
- Ejection: Semilunar valves open. Blood ejected from ventricles (aortic or pulmonary).
- Semilunar Valve Closure: Semilunar valves close (S2 sound), marking the end of systole.
- Diastole: All four valves are closed. Ventricular relaxation, isometric relaxation. Atria fill with blood. AV valves open, restarting the cycle.
Breast Assessment
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Subjective Data:
- Pain
- Lump
- Discharge
- Rash
- Swelling
- Trauma
- History of breast disease
- Surgery or radiation
- Medications
- Client-centered concerns
Breast Cancer Risk Factors
- Non-modifiable: Age, biopsy-confirmed atypical cell growth, certain genetic mutations, mammographically dense breasts, personal history of early onset breast cancer, two or more first-degree relatives with breast cancer, high endogenous estrogen or testosterone levels, high-dose radiation to the chest, Ashkenazi Jewish heritage, early menarche, height, no full-term pregnancies.
- Modifiable: Alcohol consumption, late age at first full-term pregnancy, late menopause, personal history of endometrial, ovarian, or colon cancer, never breastfed a child, obesity, recent and long-term use of menopausal hormone therapy, recent oral contraceptive use.
Mammograms
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Importance: Reveal cancers too small for physical examination, potentially enabling curable early detection.
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Preparation:
- No deodorant, cream, lotions, or powders on underarms or breasts.
- Schedule during the time of month when breasts are not tender.
- Bring past mammogram films.
- Avoid excessive caffeine.
- Provide family breast health history.
- Inform providers of any problems.
- Bring a list of breast treatment dates and locations.
Clinical Breast Exam (CBE)
- Preparation: Have necessary equipment, including a small pillow, ruler (centimeters), short gown, teaching aid or pamphlet.
Inspection
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Positions:
- Arms at sides, turn side-to-side (symmetry).
- Arms lifted slowly overhead (symmetrical movement).
- Hands on hips, palms together (slight breast uplift).
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Key Observations:
- Symmetry
- Skin changes (color, dimpling, discoloration)
- Nipple appearance (inversion, discharge, size, direction)
Palpation
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Techniques:
- Vertical Strip Pattern: Axillary area to bra line, medially in overlapping vertical lines.
- Wedge Technique: Nipple to axillary area, like spokes on a wheel.
- Concentric Circles Pattern: Nipple to axillary area, circular pattern.
- Bimanual Technique: One hand supporting the breast, the other palpating against it.
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Bimanual Palpation: Effective for pendulous breasts, with client seated and leaning forward.
Lump/Mass Characteristics
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Documentation:
- Location
- Size
- Shape
- Consistency
- Mobility
- Distinctness
- Skin over lump
- Tenderness
- Lymphadenopathy
Self-Breast Exam (SBE)
- Best timing: Right after menstrual period (days 4-7).
- Non-menstruating: Choose a familiar date as a reminder.
- Mirror Inspection: Look for size, shape, dimpling, discharge, and contour.
- Shower Palpation: Soap and water assist with palpation.
Male Breast Exam
- Inspection: Examine chest wall for skin changes, lumps, and swelling.
- Palpation: Palpate nipple area for lumps, enlargement, or tissue changes.
- Normal: Smooth, even tissue with no nodules.
- Discharge: Rare.
Breast Health Promotion
- Maintain a healthy weight.
- Take vitamin D supplements.
- Limit alcohol intake.
- Moderate exercise (30 minutes, 5 times weekly).
- Avoid tobacco and secondhand smoke.
- Manage stress and prioritize adequate sleep.
Head, Face, and Neck Assessment
Health History
-
Questions:
- Unusually frequent or severe headaches (location, duration, associated symptoms, precipitating factors, medications, family history).
- Head injuries (recent or past, details of event, dizziness).
- Neck pain (onset, location, numbness or tingling in arms/shoulders/hands).
- Recent infections.
- Lumps or swelling changes.
- Smoking or chewing tobacco.
- Alcohol consumption.
- Diagnoses of thyroid issues.
- Neck or head surgery history.
Inspection and Palpation Observations
- Head: Skull size and shape (normocephalic, microcephaly, macrocephaly).
- Face: Facial expression, symmetry, abnormalities.
- Neck: Head centered midline, symmetric accessory neck muscles.
Neck Assessments
- Trachea: Observe for midline movement during swallowing.
- Range of Motion (ROM): Smooth, controlled flexion, extension, rotation, and lateral bending.
- Muscle Strength: Shrug shoulders and perform ROM against resistance.
Regional Lymph Nodes
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Location:
- Preauricular
- Posterior auricular
- Occipital
- Submental
- Submandibular
- Jugulogastric
- Superficial cervical
- Deep cervical
- Posterior cervical
- Supraclavicular
Carotid Pulse, Trachea, and Lymph Node Assessment
- Carotid Pulse: Assess with gentle palpation, one side at a time.
- Trachea: Palpate for location, deviation, and mobility during swallowing.
- Lymph Nodes: Palpate gently using a circular motion in each region. Note size, shape, consistency, mobility, tenderness, and any signs of inflammation.
Expected Findings
- Healthy Head, Face, and Neck:
- Normocephalic head, symmetric facial features, and a midline, non-deviating trachea.
- Smooth, controlled ROM in the neck.
- Palpable, non-tender lymph nodes (less than 0.5 cm in diameter).
Head and Neck Health Promotion
- Encourage regular dental check-ups and oral hygiene practices to prevent infections and maintain oral health.
- Advise against smoking and excessive alcohol consumption as risk factors for oral cancer.
- Emphasize the importance of wearing helmets during activities with a risk of head injury.
- Encourage early intervention for any unusual symptoms or concerns.
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Description
Test your knowledge on respiratory assessment techniques, including definitions of bradypnea, hyperventilation, and thoracic cage shapes. This quiz will also evaluate your understanding of percussion notes and auscultation strategies. Perfect for medical students and health professionals!
