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Vascular supply to the breast is primarily through branches of which two arteries? Thoracoacromial artery and internal mammary artery.

What is thelarche? The onset of secondary breast development. (during puberty).

The upper arm drains into which area of lymph nodes? Begins in the hand and runs upwards in the axillary direction, reaching the cubital nodes.

 what changes occur when axillary lymph nodes are removed. Lymphedema can happen any time after lymph nodes are removed.

The mother of a girl at Tanner stage 2 asks whether her daughter will start menses early. What is the correct response to give this mother? This would be a normal finding to start early. The menstrual cycle normally appears or happens during stage III.

 Name the three methods commonly used for ensuring palpation of the entire breast. Chest wall palpation, lymph node palpation and bimanual digital palpation.

What do retractions and dimpling signify? Dimpling of the breast tissue can be a sign of a serious form of cancer known as inflammatory breast cancer. (i.e.) Carcinoma. Dimpling as a sign of breast cancer tends to occur in only one breast. If dimpling affects both breasts, the person probably does not have breast cancer. 

A patient who is in her first trimester of pregnancy asks you what changes she should expect in her breasts. What information and important instructions should you give to this patient? Surging hormones and a shift in breast structure mean your nipples and breasts may feel sensitive and tender from as early as three or four weeks.

Describe the appearance of the breasts in postmenopausal women. Three is significant change in size and shape. Low level of estrogen makes the breast tissue to begin to become less elastic and dry.

C reate a chart that compares and contrasts the following conditions:

1. Fibrocystic disease
2. Fibroadenoma
3. Malignant breast tumor

• Name the disease of the breast that is a surface manifestation of underlying ductal carcinoma.  Paget’s disease of the breast.   What is the peak incidence of breast malignancy?  During the premenopausal years.      4  Fibrocystic disease 5  Fibroadenoma 6  Malignant breast tumor7  Non-cancerous condition. Occurs in breast. Breast have tendency to feel lumpy. 8  Non-cancerous condition. Occurs in breast. Results in benign tumors, usually found in younger women. (i.e.) 15-35 yrs. 9  Cancerous condition. Occurs in breast. Results in lumps in breast as well as bloody nipple discharge. Change of shape & texture of breast.Explain the kidneys’ role in fluid and electrolyte homeostasis. They help maintain electrolyte concentrations by filtering electrolytes and water from blood, returning some to the blood, and excreting any excess into the urine. Maintains balance.

  How soon after birth bowel sounds should be heard. 1-2 hours after birth.

  What is the function of the alimentary tract? To nourish the body. Ingestion and digestion.
  Which organ plays an important role in the metabolism of carbohydrates, fats, and proteins? The liver.
  Generate a list of relevant data to gather when assessing abdominal pain. Vital signs, location of palpation, tenderness, murphy sign, mcburney and psoas. Assessment and evaluation of present bowel sounds.
  How do you would assess for masses in the abdomen and how they would document such findings. Inspection, auscultation and palpation are the techniques used to locate any masses present. Patient position is supine on the examination table.
  Name the sign that appears as a bluish peri-umbilical discoloration and suggests intra-abdominal bleeding. Cullen’s sign.

  What could a single umbilical artery alert you to in a newborn? Risk of congenital malformations, especially genitourinary malformations and chromosomal anomalies.

  Which type of hernia is common in infants? Umbilical hernias. These hernias are common in newborns and babies younger than 6 months.

   Define Crohn’s disease. Crohn’s disease is an inflammatory bowel disease (IBD). ) It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. 

   If a sudden onset of severe epigastric pain is continuous, unrelieved, and radiating to the groin and back, what problem should be considered? This is a classic sign of a renal calculi.
  MB is a 44-year-old white female patient. She is obese, with a past medical history of hypertension, hyperlipidemia, and diabetes. She admits that she does not exercise. She is being evaluated today for right upper quadrant abdominal pain.
  1- Differentiate between the three types of cholecystitis. Acute cholecystitis is inflammation in the gallbladder which accompanies nausea fever and abdominal pain. Chronic cholecystitis is chronic inflammation in the gallbladder is less severe than AC, less lasting. Acute cholescystitis with formation of renal calculi stone.

  2- Describe the method for palpating the gallbladder. Gently place the palpating hand below the right lower rib margin at the mid-clavicular line and ask the patient to exhale as much as possible. As the patient exhales, slowly push your hand deeper. Then ask the patient to inhale deeply. A positive Murphy sign is the sudden cessation of inspiration with pain

• 3- Differentiate between the common symptoms of cholecystitis pain and the associated symptoms. Severe pain in your upper right or center abdomen. Pain that spreads to your right shoulder or back. Tenderness over your abdomen when it’s touched.
• References
• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidels guide to physical examination (p. 351-415) St. Louis, MI: Elsevier Mosby
   

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