5.2 Assessing Female Breasts and GU System

Question 1

Review of Systems (Breast)

Answer 1

• Skin Changes (rashes, change in texture of breast)
• Swelling (masses, lumps, found on breast)
  HISTORY
• Surgery/Injury to breast tissue
• History of lactation
• Discharge from nipples
• Preform self breast exams
• Preventative appointments for exams and mammograms (x-ray of breast)

Question 2

Inspection of Breast

Answer 2

• Shape/Contour
  (Note retractions, protrusions or nipple inversion)
• Symmetry
  (Should be symmetrical, one may be slightly larger)
  (Nipples should point in same direction)
• Check color/texture of skin while sitting in various positions
  (Hands at sides)
  (Hands above head)
  (Hands on hips)
  (Leaning forward)

Question 3

Palpation of Breast

Answer 3

• Patient should lie down with hand above head to spread breast tissue
• Move vertically up and down breast tissue from middle of sternum out towards axilla
  NOTE
• Breast Size
• Softness vs Firmness
• Tenderness
• Lumps (fixed or mobile)

Question 4

Palpation of Breast (cont)

Answer 4

Nipple discharge expressed?
(Abnormal unless patient has history of lactation)

Document all abnormalities with their location to where they would lie on a face of a clock
(Right Breast 11:00)

Question 5

Self Breast Exam (SBE)

Answer 5

• Controversial as it may induce fear/anxiety.
• Still recommended by providers
• Men should also know how to preform SBE

Question 6

Self Breast Exam (SBE) (cont)

Answer 6

• Should be preformed once a month
  (7 days after start of woman’s period but as long as patient does it same day each month it is ok)
• Preformed once a month because texture of breast tissue changes with change in hormones during menstrual cycle
• Check same position every time noting irregularities, lumps, changes.
  (Changes should be reported to provider)

Question 7

Menstrual Cycle ROS

Answer 7

Date of last menstrual period (LMP)

• Period regular/irregular
• Has patient reached menopause

History of

• Amenorrhea (absence of menstruations)
• Menorrhagia (menstrual bleeding lasting more than 3 days)

Question 8

Pelvic/Vaginal/Urinary ROS

Answer 8

History

• Pelvic Pain
• Vaginal Irritation/discharge/odor
• Vulvar irritation

Other urinary symtoms

Question 9

Sexual Activity ROS

Answer 9

• Is the patient sexually active
  (Has there been instances of sexual assault)
• History of STI’s
• Patient self care habits
  (Does patient use contraceptives)
  (Does patient douche - wash inside vagina)
• History of female genital mutilation (circumcision)

Question 10

Physical Inspection

Answer 10

• Ensure privacy
• Ensure there is chaperone in the room during the exam
• Place position in lithotomy position

Question 11

Inspection

Answer 11

Skin and hair distribution in genital area
(Note Tanner Stage - Sexual Maturity Rating)

External Structures
(Evidence of Prolapse)

Question 12

Palpation

Answer 12

• Palpate Urethra and Skene’s Glands
• Tone of Pelvic Musculature
  (Ask about Kegel Exercises)

Question 13

Speculum Exam

Answer 13

Used to inspect vagina and cervix
- Pathology and Cytology samples are collected
(Papanicolaou Smear - Pap Smear)

Testing for STI’s are also done

• Human Papillomavirus (HPV)
• Gonorrhea
• Chlamydia

Bi-manual approach at the end to palpate internal organs like uterus and ovaries