Breast

Question 1

What must you do before beginning the examination?

Answer 1

Arrange for a chaperone to be present
Ask the patient whether they have any pain
Position the patient comfortably on the edge of the couch with their arms by their sides

Question 2

What are you looking for on inspection?

Answer 2

Symmetry (in terms of tethering/dimpling of skin, asymmetry is normal otherwise)
Visible masses
Erythema, scaling of the nipple/areolar
Inspect the nipple for retraction (though enquire about duration as may be normal)
Ask patient to raise both arms, hands behind head and push shoulders back - look for tethering as patient does this
Ask patient to put hands on hips and push in - accentuates any lumps tethered to pectoralis muscle

Question 3

How do you prepare the patient for palpation?

Answer 3

Ask the individual to lie down at 45 degrees, large breasted women may want to place their arms over their heads
mentally divide the breast into 4 quadrants - upper inner and outer and lower inner and outer plus the axilla and nipple

Question 4

What is the technique for palpation?

Answer 4

Palpate each area using the pads (not tips) of your fingers
Make small circles as if you were rolling a marble
Increase pressure to examine all layers - subcut tissue, mid-level tissue and tissue adjacent to underlying chest wall

Question 5

How do you palpate the axillary lymph nodes?

Answer 5

Support patients arm and palpate using the same technique
If you discover a lump, describe its size (measure exactly if possible), consistency, shape, mobility of surrounding tissue, tender on palpation? Hot?

Question 6

What else needs to be examined?

Answer 6

Palpate the nipple - discharge?
Supraclavicualr fossa - lymphadenopathy?
Percuss the abdomen for hepatomegaly and vertebral spinous processes for tenderness (if patient has Hx of malignant breast disease