breast and rectal examination Flashcards
What are common presentations for breast problems?
Lumps
Discharge
Skin tethering and colour change
Pain
Do you need a chaperone for breast examination?
Yes state that you would do this
What should you ask the patient at the start?
If they have any pain, lumps or swelling and in which breast
On inspection what are you looking for?
Asymmetry Skin change Swelling Scars Nipple changes
What are the skin changes you are looking for?
Erythema –infection / superficial malignancy
Puckering –may indicateanunderlying malignant mass
Peaud’orange–cutaneous oedema– inflammatory breast cancer
What are the nipple changes you are looking for?
Retraction –congenital /underlying tumour / ductal ectasia
Discharge –may indicate infection or malignancy
Scale–may indicate Eczema or Paget’s disease
What is Peau D’orange skin?
It is inflammatory breast cancer
The cancer cells do not form tumour but instead block the lymphatic vessels,
Fluid accumulates and the breast looks inflamed
What two movements should you ask the patient to do when inspecting?
Hand behind head
Then on hip, then lean forwrad
What are you looking for when hands by head?
Masses
Asymmetry
Dimpling / puckering
If you see a mass when hands are on hip what should you do?
Ask them to move pectorals muscle and see if the mass moves. This is known as tethering and sign of invasive malignancy
Why do you ask the patient to lean forward when hands by hip?
This will exacerbate any skin dimpling or puckering related to underlining mass
What are you suppose to palpate?
4 quadrants of breat Sub nippler area use back of hand Axillary tail Axillia Supra claviular fossa Sternal angle Then can do rest of lymph
Do you palpate the breast with lump/pain first or second?
Second
In what area of the breast does breast cancer normally develop in?
Upper outer quadrant
How do you summarise a mass/lump you have found?
Position Size and shape Consistency Mobility Over lining skin changes Fluctuance
What do you say in terms of position of the mass?
What quadrant it is in.
Related to clock face
How far it is from the nipple
How can you describe the consistency of a mass?
Smooth, lumpy, rubbery, firm, stony
Which type of breast lump commonly is mobile?
Fibroadenoma
What is a very common breast lump in under 30 females?
Fibroadenoma
Commonly is mobile and moves away from the hand
When testing for fluctuance what would positive test indicate?
Fluid filled cyst once you apple pressure using both hands
What does yellow/green nipple discharge indicate?
Infection
What does blood discharge of nipple indicate?
Malignancy–> papilloma
Is fibroadenoma cancerous?
No it is a solid noncancerous breast tumour
Describe the structure of a fibroadenoma?
Firm, smooth, rubbery or hard with a defined edges
What is the difference between eczema of the breast and paget disease of breast?
Paget disease of breast include the nippls
What does paget disease of breast indicate?
Ductal carcinoma
Why would you do a rectal examination?
GI disturbances
Assessment of the male prostate gland or female cervix
The examination of the acute abdomen
What would you comment on in inspection of the buttocks?
Polypse Warts Worms Haemorrhages Fissures Prolapse Carcinoma Discharge
What conditions would be contradiction to you doing a rectal examination?
3rd degree heart block
Autonomic dysreflexia
Excessive bleeding
Patient has fistulae
When first entering the patient what should you assess?
Ask the patient to bear down to assess sphincter tone
