Breast Exam

Question 1

inspection

Answer 1

asking the patient to lower the gown and the student should visually inspect the breasts from front and sides

look for : size symmetry (some variation is normal, shape, contour (flattening, masses, and dimpling), skin (color, edema, rashes, thickening, and venous pattern), and scars (previous surgery, injuries).

arm maneuvers: overhead, waist, and leaning forward.
look for any retraction when the patient is leaning forward, or contracting the pectoral muscles.

Question 2

palpation : lymph nodes

Answer 2

cervical nodes: these nodes are found along the sides of the neck.
axillary nodes: patient is seated position using appropriate draping technique. with patient’s arm at side and examiner lifting arm away from side to access nodes
supraclavicular nodes: these nodes are found along the line immediately above the clavicle. this is done by the student stepping around behind the patient.

Question 3

palpation: bimanual while patient sitting

Answer 3

The student should perform bimanual palpation with the patient seated position, using appropriate draping technique
The student should use the right hand above the left hand below to palpate the right breast.
should use the pads of fingertips to compress the breast tissue between fingertips. Using this technique, the student can check for consistency, nodules, masses, and tenderness, which might not be felt in supine breast exam. repeat for left side by standing on patient’s left side and reversing hands. (left on top, right on bottom)

Question 4

Palpation while patient supine

Answer 4

student should pull out footrest and ask the patient to put her arm over head during supine palpation. the arm over head helps to stretch the breast tissue against the chest wall
the student then performs complete palpation of the breasts. Use the flat part of the fingers and a rotary motion, against the chest wall using a radial or spiral pattenr without missing areas, compressing the breast tissue against the chest wall in all quadrants of the breast.

student should be noting tissue consistency, elasticity, nodules, indurations, masses, and tenderness.

student also performs palpation of breast tissue, which continues up the chest wall to the clavicle (collar bone) and towards the axilla (armpit)

the student inspects and palpates the nipples looking for size shape, inversion, rashes, ulceration, discharge, scaling, crusting elasticity, retraction areolar edema or masses. do not squeeze the nipple looking for discharge.