Breast Exam Flashcards
How are the breasts divided?
- To describe your findings, divide the breast into four quadrants
A. Horizontal and vertical lines crossing the nipple
B. Note that the axillary tail of breast tissue extends into the anterior axillary fold - As an alternative method, localize findings as the time on the face of a clock and distance in centimeters from the nipple
What are common cc?
- Breast pain/tenderness
- Breast mass
- Nipple changes
A. Retraction, ulceration, scaling - Nipple discharge
A. Spontaneous, upon compression - Change in skin of breast
A. Color, induration - Change in size of breast
What questions about breasts need to be asked?
Do you examine your breasts? How often?
Do you have discomfort, pain, or lumps?
Do you have discharge from the nipple? When does it occur?
During the menstrual cycle, do you examine your breasts?
5-7 days after onset of menses is the ideal time
What pt education needs to be discussed?
Assessing risk of breast cancer
Screening measures: self breast exam, clinical breast exam, and mammography
How to do self breast exam
Concerns about palpable masses of the breast
What is the order of a female breast exam?
Inspection Palpation Breast Nipple Axillae
What technques are used in a breast exam?
Use a systematic and thorough search pattern
Use finger pads
Vary palpation pressures
Use a circular motion
What needs to be inspection on the female breast exam?
- Inspect the breasts with the patient in sitting position and disrobed to the waist
- Look for skin changes (color, thickening, and unusually prominent pores), size and symmetry, contour, characteristics of the nipples (size, shape, direction in which they point, rashes, ulceration, and discharge)
- Ask the patient to raise her arms above her head or press them against the hips as this can bring out dimpling or retraction
What four views are indicated for the inspection of the female breast?
arms at sides, arms over head, arms pressed against hips, and leaning forward
What is included in the palpation of the female breast exam?
- Place the patient in the supine position
- Palpate a rectangular area from clavicle to inframammary fold and midsternal line to posterior axillary line and into axilla for the tail of the breast
- Thorough examination takes 3 minutes per breast
- Use finger pads of the 2nd, 3rd, and 4th fingers
- Use the vertical strip pattern (best validated technique)
- Palpate in small, concentric circles
A. Apply light, medium, and deep pressure - Examine the entire breast, including periphery, tail, and axilla
- Lateral portion of breast
A. Ask the patient to roll onto the opposite hip, hand on forehead with shoulder pressed against exam table. This flattens lateral breast tissue - Medial portion of breast
A. Ask the patient to lie with shoulders flat against the exam table; place her hand at her neck and lift up her elbow until it is even with her shoulder
When palpating, what is the breast tissue examined for?
- Consistency of tissues
- Tenderness
- Nodules
Location
Size
Shape
Consistency
Delimitation
Tenderness
Mobility
How are the nipples examined?
Palpate each nipple
Note elasticity
What findings are consistent with malignancies?
Hard consistency Irregular shape Dimpling of overlying skin Associated retraction of nipple Non-tender
How is the male breast examined?
Inspect the nipple and areola for nodules, swelling, ulceration
Palpate the areola and breast tissue for nodules
What do you do if the male breast is enlarged?
Distinguish between soft, fatty enlargement of obesity and the firm disc of glandular enlargement (gynecomastia)
How is the axillae inspected?
1. Have patient in a sitting position (or laying down) Inspection Rash Infection Unusual pigmentation
