Breast examination

Question 1

What would you check for during the inspection part of a breast exam?

Answer 1

1. Obvious lumps
2. Skin changes
3. Scars from previous surgery (breast AND axilla)
4. Nipples (inversion, discharge, Paget’s disease of the nipple)

Question 2

How would you ask patients to move their arms to get a better view of their breasts?

Answer 2

Hands resting by side
Raising hands over the head
Pushing hands into hips
Pushing hands into bed

Question 3

What skin changes would you look for specifically?

Answer 3

Dimpling

Peau d’orange

Question 4

What common surgeries would you consider when looking for scars?

Answer 4

Mastectomy

Lumpectomy

Question 5

What is nipple inversion a sign of?

Answer 5

Advanced malignant disease

Question 6

What would you say about nipple discharge?

Answer 6

Note colour and blood-staining

Question 7

What is Paget’s disease of the nipple a sign of?

Answer 7

Intraductal carcinoma

Question 8

What would you check for during the palpation part of a breast exam?

Answer 8

“Let me know if there is any discomfort”, and watch their face

1. Assess breasts in turn using a systematic approach (past of three middle fingers)
2. If patient has talked about discharge, ask them to express some
3. Palpate axillary lymph nodes
4. Palpate lymph nodes in head and neck

Question 9

What would you suggest after a breast examination?

Answer 9

1. If lump found: complete triple assessment of breast with fine needle aspiration and imaging
2. If malignancy suspected: perform a full systematic examination to look for evidence of metastatic disease

Question 10

What are benign causes of breast lump?

Answer 10

Fibroadenoma
Breast cyst (painful)
Abscess (hot, swollen and painful breast)

Question 11

What causes breast dimpling?

Answer 11

Intra-mammary tumour can pull on ligament of Astley Cooper and cause dimpling

Raising hands accentuates this