Breast examination Flashcards
Describe the step-by-step approach to the breast examination.
- Inspection (6 positions)
- Palpation of breast
- Axillary and cervical lymph node examination
Assume you have to perform lymph node examination but the examiner may tell you to assume done.
Describe the inspection step of the breast examination.
With the patient sitting on the side of the bed ask them to place their hands on their thighs to relax the pectoral muscles. Inspect the breasts looking for:
- Scars
- Asymmetry
- Masses
- Nipple abnormalities
- Skin changes
Repeat inspection with the patient pressing their hands into their hips to contract the pectoralis muscles.
Finally, complete your inspection by asking the patient to place their hands behind their head and lean forward so that the breasts are pendulous.
This position exposes the entire breast and will exaggerate any asymmetry, skin dimpling or puckering.
Describe the palpation step of the breast examination.
Patient should be lying down. Begin palpation on the asymptomatic breast first and then repeat all examination steps on the contralateral breast. Ask the patient to place the hand on the side being examined behind their head to fully expose the breast.
Spiral method: begin palpation at the nipple and work outwards in a concentric circular motion.
The axillary tail is a projection of breast tissue that begins in the upper outer quadrant of the breast and extends into the axilla. The majority of breast cancers develop in the upper outer quadrant so it’s essential this area is examined thoroughly.
If a mass is detected, assess the following characteristics:
* Location
* Size
* Shape
* Consistency
* Mobility
* Fluctuance
* Overlying skin changes
Use the flats of your middle three fingers to compress the areolar tissue towards the nipple as you inspect for any nipple discharge.
If there is a history of nipple discharge, but none is visible, ask the patient to attempt to express discharge from the nipple (if they are comfortable to do so) and assess the characteristics of the discharge:
- Colour (e.g. blood-stained, green, yellow)
- Consistency (e.g. thick, watery)
- Volume
Describe the palpation step of the lymph nodes for breast examination.
Ensure the patient is positioned lying down.
Ask if the patient has any pain in either shoulder before moving the arm.
- Begin by inspecting each axilla for evidence of scars, masses, or skin changes.
- When examining the right axilla, hold the patient’s right forearm in your right hand and instruct them to relax it completely, allowing you to support the weight. This allows the axillary muscles to relax.
- Palpation should then be performed with the left hand. The reverse is applied when examining the left axilla.
- Examination of axilla should cover the pectoral (anterior), central (medial), subscapular (posterior), humoral (lateral), and apical groups of lymph nodes. An example of a systematic routine you could follow is listed below:
- Repeat assessment on the contralateral axilla.
Examine the following groups of lymph nodes:
- Cervical lymph nodes
- Supraclavicular lymph nodes
- Infraclavicular lymph nodes
- Parasternal lymph nodes
