Breast Examination

Question 1

How can you explain what you are going to do?

Answer 1

I will inspect the area and feel for any changes in the breast tissue as well as checking your armpits and neck.

Question 2

Inspect:

You would get them to sit on the edge of a bed.

What 4 things would you first note form inspection?

Answer 2

Size
Shape
Symmetry of breasts
Colour

Question 3

Inspect:

What does dimpling/tethering suggest?

What does peau d’orange suggest? Why does it happen?

What does new nipple inversion suggest?

What does Paget’s disease cause on the breasts?
Is it bi/unilateral?

Answer 3

Skin attached to the tumour

Inflammatory cancer - look up

Due to stromal infiltration, lymphatic obstruction and oedema

Possible ductal cancer

Unilateral red, eczematous lesion of the nipple and areola that may ulcerate and bleed.

Question 4

Inspect:

Hands-on head:
- What do you do this for?

Hands-on hips and push inwards to contract pec major:

• What do you look for?
• If a lump rises, what does it mean?

Answer 4

Allows you to see any tethering taking place - especially in the axilla and nipple inversion

Dimpling or nipple inversion

The lump is above the muscle

Question 5

Palpation:

What do you ask about before palpating?

If there is a lump in one breast, where do you start?

Where should they place their hands?

If the patient has reported some discharge what can you get them to do?

What must you not forget to palpate before moving onto the next side?

Answer 5

Pain

The other breast

One hand behind your head, the other by their side

Express some discharge by squeezing nipple and put it on a glass slide for cytology

Lymph nodes

Question 6

Why may you wish to do a resp exam if you suspect mets?

Answer 6

Pleural effusion