Breast History and Examination

Question 1

How should you prepare a patient for a breast examination?

Answer 1

Introduce yourself + check patient details
Explain the exam and gain consent
Ensure a chaperone is present
Position the patient at 45 degrees
Adequatley expose the patient, provide a blanket to maintain privacy, minimise the area and duration of the exposure.

Question 2

What different positions does the beast need to be inspected in?

Answer 2

Sitting arms be side (aka on top of legs)
Then hands on hips, push inwards
Then arms behind and above head
Ask to lean forward keeping arms behind their head
These varying positions exacerbate any skin dimpling related to an underlying mass

Question 3

What are you looking for when inspecting the breast?

Answer 3

Scars - lumpectomy, mastectomy
Obvious asymmetry - not ehealthy breast are often slightly asymmetrical
Mass - size and position, overlying skin changes
Skin changes
Nipple changes

Question 4

What can different skin changes in the breast indicate?

Answer 4

erythema (infection, superficial malignancy),
puckering/dimpling (underlying malignant mass)
peu’d orange (cuteanous odema inflammatory breast cancer)

Question 5

What can different nipple changes to the breast indicate?

Answer 5

Retraction - congenital, tumour, ductal ectasia
Discharge - infection or malignancy
Rash - eczema, pagets

Question 6

How should you palpate the breast during the breast examination?

Answer 6

Ask patient to indicate the site of the lump
Palpate normal side first - then abnormal
Systematic approach:
A - clock face
B - spiral method - start at nipple and work outwards
Remember to palpate the axillary tail
If patients reports nipple discharge - ask them to squeeze nipple to demonstrate it if happy to do so.
If mass found palpate in detail and assess for fluctuance.
Palpate - supra and infraclavicular lymph nodes and cervical
Palpate the lymph nodes in the axilla

Question 7

How should you describe a breast lump at the end of a clinical examination?

Answer 7

Position - what quadrant/clock position/distance from nipple
Size and shape
Consistency - smooth, firm, stony, rubbery
Skin changes - overlying eryhtmea or puckering
Mobility - freely, more with overlying skin
Fluctuance - fluid filled

Question 8

What does a benign breast lump tend to present as on breast examination?

Answer 8

Firm and rubbery
Painful
regular and smooth
Mobile, not fixed
No skin changes
No nipple changes

Question 9

What does a malignant breast lump tend to present as on breast examination?

Answer 9

Hard
Painless
Irregular
Fixed to skin/chest wall
Dimpling
Nipple retraction.

Question 10

Where does breast cancer commonly metastasise to?

Answer 10

Bones
Liver
Lungs
Brain