Clinical/Comm Skills - Week 7 - Breast Examination

Question 1

Before taking a breast examination important to take a history covering four main points

• Present Symptom
• Previous Breast Problems
• Risk Factors
• General Health - PMH, DH, SH
  What are common symptoms a patient could present with?

Answer 1

Lump
Pain

Nipple Discharge or inversion

Skin Changes

Changes in Shape

Question 2

what is important to gain before starting the examination from the patient?

Answer 2

• Introduction to patient
• Confirm patient details – Name, DoB
• Explain proposed examination to patient
• Confirm chaperone present
• Confirm patient consents to examination; check for any pre-existing discomfort
• Wash hands and put on gloves
• Position patient sitting up on edge of bed
• Adequately expose patient for examination (waist up)

Question 3

What are the three areas examined in the examination?

What do you look for on inspection?

Answer 3

• Breasts
• Axilla
• Supraclavicular fossae

Inspection

Patient relaxes hands on thighs - look at breasts- symmetry, scars, lumps, skin, nipple discharge or inversion

Repeat inspection with patients hands above head

Repeat inspection with patients hands pressed into hips - contracts the pectoralis major - will fix lumps if attached

Question 4

What is carried out when palpating the breasts?

Answer 4

• Ask patient to place hand behind head
• Palpate breast with palm of hand
• Work outside of breast in to nipple
• Ensure axillary tail is examined
• Ensure nipple is examined
• Ask patient to reproduce nipple discharge if present
• Ask patient to swap which hand is behind head and examine the other breast in the above manner

Question 5

What is carried out when palpating the axilla?

Answer 5

Examine the axilla by supporting the weight of the patients arm in yours and Using other hand examine the anterior, posterior, medial, lateral and apex of axilla for lumps and lymphadenopathy
Repeat this examination for the other side

Question 6

After now insepcting and palpating the breasts and axilla, is the examination complete?

Answer 6

Bilaterally feel for supraclavicular lymphadenopathy

Get patient to swivel round on the chair and then that is it finished