Examination Flashcards
What direct questions should you ask if you find a lump?
Previous lumps Family history Pain Nipple discharge Nipple inversion Skin changes Change in size in relation to menstrual cycle Number of pregnancies First and last period Postnatal Breast feeding Drugs (HRT/pill) Metastatic disease (weight loss, breathlessness, back main)
What questions should you ask about breast pain?
Bilateral/unilateral Rule out cardiac chest pain History of trauma Any mass Related to menstrual cycle
What questions should you ask about nipple discharge?
Amount Nature (colour, consistency, blood) Spontaneous or non-spontaneous Any changes in nipple or areola Mastalgia&ie
What are the causes of non-malignant and non-cyclical breast pain?
Tietze’s syndrome- costochondritis plus swelling of costal cartilage
Bornholm disease/devil’s grip- coxsackie b virus, causing chest and abdominal pain
Angina
Gallstones
Lung disease
Thoracic outlet syndrome
Oestrogens, HRT
What are the causes of nipple discharge?
Duct ectasia- green/brown/red (often multiple ducts and bilateral, cessation of smoking reduces)
Intra-ductal papilloma
Adenoma
Carcinoma- bloody discharge (single duct)
Lactation
What are the stages of the breast examination?
Inspection- (assess size and shape, masses, which quadrant, ulceration, dimpling, nipple inversion/discharge)
Palpation of the breast- (Confirm size and shape of nay lump, fixed to underlying structures? is it fluctuant/compressible/hard, temperature, tender, mobile (fibroadenoma)
Palpation of the axilla for lymph nodes- (metastatic spread, ipsilateral/bilateral, matted, fixed)
Further examination- (examine abdomen for hepatomegaly, spine for tenderness, lungs)
What’s the anatomical location of the breasts?
Extend from the 2nd to 6th ribs and transversely from the lateral border of the sternum to the mid-axillary line
What is galactorrhea?
After childbearing women continue to discharge small secretion of milk
Can be first presenting symptom of prolactin-secreting pituitary adenoma
Ask about headaches, visual disturbances, neurological symptoms
What is gynaecomastia?
Enlargement of male breast tissue which should not normally be palpable
Seen in adolescence, elderly and obese
In many patients it’s drug related- oestrogen-receptor binders (oestrogen, digoxin, marijuana) anti-androgens (spironolactone, cimetidine)
Ask about drug and hormone treatment
Look for hypopituitarism, chronic liver disease, thyrotoxicosis, examine genitalia
What is found upon examination for inflammatory breast cancer?
Presents with oedematous, indurated and inflamed skin (red, hot and itchy)
Not usually associated with a lump, MRI is useful
Prognosis is very poor
What examination findings are characteristic of breast cancer?
Mass or dimpling
P’eau d’orange
Ulceration
Nipple inversion, destruction, deviation, discharge
Paget’s disease
Hard non-tender lump (50% in upper outer quadrant)
Axillary or supraclavicular lymphadenopathy
May present with lymphedema in affected arm
