Female Exam Flashcards
What are the borders of the breast?
- Superior border: Clavicle
- Inferior border: 6th rib
- Medial border: Sternum
- Lateral border: midaxillary
What are the four components to a clinical breast exam?
- Introduction
- Breast Inspection
- Lymph node palpation
- Breast palpation
What is the order of inspecting both breast?
- Patient sitting, arms at sides
- Patient sitting, arms above head
- Patient sitting, hands pressed to hips
- Patient leaning forward, supporting them
What should you note during your inspection?
- Size
- Symmetry (some variation is normal)
- Shape
- Contour (flattening, masses, and dimpling)
- Skin (color, edema, rashes, lesions, thickening, and venous pattern)
- Scars (previous surgery, injuries)
- Nipple eversion or inversion
- resent onset of unilateral nipple inversion is suggestive of underlying malignancy
What lymph nodes would you palpate on a breast exam?
- Supraclavicular lymph nodes
- Axillary lymph nodes (3 sweeps) and lateral chain
- Rich network with primary lymphatic drainage to axillae; secondary drainage to internal mammary
- Can also drain to supraclavicular and jugular nodes
How should you palpate a patients breast during examination?
This may be done with patient supine or seated:
- Arm behind head
- Four quadrants
- Tail of Spence (up to clavicle and towards axilla)
- Nipple
- Areola
- Keep drape over areas not currently being examined
- Ask patient if the amount of pressure is comfortable during palpation
What are the five segments of the breast?
- Upper outer quadrant
- Upper inner quadrant
- Lower inner quadrant
- Lower outer quadrant
- Tail of Spence
When notating the location of a mass/lesions?
Clockwise
What patterns can be used during breast palpation?
Vertical strip / lawnmower / ladder
Concentric circles
Radial spoke
- Utilize the pads of the fingers
What should you note during breast palpation?
Nodules Indurations Masses Tenderness Nipple discharge
What is the duration of palpation for a breast exam?
- Bra size B:
- 3 minutes per breast
- 6 minutes total time
Average time physicians spent in one study- 1.8 minutes to examine both breasts
How should you expect when assessing for nipple discharge?
Check for nipple discharge by placing two fingers from each hand at edge of areola:
- Press down, inward toward nipple, then up & back down
- Repeat at 90 degrees to first position
Light milky discharge may be normal
Serous or bloody discharge typically abnormal
What are the special examinations?
- Mastectomy or Breast augmentation
- Examine scar and axilla
- Lymphedema
How should you document a breast examination?
- Inspection – size, symmetry, shape, contour, skin, scars
- Palpation – consistency, tenderness, nodules, lymphadenopathy
Example:
“No chest deformity or asymmetry. Normal contour. No nodules, masses, tenderness, or axillary adenopathy. No nipple discharge.”
What are some pertinent questions during an interview? (Breast)
Pertinent questions:
- Self-examination?
- Lumps, nodules, enlargement, tenderness?
- Nipple discharge?
- Imaging?
What should you look for a past medical history? (Breast)
PMHx: Breast disease or cancer, obesity, history of radiation to chest
Reproductive history:
Age at menarche, age at first pregnancy, menopause status, breastfeeding history
What additional information should you ask about during an interview? (Breast)
PSHX: Breast biopsies
Social: Smoking, alcohol use, exercise
Family Hx: Breast or ovarian cancer
Medications: OCPs or hormones
What are some common complaints? (Breast)
Breast lump
Breast pain/discomfort
Nipple discharge
How should you take a patients HPI for a CC: Breast Lump?
HPI: Location (unilateral vs. bilateral) How was it found? How long has it been present? Changed in size? Change with menstrual cycle? Nipple discharge? Pain? Skin changes?
PE Location Size Shape Consistency Delimitation Tenderness Mobility
