Wk 15 Breast and pelvic exam Flashcards
5 concerns for breast exam
- Lumps
Pain
Skin changes
Nipple discharge
Complications of breastfeeding
3 steps for breast exam
- inspection while sitting
- palpation while sitting - lymph nodes
- palpation while supine - breast tissue
5 sitting breast exam findings
Appearance of the skin (color, skin thickening)
Size difference
Symmetry
Contour (visible masses, dimpling)
Characteristics of nipple (ulceration, discharge, inversion, pointing in different directions)
What does Peau d’orange suggest?
lymphatic obstruction
Check for breast lymphadenopathy
Breast palpation while sitting
Central axilla: starting high in axilla, along chest wall
Pectoral/anterior nodes
Stand in front of patient
Palpate anterior axillary fold between fingers and thumb
Lateral nodes
Palpate high in axilla to along upper humerus
Subscapular/posterior nodes
Stand behind patient
Palpate posterior axillary fold between fingers and thumb
Infraclavicular Supraclavicular
*What size is normal?
Normal in axilla < 3 cm, normal in supraclavicular < 1 cm
What are 3 patterns for breast palpation while supine?
What range should be covered for breast exam?
Clavicle to 6th rib, sternum to anterior axillary line
6 points and reasoning or pelvic exam
Cervical cancer screening (pap smear)
Vulvar concerns
Pain, lesions, irritation/itching
Vaginal complaints
Pain, discharge, irritation/itching
Pelvic pain and dyspareunia (pain with intercourse)
Abnormal bleeding: irregular, heavy, bleeding after
intercourse
*NObenefitforovariancancerscreening: ~10,000 pelvic examinations are required to detect one ovarian cancer, and generally it is advanced disease
Pap smear steps
Where does Ob Hx go in hx taking?
Can be after SHx or Soc Hx