clinical- breast examination

Breast Examination
Introduce yourself
Exposure:  to umbilicus (not infront other pt. & ask for chaperon)
                        45o Foot of bed ·  Symmetry → Br. symm.& Nipples same level · contour → regular/irregular
 OR Side       ·  4 Quadrants → Mass/ No 
                           ·  Nipple → retraction/ erosion/ discharge & areolafissure
·  Skin: scar (ask), stage IV signs (peau d’orange 1, ulcer 2, red, dimples)
RAISING ARM ·   Axillary tail & Arm for mass          ·   Teethering of skin 
ELEVATE BREAST  ·   Back of breast → Mass/ No   ·   Teethering of skin
HAND ON WAIST     ·  4 Quadrants → Mass/ No        ·   Teethering of skin
Describe Mass: 5S
3-     Palpation (45o→ HAND ON WAIST)   Ask about ds breast & Start by NORMAL breast
1-  Superficial palpation: for mass (using pulp of middle 3 fingers) & If do not find ask pt.
· 4 quadrants             · Areola
· Axillary tail             · Back of breast (inframammary area)
         Mass 3S TT ESCRS
        - Site, Shape, Size                    -  Temperature, Tenderness      
-  Edge → well/ ill defined,     -  Surface → smooth/ irregular,
-  Consistency → firm/ hard,   -   Mobility in 2 planes → mobile/ fixed
-  Relation to Skin (pinch) → teethered (1 point)/ fixed (all mass)/ not
-  Relation to pectoralis ms 3 (Hand on waist) → fixed/ not   

              2-  Axillary & Supra-clavicular L.N.s (support by ipsilateral hand & palate by contralat. hand by tip of fingers & rolling movement)
1-  Anterior group      2- Central group        3- Lateral (humeral) group                                  4- Apical group (bimanual below clavicle)  5- Posterior group (reverse hands)
6-  Supra-clavicular L.N. ( pt. shrug shoulders & examine from behind)
3-  Discharge: Ask pt. to express any discharge

3-     Percussion of vertebrae → tender/ not (for metastasis)
I would like to finish my examination by:
1- Auscultation of lung base (for malignant lung effusion)
2- Examination of Abdomen (for hepatomegaly or ascites due to liver metastasis)
3- Percussion of back for tender segment (if not done)
1 Ulcer = cancer encurise               2 Peau d’orange = superficial edema
3 Ask the patient to put her hands in her waist, move the mass in 2 perpendicular directions, then ask her To press against her hips, move the mass in 2 directions (inline & perpendicular to the fibres of the pectoral muscles), if the movement is limited then the mass is fixed to the muscle.

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