BREAST examination
Intro
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WIPE + Consent
Which breast is concerning you?
Chaperone
General
inspection
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Unwell? Cachexia? age?
Past signs of cancer:
• Hair loss, radiation burns, mastectomy
Breast
inspection
•
4 positions (arms = Relaxed, on Thighs,
pressed into hips, behind head and
leaning forward)
Lift breast and examine sub mammary
folds
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Looking for: (A SKINNY NIPPLE
SCAR)
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Palpation
Asymmetry -> Swelling, Lumps
Skin changes -> erythema,
dimpling, Peau d'orange, pitting
Nipple changes (inversion,
Tethering)
Scars
•
3 finger palmar surface (circular motion)
+ hand behind head
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Start distally and work towards nipple
Axillary tail -> thumb and 2 fingers
Nipple: discharge -> attempt to express if
so
Lymph
nodes
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Axillary -> Clavicular and Cervical
Hand on back of head
Complete
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Summary
Ultrasound + core biopsy/ needle
aspiration
Mammogram (>30)
Examine for disseminated malignancy
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Masses:
• Location
• Size
• Consistency
• Fluctuance
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Size
Consistency
Fixation
Screening:
50-70 every 3 years (mammogram)
Peri vascular exam
Intro
WIPE + expose (chaperone?)
Gen
inspect
Patient: Pain, discomfort, amputations/ dressings
Bed: Oxygen, medications, Food
Upper
limb
Inspect
• Tendon Xanthelasma
• Glucose prick marks
• Skin
o Peri Cyanosis
o Tar staining
o Gangrene
o Pallor
Perfusion
• Temperature
• Cap refill
• Radial pulse (rhythm and RR delay)
• Brachial pulse (Volume and character)
Face
Eyes
• Hyperlipidaemia (corneal arcus and xanthelasma)
Mouth
• Central cyanosis
Carotid pulse
• Character (bruits?) – auscultate + feel
Abdomen
Legs
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Inspect for pulsation
AA check + Aortic and renal bruits
Inspection (SIT changes MOS)
• Changes
o Skin colour (pink, pale, mottled)
o Ischaemic (toes and heel)
o Trophic (hair loss, shiny/thin skin, ulcers)
• Muscle wasting
• Pedal oedema
• Scars (CABG grafts)
Palpation/perfusion
• Temperature
• Cap refill
• Pulses
o Femoral, popliteal, Posterior tibial, dorsalis
pedis
• Check for tenderness in calves + Peripheral sensation
Buerger's angle
• Raise leg till pale (<30 angle -> severe ischaemia
• Drop and watch for return of blood
To
complete
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Thank and summary
Full CV exam, test sensation and doppler US
Further investigations
o MR/ CT angio, ulcer swabs, ECG, HbA1C