Clinical Skills - Breast Exam

Front 1

What are the four positions in which a woman's breasts must be inspected?

Back 1

1) Arms at side
2) Arms over head
3) Arms pressed against hips
4) Leaning forward

Front 2

What position should the patient be in for palpation of the breast?

Back 2

Supine

Front 3

How long should thorough palpation of each breast take?

Back 3

3 minutes each

Front 4

Describe the technique for palpation of a patient's breast.

Back 4

Place the patient in the supine position
...

Front 5

Describe proper draping technique during the breast examination.

Back 5

An adequate inspection initially required full exposure of the chest, but later in the examination, cover one breast while you are palpating the other.

Front 6

When is the best time during the menstrual cycle to examine the breasts and why?

Back 6

The best time for examination is 5 to 7 days after the onset of menstruation because breasts tend to swell and become more nodular before menses as a result of increasing estrogen stimulation.

Front 7

Describe the inspection phase of the breast exam.

Back 7

Remember the acronym Sam's nipples.

S - Size and shape
-flattening of the normally convex breasts suggests cancer

A - asymmetry
-some difference in size, even between areolae, is normal

M - masses and deformities

S - skin changes
-the different skin changes can be remembered with acronym TIDS

T - thickening suggests cancer
I - inflammation (swelling erythema)
D - dimpling suggests cancer
S - scars from previous operations or biopsies

Nipples - recent flattening or depression suggest retraction, which in turn suggests cancer.

Front 8

In what position should the patient be in for inspection of the breasts?

Back 8

The patient should be in the sitting position and disrobed to the waist.

Start with a general inspection with the patient's hands at her sides.

Follow up with inspection with the patient's hands over her head, at her hips, and bending forward.

The changes in position can bring out dimpling or retraction that may otherwise be invisible.

Front 9

In what position should the patient be for palpation of the breasts?

Back 9

Palpation is best performed when the breast tissue is flattened and evenly distributed.

For this reason, the patient should be supine (lying down) with her ipsilateral hand on her forehead.

Front 10

Describe the area that should be palpated during a breast exam.

Back 10

Palpate a rectangular area from the clavicle to the inframammary fold or bra line, and from the midsternal line to the posterior axillary line so as not to miss the tail of Spence.

Front 11

Describe proper palpation technique for the breast exam.

Back 11

Using the finger pads of the 2nd, 3rd, and 4th fingers, palpate in small, concentric circles at each examination point. If possible apply light, medium, and deep pressure.

Front 12

What part of the fingers should be used to palpate the breast?

Back 12

Finger pads

Front 13

Which fingers are used to palpate the breast?

Back 13

The finger pads of the 2nd, 3rd, and 4th fingers are used.

Front 14

How much pressure should be applied during palpation of the breast.

Back 14

If possible apply light, medium, and deep pressure in concentric circles at each examination point.

Front 15

True or false: the vertical strip pattern is the best validated technique for detecting breast masses.

Back 15

True

Front 16

You want to palpate the lateral region of breast. Describe the positioning of the patient.

Back 16

Get the patient to role onto her contralateral hip and place her ipsilateral hand on her forehead. Her shoulders should remain pressed against the bed, however.

Front 17

You want to palpate the medial region of the breast. Describe the positioning of the patient.

Back 17

The patient should lie flat on the bed with her ipsilateral hand over her forehead. Her ipsilateral elbow should be lifted until it is evenly aligned with her shoulder. Her shoulders must remain flat on the bed.

Front 18

Describe the placement of the shoulders during the breast exam.

Back 18

Although the ipsilateral hand should be on the patient's forehead, her shoulders must remain pressed against the table.

Front 19

Describe the position of the patient's ipsilateral elbow during palpation of the medial breast.

Back 19

The patient's shoulders should be against the table. Her ipsilateral hand should be on her forehead and her ipsilateral elbow lifted until it is even with her shoulder.

Front 20

What three parameters should you be evaluating while palpating the breast?

Back 20

1) Tenderness

2) Consistency of tissues

3) Nodules

Front 21

Name 7 parameters used to describe nodules or masses found in the breast.

Back 21

1) Location
2) Size
3) Shape
4) Consistency
5) Delimination
6) Tenderness
7) Mobility

Front 22

Describe the palpation of the nipple.

Back 22

Palpate each nipple, noting its elasticity

Press the areola around the nipple, watching for spontaneous discharge.