A site for medical students - Practical,Theory,Osce Notes

How to examine the breast -OSCE guide

1. Explain procedure and seek cooperation.
2. Patient is undressed upto the waist.
3. Use adequate lighting.
4. Ask patient to sit on a chair initially opposite the examiner.
5. Examine and compare both sides.
1. Look for asymmetry of the nipple, areola or the breast in all the following positions:
  • The patient s hands should rest on her thighs.
  • The hands are firmly pressed onto the hips.
  • The arms are raised up and both the palms are placed behind the head.
  • The patient leans forwards.
  • Finally make the patient lie down on a couch with a pillow below her chest.
  • Nipple and areola: Position, size, shape, surface and any discharge.
  • Breast: Size, shape, displacement, engorged veins,
  • skin abnormalities, swelling (quadrantie location, size, shape, surface ) or ulcer (number, position, size, shape. Iloor. edge, discharge).
  • Surrounding structures: Arm-oedema, etc.
3.Lymph Nodes
Axillary, supraclavicular, scalene nodes
4.General Examination
As relevant to the case.
1. Avoid offending an unduly modest patient, but this should never prevent a complete examination.
2. In all the five positions, the patient should be symmetrically positioned. Otherwise, apparent differences in the breast will result.
3. The nipple, areola and all four quadrants must be examined In sequence in all the positions.
4. Examine in many positions to detect early changes
The pectoral muscles are relaxed in position (a)  contracted in position (b) and stretched along with the skin in position (c). The breasts are made pendulus In (d). A pillow under the back in (e) makes the breast more prominent.
5. Since the breast is a frequent site of carcinoma, a general examination is incomplete unless both the breasts have been Included.

These steps are very important for students preparing for USMLE and MRCP