Breast

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					                                        Breast


Wash Hands                                       Questions
Introduce
Explain                                          What investigations can be done to
                                                 investigate a lump?
Offer Chaperone
                                                      Fine Needle Aspiration
Consent                                               Mammography
Expose                                                Biopsy
Position pt upright with hands on                     MRI
thighs                                                Ultrasound
Inspect
                                                 What are the factors for elevated risk of
Scars
                                                 breast cancer?
Deformities
                                                      Female
Swellings                                             Old
Skin Changes                                          Family History
Asymmetry                                             Long exposure to oestrogen
Redness                                                       o Early menarche
Nipple Discharge                                              o Late menopause
Ask pt to place hands on hips                                 o Nulliparity
Ask pt to put hands behind head                               o OCP
                                                              o HRT
Ask pt to stand and lean forward
                                                      Past breast cancer
Palpate
Position pt lying on one pillow with             What is the differential diagnosis for a breast
hand under head                                  lump? (a) What is most likely in a woman aged
Examine unaffected breast                        22? (b) What is most likely in a woman aged
                                                 45? (c) What is most likely in a woman aged
Circular motion ending at nipple
                                                 75?
Axilla 4 borders Lat Med Ant Pos
                                                      Breast Cancer (c)
Supraclavicular Nodes                                 Fibroadenoma (a)
Affected breast                                       Breast Cyst (b)
Describe:                                             Breast Abcess
 Size/Shape/Edges                                    Fibrocystic changes
 Fixation (to pec mjr. By placing
     hands on hips to contract)                  What would indicate a benign nipple inversion
 Temperature                                    and what would suggest malignancy?
                                                 Benign: Symmetrical slit like inversion
 Tenderness
                                                 Malignant: Asymmertical and distorting
 Colour/Texture
Regional Nodes                                   What types of discharge are likely to be
Close                                            benign and what types should be investigated?
Cover pt.                                        Likely benign: Multiple duct,
                                                 yellow/green/white
Thank
                                                 Investigate: Single duct, bloody
Wash Hands
                                                 What are the key points to note about any
Overall                                          swelling?
U          B          S             M                 Site
                                                      Size/Shape
                                                      Attachments
                                                      Edges
                                                      Consistency
                                                      Skin Texture
                                                      Tenderness, Redness, Heat
                                                      Transillumination
                                                      Thrills/Bruits


                                                                              Michael Smith 2010

				
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posted:8/10/2012
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