Breast

Question 1

Clinical signs on inspection of breasts

Answer 1

Scars
Asymmetry
Masses
Nipple abnormalities
Skin changes

Question 2

Nipple abnormalities to note

Answer 2

Nipple inversion - breast cancer, breast abscess, mammary duct ectasia, mastitis
Nipple discharge

Question 3

Skin changes on the breast to note

Answer 3

Scaling of nipple and/or areola + erythema/pruritis = Paget’s
Erythema (infection, trauma, cancer)
Puckering (invasion of suspensory ligaments)
Peau d’orange (inflammatory breast cancer)

Question 4

Changes to breast mass presentation on pushing hands on hips

Answer 4

If moves when pec muscle contracts = tethering (invasive breast malignancy)
May accentuate puckering if mass invades suspensory ligaments

Question 5

Clinical signs to look for on hands behind head/leaning forward inspection of breasts

Answer 5

Puckering, asymmetry

Question 6

Keys for breast examination technique

Answer 6

Flats of middle three fingers, compress the tissue against the chest wall

Question 7

Characteristics of breast lumps to note

Answer 7

Location (area, distance from nipple)
Size + shape (approx dimensions, shape)
Consistency (smooth/firm/stony/rubbery)
Overlying skin changes (erythema, puckering)
Mobility (moves freely/with overlying skin/with pec contraction)
Fluctuance (hold sides then press the top, fluid-filled will bulge outwards)

Question 8

Characteristics of nipple discharge to note

Answer 8

Colour, consistency, volume

Question 9

Types of nipple discharge + implications

Answer 9

Milky - normal when pregnant/BFing, however galactorrhea indicates a prolactinoma
Purulent - thick yellow/green/brown offensive = mastitis or abscess
Watery or bloody - various but ductal carcinoma in situ is most important to consider

Question 10

3 characteristics of metastatic LNs

Answer 10

Enlarged + hard + irregular

Question 11

Correct technique for axillary LN examination

Answer 11

Pt lying down at 45 degrees
Arm behind their head
Inspect for scars, masses, skin changes
Palpate by holding their forearm with same arm then use other hand to palpate axilla, asking them to relax completely and let you take the arm’s weight
Remember - left hand to examine left axillae + vice versa
Palpate in this pattern = posterior pec major border -> wall of thorax -> anterior lat dorsi border -> underside of the arm -> apex of axilla (warn that may be uncomfortable)
Repeat on other side