Wk 15 Breast and pelvic exam

Question 1

5 concerns for breast exam

Answer 1

1.  Lumps
    Pain
    Skin changes
    Nipple discharge
    Complications of breastfeeding

Question 1

3 steps for breast exam

Answer 1

1. inspection while sitting
2. palpation while sitting - lymph nodes
3. palpation while supine - breast tissue

Question 2

5 sitting breast exam findings

Answer 2

 Appearance of the skin (color, skin thickening)
 Size difference
 Symmetry
 Contour (visible masses, dimpling)
 Characteristics of nipple (ulceration, discharge, inversion, pointing in different directions)

Question 3

What does Peau d’orange suggest?

Answer 3

lymphatic obstruction

Question 4

Check for breast lymphadenopathy

Answer 4

Question 5

Breast palpation while sitting

Answer 5

 Central axilla: starting high in axilla, along chest wall
 Pectoral/anterior nodes
 Stand in front of patient
 Palpate anterior axillary fold between fingers and thumb
 Lateral nodes
 Palpate high in axilla to along upper humerus
 Subscapular/posterior nodes
 Stand behind patient
 Palpate posterior axillary fold between fingers and thumb
 Infraclavicular  Supraclavicular
*What size is normal?
Normal in axilla < 3 cm, normal in supraclavicular < 1 cm

Question 6

What are 3 patterns for breast palpation while supine?

Answer 6

Question 7

What range should be covered for breast exam?

Answer 7

Clavicle to 6th rib, sternum to anterior axillary line

Question 8

6 points and reasoning or pelvic exam

Answer 8

 Cervical cancer screening (pap smear)
 Vulvar concerns
 Pain, lesions, irritation/itching
 Vaginal complaints
 Pain, discharge, irritation/itching
 Pelvic pain and dyspareunia (pain with intercourse)
 Abnormal bleeding: irregular, heavy, bleeding after
intercourse
*NObenefitforovariancancerscreening: ~10,000 pelvic examinations are required to detect one ovarian cancer, and generally it is advanced disease

Question 9

Pap smear steps

Answer 9

Question 10

Where does Ob Hx go in hx taking?

Answer 10

Can be after SHx or Soc Hx