1. Explain procedure and seek cooperation.
These steps are very important for students preparing for USMLE and MRCP
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.
Inspection
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.
Axillary, supraclavicular, scalene nodes
4.General Examination
As relevant to the case.
Note
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
