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IVMS ICM -Physical diagnosis- FM Breast Exam
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IVMS ICM -Physical diagnosis- FM Breast Exam

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IVMS ICM -Physical diagnosis- FM Breast Exam

IVMS ICM -Physical diagnosis- FM Breast Exam

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IVMS ICM -Physical diagnosis- FM Breast Exam IVMS ICM -Physical diagnosis- FM Breast Exam Document Transcript

  • Physical Diagnosis Examination of the FM Breast Marc Imhotep Cray, M.D.For definitive study refer to Bates Pocket Guide to PhysicalExamination and History Taking by Lynn S. Bickley Contents Outline Equipment Needed None General Considerations Inspection Palpation Notes The patient must be properly gowned for this examination. All upper body clothing should be removed. General Considerations The patient must be properly gowned for this examination. All upper body clothing should be removed. Breast tissue changes with age, pregnancy, and menstral status. The procedure described here can also be used for self- examination using a mirror for inspection. Examination of the FM Breast Page 1
  • Inspection 1. Give a brief overview of examination to patient. [1] 2. Have the patient sit at end of exam table. 3. Ask the patient to remove gown to her waist, assist only if needed. 4. Have the patient relax arms to her side. 5. Examine visually for following: Approximate symmetry Dimpling or retraction of skin Swelling or discoloration Orange peel effect on skin Position of nipple 6. Observe the movement of breast tissue during the following maneuvers: Shrug shoulders with hands on hips Slowly raise arms above head Lean forward with hands on knees (large breasts only) 7. Have the patient replace the gown. 8. Reassure the patient, if the exam is normal so far, say so.Palpation 1. Have the patient lie supine on the exam table. 2. Ask the patient to remove the gown from one breast and place her hand behind her head on that side. 3. Begin to palpate at junction of clavicle and sternum using the pads of the index, middle, and ring fingers. If open sores or discharge are visible, wear gloves. 4. Press breast tissue against the chest wall in small circular motions. Use very light pressure to assess superficial layer, moderate pressure for middle layer and firm pressure for deep layers. Examination of the FM Breast Page 2
  • 5. Palpate the breast in overlapping vertical strips. Continue until you have covered the entire breast including the axillary "tail." [2] 6. Palpate around the areola and the depression under the nipple. Press the nipple gently between thumb and index finger and make note of any discharge. 7. Lower the patients arm and palpate for axillary lymph nodes. 8. Have the patient replace the gown and repeat on the other side. 9. Reassure the patient, discuss the results of the exam.Notes 1. For definitive study refer to Bates Pocket Guide to Physical Examination and History Taking by Lynn S. Bickley 2. Bates refers to circular or clock face patterns. These are considered to be inferior to the "lawn mower" pattern of vertical strips and should not be used. Examination of the FM Breast Page 3