Breast Clinical Examination (unuploaded).pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Clinical Breast Examination

3. Clinical Breast Examination Versus Breast Self Examination. In two situations- Complaints related to breast. Screening – Every 1to 3years between 20-40 years of age. Every year after 40 years of age.

4. Tips for Examination

5. Tips for Examination Examination – Eyes first and the most Hands next Tongue not at all. Examine always- Opposite side (paired organs) first Regional Lymph nodes and vice versa.

6. Aim of Examination To make a diagnosis. Ignore Popups.

7. Surgical diagnosis

8. Surgical diagnosis There are only two lesions in surgery- Ulcer Swelling /Lump Diagnosis of ulcer is made by its edge. Diagnosis of swelling is made by finding out its level i.e.. Skin Subcutaneous Superficial /deep to muscle Intra abdominal R etroperitoneal

9. Ulcer diagnosis

10. Clinical Examination of Breast

11. Clinical Examination of Breast Steps of Examination Inspection Palpation Percussion Auscultation

12. Inspection Position of patient- Sitting with arms at her sides. Raise both arms. Bend forward at hips.

13. Inspection Compare with other breast. Size difference Level of nipples/ recent retraction/discharge/crusting Visible vessels. Visible lump Redness. p eau d'orange   Skin retraction Cancer en cuirasse

14. p eau d’ orange 

15. Recent Nipple retraction

16. Paget’s disease of breast

17. cancer en cuirasse

18. Palpation

19. Palpation Patient sitting then lying down. Use flat of hand > flat of fingers > pinch. Don’t miss areola Patient points to lump. Palpate other breast first. Examiner should slide palpating hand rather than lift. Vertical strip in sitting and spokes of wheel in lying down position. Don’t attempt to milk unless c/o nipple discharge.

20. Palpation proper First point in palpation – local temperature Second is tenderness. Consistency Soft/Firm/hard Uniform/ Variable Mobility Fixity to muscles Pectoralis Major Serratus anterior

21. How to palpate

22. Lymph nodes

23. Lymph nodes Axilla Supraclavicular.

24. Axillary Lymph Nodes Axillary Lymph nodes Groups : Anterior -Pectoral Posterior-Subscapular Lateral- Brachial Medial - central Apical Infraclavicular Supraclavicular

25. Palpation :Axillary Lymph nodes

26. Palpation :Axillary Lymph nodes 1.From in front,examiner’s opposite hand- Anterior -Pectoral Medial - central Apical Infraclavicular 2.From in front,examiner’s same hand- Lateral- Brachial 2.From behind,examiner’s same hand- Posterior-Subscapular Supraclavicular

27. Infraclavicular ln. Deltopectoral groove

28. Palpation :Axillary Lymph nodes Number Size Consistency Matted or not Fixity

29. Palpation :Axillary Lymph nodes Suspicious for mets- Hard Fixed >1cm.

30. Fluctuation Three finger methods – for breast cyst.

31. Documentation Abnormalities found should be recorded accurately Use a diagram Using nipple as centre of clock record- O’Clock position Distance from nipple Depth from skin Shape and size Colour Consistency Fixity.

32. Harms of Screening Clinical Breast Examination

33. Harms of Screening Clinical Breast Examination False assurance Unnecessary biopsies

34. Get this ppt in mobile Download Microsoft PowerPoint from play store. Open Google assistant Open Google lens. Scan qr code from next slide.

35. Get this ppt in mobile

36. Get my ppt collection https:// www.slideshare.net/drpradeeppande/edit_my_uploads https:// www.dropbox.com/sh/x600md3cvj85woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl=0 https://www.facebook.com/doctorpradeeppande/?ref=pages_you_manage