Breast examination - OSCE Guide | Geeky Medics

3/4/15, 7:51 PM

BREAST EXAMINATION OSCE GUIDE

Breast examination frequently appears in OSCEs. Youll be expected to pick up the
relevant clinical signs using your examination skills. This breast examination OSCE
guide provides a clear concise, step by step approach to examining the breast.
Introduction
Wash hands
Introduce yourself
Confirm patient details - name / DOB

Explain examination:
Today Ive been asked to perform a breast examination, do you understand what this
will involve?
The examination will involve me first inspecting the breasts, then placing a hand on
the breasts to assess the breast tissue. Finally I will examine the glands of your neck
and arm pit.
Explain the need for a chaperone:
One of the female nursing staff will be present throughout the examination, acting as
a chaperone, is this ok?
Check understanding:
Does everything Ive said make sense?
Do you feel you understand what the examination will involve?
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Do you have any questions?

Gain consent:
Are you happy for me to carry out the breast examination?
Position patient laid on a bed at 45
Ask patient to undress down to the waist behind the curtain provide blanket
to cover
Ask if the patient has pain anywhere before you begin!
General inspection
Is the patient comfortable at rest? pain / SOB
Obvious masses, scars or asymmetry?
Close inspection
Arms by side
Position the patient at 45 with their arms relaxed by their sides
Scars - small scars (lumpectomy e.g. lipoma) / large diagonal scars (mastectomy)
Asymmetry healthy breasts are often asymmetrical
Masses note the size & position any masses - look for overlying skin changes
Skin changes:
Erythema
Puckering may indicate an underlying mass - e.g. breast cancer
Peau dorange - multiple dimples giving an orange skin like appearance http://geekymedics.com/2010/10/08/breast-examination-osce-guide/

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inflammatory breast cancer

Nipple changes - retraction / discharge / eczema (Pagets disease)

Arms above head

Ask patient to place both hands behind their head
Repeat inspection
Inspect for masses and puckering
Inspect the axillae for any obvious abnormalities masses / erythema
Hands on hips
Ask patient to place hands on their hips & push inwards (to tense pectoralis major)
Repeat inspection again
Observe for any masses & evidence of tethering
.
Palpation
Breast
Examine the normal asymptomatic breast first
1. Ask patient to place their hand, on the side being examined, behind their
head
2. Imagine the breast as a clock face, ensuring your examination covers
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Breast examination - OSCE Guide | Geeky Medics

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all hours
3. Use the flat of your fingers to compress the breast tissue against the chest
wall
4. Note any lumps in the breast tissue, paying attention to their position,
size, shape, consistency, overlying skin changes and mobility
5. Move in a clockwise motion around the breast, starting from outside
& moving inwards
6. Ensure to palpate the axillary tail, as breast tissue extends into the
axillary area.
7. Palpate the nipple and its underlying tissue, feeling for any masses
8. If the patient reports having nipple discharge, ask them to squeeze the
nipple to demonstrate this
If a mass is noted, assess the following:
Texture
Tenderness
Mobility
.

Axilla
Examine the axillae, palpating for any lymphadenopathy - malignancy /
infection
Support the patients arm on the side being examined with your forearm

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If youre examining the right axilla, use your right arm to support the
patients (vice versa for left)

Palpate the axilla with your free hand, ensuring to cover all areas of the
axilla:
Medial / lateral / anterior / posterior walls
Apex of the axilla
.
Other lymph nodes
Finally perform a general lymph node examination of the following areas:
Cervical jugular chain
Supraclavicular
Infraclavicular

Repeat the examination on the other breast

To complete the examination
Thank patient
Cover patient up with a blanket / sheet
Leave the room & allow them time to re-dress
Wash hands
Summarise findings

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.
Say you would
Perform further investigations if indicated:
Ultrasound
Mammography
Biopsy (fine needle aspiration / core biopsy) to determine histology
.

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