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OSCE
-Buster: Examine the Breasts
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05.11.06 (2 years ago)
#1
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"Please examine Mrs Reed, who is a 40 year old lady, who has recently been complaining of mastalgia in her left breast."
What to do:
This is my order of examination - I find its fluent to inspect and palpate, lay flat and palpate, then examine from the back (nodes, chest, bones etc). You may have your own order of examining though. However, if you follow the inspect, palpate, percuss, ausculate routine you won't miss anything out.
1 - INTRODUCTION
Introduce yourself to the patient
Check their identification
Explain what you wish to do and obtain consent
Ensure chapparone is present
2 - EXPOSE AND POSITION
Expose the patients chest and abdoment
Sit the patient at 45 degrees
3 - INSPECT
Inspect the 4 quadrants of the breast for masses and skin changes
Inspect the axillary tail for masses, nodes and skin changes
Inspect the nipple and areola for retraction, discharge, puckering, skin changes
Inspect for symmetry
Ask the patient to raise their arms over their head - again inspect!
Ask the patient to press their hands firmly on their hips - inspect again!
4 - PALPATE
Palpate all 4 quadrants of the breat systematically
Palpate the areola
5 - LAY FLAT AND PALPATE
Lay the patient flat
Palpate all 4 quadrants
Palpate the areola
Palpate into the axillary tail for nodes
Check for hepatomegaly
6 - SIT UP AND PALPATE
Palpate for nodes in the axilla
Palpate the supraclavicular and cervical lymph nodes
Palpate the vertebrae for bony tenderness
7 - PERCUSS
Percuss the lung fields for dullness (ie: metastatic effusions)
8 - AUSCULTATE
Ausculate the lung bases for signs of metastatic spread
9 - FINISH
Cover the patient up
Thank the patient for their time
Wash your hands
Common things to see in OSCEs
Young patient - Fibroadenoma
Reproductive age - Fibroadenosis
All ages - Breast cyst
Mannequins - Nodes, Cancers
There are mannequins in existance that simulate breast diseases! I'm not sure if the GMC has these, but I am aware of several medical schools who have them. You should examine in exactly the same way (they can do all the maneuvers too) and can have lumps places in certain areas and have nodes.
Hope it helps.
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