Breast

History Questions:
(An Old/A Young) (M/F) patient named____________________ S/O
___________________ of age__________ was admitted to hospital on
__________ via Emergency/OPD. He/She is resident of
__________________________ and ______________ by profession.
The patient was presented with the following presenting complaints.
a) ___________________________________________
b) ___________________________________________
c) ___________________________________________
Diabetic Alcoholic Smoker Hyper- Drug Arthritis TB Hospital/ Travel
tensive
Addict Accident

• Lump/Ulcer (Detailed)? • Nipple Discoloration?

• Lump/Ulcer in Axilla/Neck • Nipple Duplication? (Accessory in
(Detail)? Axilla and Inner Thigh)
------------------------------------------------ ------------------------------------------------
• Pain (ODIPARA-CR) and Relation • Respiratory Symp (Chest Pain,
With Menses? Cough, Hemoptysis)?
• Skin Changes of Breast • Abdominal Symp (Pain, Appetite,
(Ulcer/Necrosis/Fungation)? Jaundice, Distention)?
• Change in Size & Symmetry of • Urinary Symp (Urination/
Breast? Defecation Control?
• Ask About Other Breast? • CNS Symp
• Breastfeeding History? (Convulsions/Vomit/Vision/Mood/
Headache/Limb Weakness)
• Trauma History? ------------------------------------------------
------------------------------------------------ • Fever?
• Nipple Discharge
(Blood/Green/Serous/Serosanguino • Appetite?
us/Purulent/Milky) (From Fistula or • Weight loss?
Nipple)? • Bone Pain?
• Nipple Retraction?
• Nipple Deviation?
• Nipple Destruction?
• Nipple Displacement?

Examination Points:
Inspection:
• [Arrange Screen,
Chaperone; Neck to
Waist Exposure; Normal • [Bend Forward]
Breast First; Positions
could be “Sitting, 45°,
Recumbent, Forward
Bending”]
------------------------------------ • [Sitting; Arms by Side]
• [Sitting; Arms by Side] • Also: See Axilla and
• Breast Size, Shape,
Position, Symmetry, and
Displacement?
• Breast Skin Changes
(Puckering, Peau
d'orange, Nodules,
Eczema, Darkening,
Discoloration, Mondor’s
disease, Fungation,
Necrosis, Ulcer)
• Other Skin Changes
(Fistula, Striae, Scar,
Visible Veins/Pulsations, • Ask ‫دردوتںیہنوہیت؟‬
Pallor)?
• Nipple Size and Shape • Temperature/Pain/Tender
(Prominent/Flat), Surface
(Crack/Fissure/Eczema), • May Ask Patient to Find
Transverse Slit,
Horizontal and Vertical
Distance?
• Nipple Retraction,
Discharge, Deviation,
Destruction,
Displacement,
Discoloration,
Duplication
• Areola (Montgomery
tubercles) Size, Color
(Pink/Dark), Surface,
Ulcer, Eczema, and
Texture?
------------------------------------
• [Raise Arms Above Head,
May Also Lift Brest to
See Underneath]
• Intertrigo?
------------------------------------
• [Press Hands Against
Breast
Hips, Check Ant Axillary
Fold Tension]
• Swelling Revealed?
------------------------------------
• Failure of Nipples to Fall
Away?
------------------------------------
Arms (Brawny Edema,
Ulnar, Radial, and
Median Nerve Areas),
Supraclavicular Fossa
and LNs
Palpation:
• [With Flat of Fingers, All
4 Quadrants, Start With • Fixity to Ribs/IC
Normal Breast Follower
by Other, Simultaneous
Palpation, Palpate
Behind Nipples as Well]
ness?
Swelling For You
• Breast Texture
(Soft/Firm/Fibrous/Nodu
lar)
• Lump Complete.
Quadrant? 2-
Dimensional Mobility? • Axillary Tail?
In Both, Relax and Tens • Arms (Ulnar, Radial, and
Pec Muscles States
• Ulcer? Complete (Cancer
en-cuirasse)
• Fixity to Breast (Breast
in One Hand and Lump
in Other, No Independent
Movement)
• Fixity to Skin (Pinch)
(In Normal and Tensed • Mediastinal Nodes? Wide
Pec)(Skin Can’t Be
Pinched, Lump Can’t
Move)
• Fixity to Pec Fascia
(Tethering) (In Normal
and Tensed Pec)(Dimple
Forms When Lump
Moves, Lump Moves in
Arc)
• Fixity to Pec Maj
Muscle (Tense Pec,
Move Lump Along and
Perpendicular to
Fibers)(Restricted While
Moving Along)
• Fixity to Lats (Check
Mobility, Resist 90°
Flexed Elbow Abducting
at Shoulder and Check
Mobility Again)
• Fixity to Serr Ant
Muscle (Check Mobility,
Push Against
Wall/Shoulder and Check
Mobility Again)
Muscles (Mass Immobile
and Fixed, Doesn’t Fall
on Leaning and Doesn’t
Rise on Raising Arms)
• Nipple Palpation (Deep
to it)? Retraction on
Palpation? Also
Tenderness, Hardness,
Mobility
• Areola Squeeze (To
Evert Nipple and Draw
Discharge)?
• Axilla and Compere
Axilla?
Median Nerve, Bluish
Distal Edema)
• Lymph Nodes (Ant/Inter
Pec/Central/ Lateral/
Posterior/Apical/Supracla
vicular/ ?
Percussion:
Mediastinum? Liver?
Also:
• Resp, Abdomen, CNS,
Spine, Bone, Pelvis?