Breast Examination


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 doctor in General Practice

Patient: Mrs Summer, a 45 year old lady, has come to clinic with breast pain and you have been asked to perform a breast examination

Task:

– Perform a breast examination

– After 6 minutes you will be asked a series of questions by the examiner.

– Answer any questions that the patient may have

Note to actor:Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

 

You are Mrs Summer, a 45 year old, who’s had breast pain in both breasts for the last few months. You’ve come into clinic and the GP has asked his colleague to perform a breast examination. You are happy to be examined and you do not have any questions.

 

If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Role
Clarifies who they are talking to
Asks patient for preferred name


Examination basics Examination basics
Washes hands
Appropriately exposes patient
Chaperone present


Inspection Inspection
Compares breasts directly
Hands by side
Hands on hips
Raising hands above head


Inspection Inspection
Lumps
Skin changes
Scars
Nipples (inversion, discharge)


Palpation Palpation
Patient laying at 45 degrees, hands behind head
Palpates all four quadrants, in a “clockwise manner”


Palpation Palpation
Palpates axillary tail
Palpates axilla for lymphadenopathy
Assesses whether there is nipple discharge
Palpates supraclavicular fossa for lymphadenopathy


Palpation Symptomatic breast palpation
Repeats the above for other breast


Finishing Finishing remarks
Invites patient to dress again
Re-washes hands


Question How would you fully assess any patient with a breast lump?
Mentions "Tripple Assessment"
Clinical examination
Imaging: USS / mammography
Tissue sample: core biopsy / fine needle aspiration


Question What are the common differentials of a breast lump in this age (45)?
Breast cyst
Fibroadenoma
Malignant
Breast abscess


Question What examination findings of would indicate breast malignancy?
Lump - enlarging / firm / diffuse margins / fixed to structures etc...
Nipple - retraction / tethering / blood stained discharge etc...
Skin - puckering / peau d’orange
Lymphadenopathy



Score