Breast Examination - OSCE Guide | UKMLA | CPSA | PLAB 2

Summary

In this video, Simon, a junior doctor, performs a breast examination on Leola, a 23-year-old woman who has noticed a lump in her left breast. The examination involves a thorough inspection and palpation of both breasts and surrounding areas, including the armpits and neck, checking for any abnormalities or signs of malignancy. Upon examination, Simon identifies nipple retraction and a firm, tethered mass in the left breast, prompting further tests such as an ultrasound and biopsy to assess for potential cancer. The process is handled professionally with appropriate chaperoning and care.

Takeaways

• 😀 A junior doctor named Simon is performing a breast examination on a 23-year-old patient named Leola.
• 😀 Leola has concerns about a lump in her left breast, which is the focus of the examination.
• 😀 The doctor explains the examination process to Leola and ensures she is comfortable with the procedure.
• 😀 Leola is asked to undress and wear a gown, while a nurse chaperone is provided for the examination.
• 😀 During the examination, Leola is instructed to position herself in different ways to help with the inspection.
• 😀 The doctor checks for any nipple discharge by gently squeezing the nipple, first on the right side and then the left.
• 😀 The doctor palpates both breasts and examines the armpit glands for any abnormalities.
• 😀 The left breast is found to have a 3x3 cm firm mass at approximately 2:00, which appears tethered to underlying tissues.
• 😀 The right breast shows nipple ulceration and lower outer quadrant erythema (redness).
• 😀 The left breast also has nipple retraction and changes in the lower outer quadrant, suggesting possible concerns.
• 😀 The doctor recommends further testing, including an ultrasound scan, core biopsy, or fine needle aspiration, to assess the mass and check for disseminated malignancy.

Q & A

What is the purpose of the breast examination in this script?

The purpose of the breast examination is to assess Leola's breast health, specifically to investigate a lump she felt in her left breast and to examine the surrounding tissue for any abnormalities.

What is the significance of the nipple ulceration and athema in the right breast?

Nipple ulceration and athema (redness) in the lower outer right quadrant are potential signs of an underlying issue, possibly a benign or malignant condition, and warrant further investigation.

What symptoms were observed in Leola's left breast during the examination?

In the left breast, there was evidence of nipple retraction and podor range (potential skin changes), as well as a firm, craggy mass, which could be indicative of a serious condition like a tumor.

What is the significance of the firm craggy mass found in the left breast?

The firm, craggy mass found in the left breast, located 4 cm from the nipple, could be a sign of a benign or malignant tumor. Its tethering to underlying tissues suggests that it may be more deeply rooted, which requires further examination.

What is the size of the mass found in the left breast?

The mass in the left breast is 3x3 cm in size.

What tests are recommended to further investigate Leola's condition?

Further investigations such as an ultrasound scan and either a core biopsy or fine needle aspiration of the mass are recommended to confirm the diagnosis and determine if malignancy is present.

What was the role of the nursing staff during the breast examination?

The nursing staff acted as a chaperone throughout the breast examination to provide support and ensure the patient's comfort and safety during the procedure.

What did the examiner ask Leola to do at various stages of the physical examination?

The examiner asked Leola to put her hands on her hips, press down on her hips, place her hands behind her head, push her elbows back, and lean forward to assist with the inspection of the breast tissue.

What did the examiner check for by squeezing Leola's nipple?

The examiner squeezed Leola's nipple to check for any discharge, which could be a sign of an underlying issue such as infection, ductal problems, or malignancy.

How did the examiner check the lymph nodes during the examination?

The examiner palpated the lymph nodes in the armpit and neck to check for any signs of enlargement or abnormalities, which could indicate the spread of malignancy.