Examinations
CPSA · Clinical examination · General surgery
Breast examination
Inspect (at rest and with manoeuvres) → palpate all quadrants + tail + nodes → characterise any lump. Always chaperoned; refer any discrete lump on the 2-week-wait pathway.
Practise it out loudPosition: Sitting for inspection, then reclined at 45° with the arm behind the head for palpation. Chaperone essential.
The routine
Inspect
- 1At rest, arms raised, and hands pressing on hips: asymmetry, skin changes (peau d’orange, dimpling/tethering), nipple inversion/discharge, scars
- 2Inspect both breasts in each position
Palpate
- 1Examine the normal breast first; palpate all four quadrants + the axillary tail of Spence with a flat hand
- 2Characterise any lump: site, size, shape, consistency, mobility, tethering, tenderness
- 3Examine the nipple; check for discharge
Lymph nodes
- 1Axillary nodes (support the arm), supraclavicular and infraclavicular nodes
Signs & what they mean
Hard, irregular, fixed/tethered lump ± skin dimpling ± nodesBreast carcinoma (urgent 2-week-wait referral)
Smooth, firm, highly mobile lump in a young womanFibroadenoma (“breast mouse”)
Peau d’orange, erythema, warmthInflammatory breast cancer / abscess
Fluctuant tender lump ± overlying erythema (lactating)Breast abscess
To complete, I would…
- Refer any discrete lump for triple assessment (clinical, imaging — mammogram/USS, biopsy)
- Take a full breast and family history (BRCA)
- Examine for hepatomegaly and spinal tenderness if metastatic disease suspected
OSCE tips
- Always use a chaperone and explain each step — professionalism marks.
- Any discrete lump = triple assessment; don’t reassure without it.
- Examine the normal side first for comparison.