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Endocrine Skills And Examination
Introduce, explain, glance from end of bed. The patient should be chaperoned if possible.
Ask "where is the area of concern?"
The patient should be positioned sitting on the edge of the bed with her arms by her side, with the upper half of her body exposed.
Reposition with hands on head, and hands on her hip whilst contracting the pectoralis muscles
Look for asymmetry, masses, dimpling (tethering to deep muscles, indicating cancer), scars, nipple inversion, Paget's disease (eczematous changes of the nipple as a result of cancer.
Position the patient at 45 degrees, rolled slightly to the contralateral side being examined. Start examining the normal breast first. The hand of the side being examined should be behind her head.
Palpate the 4 quadrants and the central nipple (ask first, because it is sensitive). The most common site for malignancies is the upper, outer quadrant.
To palpate the axillae, relax her pectoral muscles by taking the weight of her arm in yours. Insert your fingers in to the axillae and move her arm closer to her side before feeling for lymph nodes.
Palpate the contralateral side.
Feel for infra and supraclavicular lymph nodes.
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Percuss the spine for tenderness (bone mets)
Listen to the lung bases (lung mets)
Examine the abdomen for hepatomegaly (liver mets)
Cover up the patient and thank her.