Breast examination: taking an anamnesis
The first stage of diagnosis is a thorough questioning of the female patient. The physician needs to find out if there is a feeling of discomfort in the breast area, as well as clarify information regarding the presence or absence of menstrual cycle disorders.
The most important task of clinical examination in this area is timely cancer screening, i.e., the early detection of tumor processes. To achieve this goal, the physician not only performs the examination independently but also emphasizes the need for regular self-monitoring—the patient must be taught the technique of systematic self-examination.
To obtain the most reliable results from a physical examination, it is important to observe the correct timing: the optimal time for the procedure is considered to be one to two weeks after menstruation has ended.
Assessment of discharge and physical examination
During objective examination and palpation of the mammary glands, the physician assesses for tenderness and purposefully searches for nodular neoplasms. The characteristics of nipple discharge are of particular clinical significance:
- Secretion upon compression: if discharge appears exclusively upon mechanical action (squeezing), in most cases, this is not considered a pathological phenomenon.
- Spontaneous discharge: spontaneous outflow of secretion without external influence always requires in-depth diagnostic investigation.
- Unilateral character: spontaneous appearance of discharge from only one gland is an extremely alarming symptom, as it raises direct suspicion of a tumor.
A separate condition is galactorrhea (galactorrhea), which is a pathological spontaneous outflow of milk occurring outside the breastfeeding period. The main causes of this condition are menstrual cycle disorders and the onset of pregnancy.
Visual inspection of the extremities
The examination of the extremities begins with a detailed visual inspection, during which the physician assesses the general condition of the surrounding tissues: the skin, muscular system, and joints.
During the inspection, signs indicating serious constitutional and hereditary changes in the body can be detected. The most characteristic findings include:
- Violation of trunk proportions: disproportionate growth of the extremities is characteristic of genetic pathologies such as Marfan syndrome.
- Bone deformities: specific changes in the bone skeleton (thickening, shape alteration) may indicate endocrine disorders, for example, acromegaly.
Spontaneous (pathological) fractures
When examining the musculoskeletal system, it is important to take into account anamnestic data regarding fractures. Particular attention is drawn to spontaneous pathological fractures, which occur with minimal trauma due to disruption of the internal structure of bone tissue. Their causes are divided into two large groups:
- Oncological diseases: the violation of bone strength occurs against the background of the development of primary bone tumors, the formation of metastases, or multiple myeloma.
- Metabolic disorders (osteoporosis): a decrease in bone mineral density. The main risk group for developing osteoporosis includes elderly individuals and postmenopausal women. The most typical and dangerous localization of a pathological fracture in metabolic disorders is the femoral neck.
Note: the detailed technique of palpation and joint examination is covered in specialized sections of propedeutics (Chapter 12).
Briefly: answers to topical questions
What external signs during the examination of the extremities are characteristic of Marfan syndrome?
During external inspection of the extremities, Marfan syndrome is characterized by pronounced violations of trunk proportions and specific changes in the shape of the fingers.
Main visual signs:
- Arachnodactyly—abnormally long and thin "spider-like" fingers of the hands (distal parts of the upper extremities).
- Elongation of the extremities—disproportionately long arms and legs combined with tall stature of the patient.
What exactly are the specific bone deformities of the extremities in acromegaly?
Specific bone deformities of the extremities in acromegaly consist of a disproportionate enlargement of individual parts of the body, primarily the hands and feet.
External inspection reveals disproportionately large hands and feet. The clinical example also describes an increase in shoe size and a subjective feeling of "coarsening" of the hands. Acromegaly develops after the completion of epiphyseal cartilage ossification, after the puberty period, and can be combined with an enlargement of the facial skeleton.
What is the technique for palpating the mammary glands?
Palpation of the mammary glands is performed in the vertical and horizontal positions (supine and on the side). The physician examines the entire mammary gland, moving around the nipple and sequentially along the quadrants down to the inframammary fold.
There are three main methods of systematic palpation:
- Vertical strips—up-and-down movement in parallel lines across the entire area of the gland.
- Radial method—movement from the periphery to the nipple.
- Circular method—movement in concentric circles (spirals) from the nipple to the periphery or vice versa.
Nodular lesions are more clearly defined in the standing position.
Which groups of regional lymph nodes must be palpated during a breast examination?
When examining the mammary glands according to the sources, it is necessary to examine the regional zones, with an emphasis on the axillary region.
Palpable lymph node groups indicated in the sources:
- Axillary lymph nodes—examined deep within the axillary fossae; this is the main lymphatic drainage pathway from the mammary gland.
- Supraclavicular lymph nodes—palpated in the supraclavicular fossae; lymph from the upper parts of the mammary gland drains into the supraclavicular nodes.
- Subclavicular lymph nodes—palpated below the clavicle; after the axillary nodes, lymph further flows into the subclavicular nodes.
- Pectoral lymph nodes—localized under the pectoralis major muscles.
Class and exam questions
What is the optimal timeframe for performing a breast examination?
A medical examination and self-examination are best performed 1–2 weeks after the end of menstruation.
Are nipple discharges always a sign of disease?
No. If discharge appears only upon strong compression, this is usually a variant of normal. Spontaneous discharge, especially from one gland, requires urgent examination.
What is galactorrhea?
This is a pathological spontaneous outflow of milk not associated with feeding a child. It can occur during pregnancy or menstrual cycle disorders.
Who is at risk for pathological fractures associated with osteoporosis?
First of all, these are elderly people and postmenopausal women. The most vulnerable place in such patients is the femoral neck.
What else to study on this topic
- Breast palpation technique and search for nodular formations
- Causes and differential diagnosis of galactorrhea
- Marfan syndrome and acromegaly: pathogenesis of deformities
- Multiple myeloma and mechanisms of bone tissue destruction
- Detailed joint examination (Chapter 12)
Master the entire topic in the "Propaedeutics" course
This is a summary. The course covers everything tested in classes and exams.
- Full guide on "Breast and Extremity Examination" and 3,152 more pages of the subject
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Other topics in the section "Examination of the skin, lymph nodes, and individual body parts"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.