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Ebook Bates’ poktet guide to physical examination and history taking (7E): Part 2

(BQ) Part 2 book “Bates’ poktet guide to physical examination and history taking” has contents: The breasts and axillae, the abdomen, the peripheral vascular system, male genitalia and hernias, female genitalia, the musculoskeletal system, the nervous system, the pregnant woman, and other contents. | CHAPTER The Breasts and Axillae 10 The Health History Common or Concerning Symptoms ◗ Breast lump or mass ◗ Breast pain or discomfort ◗ Nipple discharge Ask, “Do you examine your breasts?” . . . “How often?” Ask about any discomfort, pain, or lumps in the breasts. Also ask about any discharge from the nipples, change in breast contour, dimpling, swelling, or puckering of the skin over the breasts. Health Promotion and Counseling: Evidence and Recommendations Important Topics for Health Promotion and Counseling ◗ ◗ ◗ ◗ Palpable masses of the breast Assessing risk of breast cancer Breast cancer screening Breast self-examination (BSE) Palpable Masses of the Breast. Breast masses show marked variation in etiology, from fibroadenomas and cysts seen in younger women, to abscess or mastitis, to primary breast cancer. All breast masses warrant careful evaluation, and definitive diagnostic measures should be pursued. 167 168 Bates’ Pocket Guide to Physical Examination and History Taking Palpable Masses of the Breast Age Common Lesion Characteristics 15–25 Fibroadenoma 25–50 Cysts Usually smooth, rubbery, round, mobile, nontender Usually soft to firm, round, mobile; often tender Nodular, ropelike Irregular, firm, may be mobile or fixed to surrounding tissue As above Fibrocystic changes Cancer Over 50 Pregnancy/ lactation Cancer until proven otherwise Lactating adenomas, cysts, mastitis, and cancer As above Adapted from Schultz MZ, Ward BA, Reiss M. Breast diseases. In: Noble J, Greene HL, Levinson W, et al., eds: Primary Care Medicine, 2nd ed. St. Louis: Mosby, 1996. See also Venet L, Strax P, Venet W, et al. Adequacies and inadequacies of breast examinations by physicians in mass screenings. Cancer 1971;28(6):1546–1551. Assessing Risk of Breast Cancer. Although 70% of affected women have no known predisposing factors, selected risk factors are well established. Use the Breast Cancer Risk Assessment Tool of the National Cancer Institute .