OBGYN OSCE – PELVIMETRY

A. BREAST EXAMINATION
 Greet the patient. Introduce yourself
 Explain the purpose
 Ask to undress down to the waist, remove bra. Drape the patient
A. Inspection
a. Ask to sit upright with their thighs relaxed
b. Ask to uncover the breasts
c. Note the presence of the ff
i. Obvious masses, swellings, scars
ii. Skin changes (erythema, puckering/dimpling/peau d orange)
iii. Nipple changes (retraction, discharge, scale)
iv. Asymmetry
d. Ask patient to place hands on their hips and push inwards (to tense
the pectoralis major)
i. Repeat inspection
ii. Observe presence of masses once again. If a mass is noted,
observe if it moves with the pectoralis muscle. This is known as tethering
which suggests malignancy
e. Ask patient to place both hands behind their head
i. Inspect the breast tissue for any masses, asymmetry,
dimpling/plucking
B. Palpation
a. Nipple and breast tissue
i. Ensure to warm hands before touching the patient
ii. Examine the “normal” asymptomatic breast first
iii. Position the patient laid on the bed at 45 deg angle
iv. Ask to place hands on side being examined behind the head
b. Nipple
i. Squeezes the nipple gently to gently to check for any discharge
ii. Note the color, amount, odor, and consistency of the discharge
c. Breast tissue (correctly performs ONE of the methods below)
i. Clock face method – each “hour”
ii. Spiral method – start at nipple and work outwards
iii. Vertical strip method – tiangge style
iv. Pie method – start at the nipple working outwards towards the
periphery of the pie slice
v. Presses downward using circular motion
vi. Apply steady pressure, pushing down to the level chest wall
vii. Apply enough pressure to palpate to 3 levels of depth:
1. Superficial
2. Medium
3. Deep to the level of chest wall
 viii. If a mass is palpated, describe according to the ff
characteristics
1. Position – accdg to quadrant, clock phase metaphor,
how far it is from the nipple
2. Size and shape – appropriate dimensions;
spherical/elongated/irregular
3. Consistency: smooth, firm, stony, rubbery, spongy
4. Mobility
5. Assoc skin changes
C. Examination of axilla
a. Instruct the patient to sit on the edge of the bed and face the physician
b. Examine right axilla using right arm to support the patient
c. Palpate the axilla with free hand, ensuring to cover all areas of the
axilla
i. Medial, lateral, anterior, posterior walls
ii. Apex
d. Checks for any lymphadenopathy
i. Cervical
ii. Supraclavicular
iii. Infraclavicular
iv. Parasternal
D. Covers the patient up with blanket. Allow patient to dress up
E. Explains findings and entertain questions
F. Thank the patient