Breast and Testicular Examination Notes

Breast Examination Overview - Upper Outer Quadrant: This area has the highest incidence of breast cancer due to a greater proportion of glandular tissue, making it crucial for thorough examination. - Positions for Breast Examination: Different positions enhance the accuracy of the examination: - A. Arms over head: This position allows better visualization and palpation of the breast tissue. - B. Arms pressed firmly on hips: Creates tension in the pectoral muscles for improved examination effectiveness. - C. Leaning forward: Facilitates better evaluation of the breast structure and any potential abnormalities. - D. Lying supine: Allows comprehensive palpation while also providing comfort to the patient. ##### Clinical Breast Patterns - Vertical strip pattern: A systematic method for examination, ensuring each part of the breast is thoroughly assessed from top to bottom. - Circular pattern: Another approach focusing on palpation in concentric circles around the breast, useful for identifying lumps or abnormalities. - Wedge pattern: A targeted examination technique, especially effective in areas where lumps are suspected, focusing on one segment at a time. ##### Conditions Requiring Further Investigation - Benign Tumors: - Usually well-defined and round or oval in shape, suggesting a non-cancerous nature. Their typical features include a smooth border and consistent texture. - Malignant Tumors: - Usually poorly defined and irregular with lobules, indicating potential malignancy. Symptoms may present as: - Peau d'orange: A condition where the skin appears dimpled or pitted, resembling orange peel. - Inverted nipple: A significant change that may indicate underlying issues, including tumors. - Skin dimpling: Another symptom to observe during physical examination, often associated with malignancies. ##### Benign Prostatic Hypertrophy / Hyperplasia (BPH) - Symptoms: - Presents with an inability to completely empty the bladder, which could lead to urinary tract infections (UTIs). Other common symptoms include: - Slow, weak stream of urine; dribbling after urination; urinary retention, which can cause significant discomfort. - Interventions: - Initial measures may include obtaining an ultrasound scan for further assessment or considering straight catheterization for immediate relief. - Common treatment options include tamsulosin (Flomax), which helps alleviate symptoms related to urinary obstruction caused by an enlarged prostate gland. - Patients are advised to avoid cold medications containing decongestants, as these can have vasopressor effects and worsen symptoms. ##### Acute Scrotal Conditions - Testicular Torsion: - Characterized by twisting or rotation of the testicles, requiring immediate medical intervention to prevent loss of the testicle. - Epididymitis: An inflammatory condition often caused by infection, leading to severe testicular pain and swelling. - Infectious Conditions: Other conditions to consider include serious ones like Fournier's gangrene, especially following trauma, which necessitates prompt surgical intervention. ##### Health Goals Related to Male GU System - Testicular Self-Exam (TSE): - An important educational and promotional activity that should be taught to males starting from their mid-teen years. Regular practice of TSE can greatly increase early detection of testicular cancer. - Testicular cancer is the most common type of cancer in men aged 20-35 years old, highlighting the need for awareness and education. ##### Testicular Torsion vs. Epididymitis - Testicular Torsion: - Pain onset is typically acute, often sudden and severe. - Associated symptoms include nausea/vomiting in approximately 50% of cases, signaling the urgency of the condition. - Fever is rare, and immediate evaluation is warranted. - Elevation of the affected testicle does not alleviate pain, differentiating it from other conditions. - Epididymitis: - Pain onset is gradual, often escalating over time. - Nausea/vomiting is generally rare, with fever present in around 50% of cases. - Elevation of the affected testicle usually relieves pain, which can assist in the diagnosis. - Antibiotic therapy is indicated for treatment, depending on the underlying cause and etiology of the condition.