Loyola Female Exam Part 3

Next part of the examination that we're going to do is the breast exam and also the examination for the axillary lymph nodes. So what I'm going to do is come in front of you Nancy and ask you if you could lower your gown down to your waist. There's going to be four different positions like I'm going to examine your breasts. So first of all, you can just relax your arms at your side. And when I'm doing this checking for any dimpling or retractions of the nipple, any rash and so forth. I don't see that.

Now could you put your arms above your head for me? And same thing, I'm just checking for any skin changes in that position. I don't see any changes. Now could you put your arms against your hips and press in? That contracts your pectoral muscles and would bring out a deeper lesion. And again, I don't see any change. And finally with your hands still pressing lean forward.

Good, and I don't see any abnormality there either. You can go ahead and raise your gown up Nancy. The next part of the examination is going to be for the axillary lymph nodes. So Nancy, if you could just lower the gown on this side. Good. What I'm going to do is to go ahead and put my fingers together. I'm going to reach up high into your armpit area and feel if there's any swollen glands. It might be a little uncomfortable, but it shouldn't hurt. What I need to have you do is to relax your arm, which is often one of the hardest things for the patient to do.

And I don't feel any lymph nodes against your chest relax your arm again. I'm going to feel the anterior fold here. And then change hands and feel for the posterior fold. Good. And I don't feel any swollen glands. You can go ahead and put that arm back. If you could lower the gown on the other side. I'm going to come around. Same thing here. If you could just kind of relax your arm. I'm going to go ahead and reach all the way up to the dome of the axilla.

If you want any abnormality, I'm going to reach for the anterior fold here too to palpate.

And now the posterior fold. Good. I don't feel any lymph nodes on this side either. You can go ahead and raise your gown.

Next part of the examination is the actual breast exam. And to do that, I'm going to go ahead and lower the exam table so it's all the way flat. I ask if you could lay flat now too, Nancy. I'm going to pull the ledge out for your comfort. And could you just expose your left breast for me? I'm going to go ahead and palpate that for lump snapper maltes. Can you raise your hand above your head? Great. And I'm going to do it just by using an up and down sort of motion palpate the entire breast surface.

Okay. You'll notice there might be a couple different levels of pressure as I go ahead and examine at any one area. Do you practice a monthly self breast exam? I do. Good. How long have you been doing that for? A number of years. I will admit there are times that I probably forget, but I do try to remember. And what time of the month do you try to do that usually? I know when you are supposed to do it, but it's probably a matter of just remembering.

Sure. Of course the ideal time to do the breast examination is about five to seven days after the onset of your period. You don't want to do your breast exam right before your period because your breasts are somewhat swollen from the hormonal changes and certainly be more tender or painful at that point. But also you might feel a lump when it's really not a lump. It's just the normal breast tissue being engorged from the hormones. How about your other female screenings Nancy? Have you had a mammogram yet? I have. Good.

How long ago was that? It was probably a year ago. Was that normal? Yes. So you didn't need any follow-up mammogram or biopsies right afterwards?

Have you had a pap smear recently? Within a year. Has it ever been abnormal? No.

Do you have calcium in your diet? I'm really not sure. That's a legitimate question. I don't know really how much one should take in. I don't drink milk on a daily basis. But I do have dairy products. But I'm really not sure how much calcium one should take. If you want to go ahead and flip up your gown there. I don't think I have your Melty's neck breast. If you could go ahead and expose this breast and put that arm above your head too. Everyone should get at least a thousand milligrams of calcium a day.

And vitamin D is also important too. So another way to get that is through yogurt. Do you take any yogurt in? Sometimes. And I do try to drink orange juice that has extra calcium and vitamins. That's a great way to get calcium for people who don't like dairy. But you might need to be supplementing that with some calcium tablets also. Tums has calcium in it. But there's also other products like CalTrate I think is one brand name for example that has calcium in it. Now certainly if the patient is over 50 you're going to be asking about some other things as far as colon cancer screening.

Stool cards, colonoscopy. It's also time to start asking about influenza vaccinations. Those I do get. Good. And then when patients get over the age of 65 then you start asking them about osteoporosis screening. So bone density tests.

And pneumonia vaccines. That would be the other big preventative healthcare items the physician can ask about. Good. And I don't feel any abnormality in the answer. You can go ahead and lift your gown up. So the breast exam is an ideal time for the physician to ask screening questions because it does take a while to, if you're doing a thorough adequate exam, to cover all those areas. The next part of the exam I'm going to do now is I'm going to raise your head up just about 30 degrees here.

Go ahead and lay back. You can turn your head to the left a bit. I'm going to be looking for the jugular venous pulsations here. I'm looking for the maximum point then. I can see it right there. I can sort of see the skin lifting up and down. I'm going to grab a ruler and another straight edge here.