for obvious reasons this is usually done on a dummy in the examination. In real life you should be chaperoned by a female nurse.
Introduce, explain, glance from end of bed. The patient should be chaperoned if possible.
Ask "where is the area of concern?"
The patient should be positioned sitting on the edge of the bed with
her arms by her side, with the upper half of her body exposed.
Inspect her next with her hands on her head, and then hands on her hip whilst contracting the pectoralis muscles
Look for asymmetry, masses, dimpling (tethering to deep muscles,
indicating cancer), scars, nipple inversion (cancerous), Paget's disease
(eczematous changes of the nipple as a result of cancer).
patient at 45 degrees, rolled slightly to the contralateral side being
examined. Start examining the normal breast first. The hand of the side
being examined should be behind her head.
Palpate the 4 quadrants and the central nipple
(ask first, because it is sensitive). The most common site for
malignancies is the upper, outer quadrant.
To palpate the axillae, relax her pectoral muscles
by taking the weight of her arm in yours. Insert your fingers in to the
axillae and move her arm closer to her side before feeling for lymph
Palpate the contralateral side.
Feel for infra and supraclavicular lymph nodes.
"I would like to "
Percuss the spine for tenderness (bone mets)
Listen to the lung bases (lung mets)
Examine the abdomen for hepatomegaly (liver mets)
Cover up the patient and thank her (I mean do this one, don't ask to do it!)
Common Conditions for OSCEs
The age group is a strong clue to what the diagnosis will be:
Fibroadenoma: benign tumor with proliferation of glandular and stromal
elements, due to estrogen
Fibroadenosis (no cysts) (also known as
fibrocystic disease, chronic
mastitis): Fibrosis, epitheliosis, adenosis (
overgrowth). Can be premalignant if has "atypical elements"
Duct papilloma (epithelial proliferation in ducts), traumatic fat
necrosis, infections include cellulitis/mastitis, abscess (usually
lactation/preg & staph aureus)