PHYSICAL EXAMINATION

OF HEENT

01/24/2025 by Meron H. (BScN, MScN) 1

Learning objectives
At the end of this chapter students will be able to:-

Explain the approaches in the

examination of head, eye, ear, nose

and throat
 Demonstrate the techniques as how

to examine H.E.E.N.T

01/24/2025 by Meron H. (BScN, MScN) 2

General overview of
P/E
You should be calm ,organized and

competent.

 Examination should take place with good

lighting and in a quite environment.

Keep the patient informed as you proceed

with your examination.

While examining the patient, it is helpful to

01/24/2025 by Meron H. (BScN, MScN) 3
 General overview of P/E Con’t
 By words or gestures, be as clear as possible in

your instructions.
 If possible try to demonstrate the patient what to

do rather than giving verbal instructions alone.

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The art of physical examination

 What are the components of or art

of physical examination?

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 General survey
 Observe the patient’s general state of health.

 Obtain the patient’s recent and current weight.

 Note posture, dress, grooming, and personal

hygiene;
 Watch the patient’s facial expression.

 Listen to the patient’s manner of speaking and

note the level of consciousness.

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1. Head examination
The Hair. Note its quantity, distribution,
texture, and pattern of loss if any. You may see
fine hair in hyperthyroidism, coarse hair in
hypothyroidism, silking of hair in AIDS pts.

The Scalp. Part the hair in several places and

look for scaliness, lumps, or other lesions.

The Skull. Observe the general size and

contour of the skull. Note any deformities,
depressions, lumps, or tenderness.
 Normally , symmetrically round
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Special examinations
The Face
 Note the patient’s facial expression and contours.

 Observe for asymmetry, involuntary movements,

edema, and masses.

 The Skin. Observe the skin, noting its color,

moisture, texture, mobility, and any lesions.

 Palpate the temperomandibular joint as the

person opens his mouth. tenderness, creptation

and limited range of motion indicates abnormality.
01/24/2025 by Meron H. (BScN, MScN) 8
 2. Eye examination
The eyeball consists of three layers of tissue:

1. The outer protective layer ; conjunctiva, sclera.

2. A middle layer of blood vessel (choroids.), pigment

cells and muscle fiber (Iris) ,ring of smooth muscle
(ciliary body).

3. An inner light sensitive layer called the retina.

01/24/2025 by Meron H. (BScN, MScN) 9

 The focusing parts of the eyes:

The lens ,the vitreous body and cornea

gives the eye its focusing power.

 Protection for the eyes:

The conjunctiva is a thin mucous membrane

covering the outer surface of the eyeball and

inner surface of the eyelid that protects
cornea from drying and infection.
Eyelid also covers the eyeball protecting it

from injury and keeping it moist.

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Possible Symptoms of eye disease
 Photophobia- is discomfort caused by

brightness in inflammation of the cornea.

 Floating: is formed by small opacities in the

vitreous body.
 Pain

 Discharge

 Double vision

 Headache

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PHYSICAL
EXAMINATION

01/24/2025 by Meron H. (BScN, MScN) 12

1. Position and alignment of the eyes.
Stand in front of the patient and survey
the eyes for position and alignment with
each other.
2. Eyebrows
Inspect the eyebrows, noting their
quantity and distribution and any
scaliness of the underlying skin.
3. Eyelids
Note the position of the lids in relation to
the eyeballs.
Inspect for width of the palpebral fissures,
edema of the lids.

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[Link] apparatus
Inspect the regions of the lacrimal gland and
lacrimal sac for swelling ,discharge, excessive
tearing.
5. Conjunctiva and sclera.
Ask the patient to look up as you depress
both lower lids with your thumbs, exposing
the sclera and conjunctiva.
Inspect the sclera ,bulbar and palpebral
conjunctiva for color.
Look for any nodules or swelling.
6. Cornea and lens.
With oblique lighting, inspect the cornea of
each
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eye for byopacities and note any opacities14in
Meron H. (BScN, MScN)
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7. Corneal reflex test-
 The patient is asked to look upward while the
examiner uses the wisp of cotton carefully and to
briefly stroke the cornea from the side and from
below.
 The normal response is blinking.
8. Corneal light reflex test
 Stand about 2ft away from the pt.
 Shine your penlight at the bridge of the nose.
 Inspect the site of reflection.
Note:
 Normally the cornea should reflect the light in
exactly the same place in both eyes.
 An asymmetrical reflex indicates strabismus
(deviation of the eye from the normal position)
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Corneal reflex test

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9. Iris
 At the same time, inspect each iris.

 The markings should be clearly defined.

 With your light shining directly from the temporal

side, look for a crescentic shadow on the medial

side of the iris.
 Since the iris is normally fairly flat ,this lighting

casts no shadow.

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10. Pupils

 Inspect the size, shape, and symmetry of the

pupils.

 If the pupils are large (>5 mm), small (<3 mm), or

unequal, measure them.

 Card with black circles showing different pupil sizes

is held next to your eye to determine the best

match.
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I. Test the pupillary reactions
Ask the patient to look into the distance, and

shine a bright light obliquely into each pupil in

turn. Look for:

The direct reaction (pupillary

constriction in the same eye)

The consensual reaction (pupillary

constriction in the opposite eye)

Always darken the room and use a bright light

before deciding
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that a light reaction is absent.
by Meron H. (BScN, MScN) 21
 II. Accommodation
 If the reaction to light is impaired, test the near
reaction in normal room light.
 Testing one eye at a time makes it easier to
concentrate on pupillary responses.
 Hold your finger or pencil about 10 cm from the
patient’s eye.
 Ask the patient to look alternately at it and into the
distance directly behind it.
 Watch for pupillary constriction with near effort.

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11. Extra ocular muscles of the eye
Controls the vertical, horizontal and diagonal
movement of the eye
I. Cardinal position test
 To makes these observations, ask the patient
to follow your finger or pencil as you sweep
through the six cardinal directions of gaze.
 To the patient’s extreme right,
 To the right and upward
 Down on the right
 Without pausing in the middle, to the
extreme left
 To the left and upward, and
 Down on the left. Pause during upward and
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Ocular muscles

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II. Cover –Un cover
test
 A cover–uncover test may reveal a slight or latent

muscle imbalance not otherwise seen. Nystagmus,

a fine rhythmic oscillation of the eyes may be
seen as an abnormal findings.
 A few beats of nystagmus on extreme lateral

gaze are within normal limits.

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12. VISUAL ACUITY

 Is the ability to see things appropriately?

 Testing of acuity should be done separately for

each eye.
 The E- Snellen’s chart is first used.

 If the patient can’t see anything on the Snellen’s

chart use hand movement.

 If the patient can’t see any hand movement

check for the light perception.

01/24/2025 by Meron H. (BScN, MScN) 26
 SNELLEN’S chart
 There are seven lines on the chart w/c represents

visual acuity of person with normal eye at 60m,

36m,24m,18m,12m, 9m, 6m,

 These numbers are the distance that a person with

normal sight could be able to see (for example a

normal person should be able to see the letter in the

first line marked 60 at 60 meters distance from the

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 A person is made to stand six meters from the E-

Snellen’s chart.

 If he can identify letters only in the first line,

marked 60, then his vision is 6/60.

 If he/she identifies up to the third line his vision is

6/24,if he is able to read up to the bottom his

acuity is said to be 6/6.

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  If pt misses 2letters in the 2nd line, record as

6/36-2
 If the client is unable to detect standing at 6

meters, ask him to stand at three meters and

identify.
 Patients with less than 3/60 vision are

classified as legally blind.


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 13. Visual field
A visual field is the entire area seen by an eye when

it looks at a central point.

The confrontation test is very easy to determine the

visual field defects by comparing it with that of the

examiner.
Patient and examiner sit facing each other at not

more than one meter apart.

When testing the left eye, the right eye of the patient

and the left eye of the examiner should be closed.

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Visual field con’t
 The patient and the examiner should then be

looking straight into each other’s eyes.

 Holding your finger equidistant between you and

the patient, ask him to say when the fingers

move.
 If you can see them but not the patient then he

has a field defect.

 By moving the finger in different quadrants, a

simple visual field can be plotted.

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Visual field

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III. Ear examination

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 Pathways of hearing

 Vibrations of sound pass through the air of the

external ear and are transmitted through the

eardrum and ossicles of the middle ear to the
cochlea, a part of the inner ear.
 The cochlea senses and codes the vibrations, and

nerve impulses are sent to the brain through the

cochlear nerve.

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 Pathways of hearing
con’t
 The first part of this pathway, from the external

ear through the middle ear known as the

conductive phase, and a disorder here causes
conductive hearing loss.
 The second part of the pathway, involving the

cochlea and the cochlear nerve, is called the

sensorineural phase; a disorder here causes
sensorineural hearing loss

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 III. Ear examination
1. The Auricle/Pina:

Inspect each auricle and surrounding tissues for

deformities, lumps, or skin lesions.

If ear pain, discharge or inflammation is suspected,

move the auricle up and down, press the tragus,

and press firmly just behind the ear.

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 2. Ear canal and drum
 To see the ear canal and drum, use an otoscope
with appropriate speculum.
 To straighten the ear canal, grasp the auricle
firmly but gently and pull it back and slightly up
ward.
 For a baby under 12 months the ear will be
pulled downward and out.
 Movement of the auricle and tragus is painful in
acute otitis external but not in otitis media.
 Tenderness behind the ear may also be present in
otitis media and/or mastoditis.

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 I. Otoscopic examination
Procedure
 Hold the otoscope handle between your thumb and

fingers, supporting your hand against the patient’s face.

 Insert the speculum gently in to the ear canal, directing

it somewhat down and forward.

 Inspect the ear canal, noting any discharge, foreign

bodies, redness of the skin, or swelling.

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 Inspect the eardrum, noting its color and

landmarks.

 Normal ear drum is shiny and gray color.

 The cone shaped light reflex is prominent in the

antero-inferior quadrant/at 5o’clock position in the

right and 7oclock position in the left drum.

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Nontender nodular swellings deep in the
ear canal.

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In acute otitis externa, shown below,
the canal is often swollen, narrowed,
moist, and tender

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 II. Auditory acuity
Measures how sharply the ear detects sound.

 To estimate hearing capacity ,test one ear at a

time.
 Ask the patient to occlude one ear with a finger.

 Then, standing 1 or 2 feet away, whisper softly

toward the unconcluded ear.

 Choose numbers or other words with two equally

accented syllables, such as “nine-four,” or

“baseball.”
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 To make sure the patient does not read your lips,

cover your mouth or obstruct the patient’s vision.

 Ask the pt. if he can hear it.

 If hearing is diminished/or absent in one of the ears,

try to distinguish between conductive and

sensorineural hearing loss.
 You need a quiet room and a tuning fork, preferably

of 512 Hz.

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 Test for lateralization (weber test)
 Place the base of the lightly vibrating tuning fork

firmly on top of the patient’s head or on the mid

forehead.
 Ask where the patient hears it: on one or both

sides.
 Normally the sound is heard in the midline or

equally in both ears.

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In unilateral conductive hearing loss, sound is

heard in (lateralized to) the impaired ear.

Visible explanations include acute otitis media,

perforation of the eardrum, and obstruction of the

ear canal etc.
 In unilateral sensorineural hearing

loss, sound is heard in the good ear.

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 2. Compare air conduction (ac) and
bone conduction (BC) (Rinne test).
 Place the base of a lightly vibrating tuning fork on

the mastoid bone, behind the ear and level with the
canal.
 When the patient can no longer hear the sound,

quickly place the fork close to the ear canal and

ascertain whether the sound can be heard again.
 Here the “U” of the fork should face forward, thus

maximizing its sound for the patient.

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 Normally the sound is heard longer through air than

through bone (AC > BC).

 In conductive hearing loss, sound is heard through

bone as long as or longer than it is through air (BC

= AC or BC > AC).
 In sensorineural hearing loss, sound is heard longer

through air (AC > BC).

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 IV. NOSE
 Note any asymmetry/deformity ,inflammation ,color

change etc.
 Tenderness of the nasal tip or alae suggests local

infection such as a furuncle.

 Test for nasal obstruction by pressing on each ala

nasi in turn and asking the patient to breathe in.

 With the aid of a penlight or otoscope light, each

nasal vestibule is examined.

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 V. Para nasal sinuses
 Are air-filled cavities within the bones of the skull.

Procedures:
 Palpate for sinus tenderness.

 Press up on the frontal sinuses from under the bony

brows, avoiding pressure on the eyes.

 Then press up on the maxillary sinuses.

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Examining Para nasal sinus

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 V. The mouth
 Look in the mucosa of the mouth with the help of
penlight and /or tongue blade.
 Inspect the oral mucosa for color, ulcers, white
patches, and nodules.
 Inspect the gum margin, teeth condition
 Inspect the color and architecture of the hard
palate, which makes the roof of the palate.
 Ask the patient to put the tongue out.
 Inspect it for symmetry -test of hypoglossal nerve.
 Note the color and texture of the dorsum of the
tongues.

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01/24/2025 by Meron H. (BScN, MScN) 55
 VI. Pharynx
 Surrounded by the anterior and posterior pillars,

tonsils and uvula.

 Note the color, symmetry, exudates, swelling,

ulceration and tonsillar enlargement.

 With the patient’s mouth open but the tongue not

protruded, ask the patient to say “ah” or yawn.

 This action may let you see the pharynx well. If not,

press a tongue blade firmly down upon the

midpoint
01/24/2025
of the arched tongue.
by Meron H. (BScN, MScN) 56
Pharynx Con’t
 Ask the patient to say “ah” or to yawn as you
watch the movements of the soft palate and the
pharynx.
 The soft palate normally raises symmetrically,
the uvula remains in the midline.
 In CN X paralysis, the soft palate fails to rise and
the uvula deviates to the opposite side.
 Then proceed with examination of gag reflex
 Inform the patient that you are going to test
the gag reflex.
 Stimulate the back of the throat lightly on each
side in turn and note the gag reflex.
 If absent CNX
01/24/2025
paralysis is suspected.
by Meron H. (BScN, MScN) 57
  In Cranial Nerve X paralysis, the soft palate

fails to rise and the uvula deviates to the

opposite side.

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APPROACH TO THE
EXAMINATION OF THE NECK AND
LYMPHO GLANDULAR SYSTEM
01/24/2025 by Meron H. (BScN, MScN) 59
 Learning objectives
At the end of this chapter the student will be able to:
 Explain the location of lymph nodes

 Demonstrate the techniques how to examine

lymph nodes ,thyroid gland and breast.

01/24/2025 by Meron H. (BScN, MScN) 60

Neck examination
 Symmetry; The neck should be erect

 Range of motion; note any limitation of

movement during active motion. Move the head to

the four direction
 Test the muscle strength and status of cranial

nerve XI by trying to resist the person’s

movement with your hands as the person shrugs
the shoulders and turns the head to the sides.

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 Tracheal examination
Palpate for any tracheal shift.

Place your index finger on the trachea in the

sternal notch and slip it off to each side

Normally the trachea is midline and the space

should be symmetric on both sides

The trachea is pushed to the unaffected side

with tumor, pneumothorax, unilateral thyroid

enlargement and pulled to ward the affected
side with atelectasis,
01/24/2025 pleural adhesions.
by Meron H. (BScN, MScN) 62
1. Lymph nodes
Most accessible lymph node groups for physical
examination are;-
 Cervical lymph node groups

 Axillary lymph node groups

 Inguinal lymph node groups

01/24/2025 by Meron H. (BScN, MScN) 63

1. Cervical lymph node groups
Feel in sequence for the following nodes:-

Pre-auricular: In front of the ear

Posterior auricular: superficial to the

mastoid process
 Occipital: at the base of the skull.

Tonsillar: at the angle of the mandible

 Submandibular: midway between the angle

and the tip of the mandible.

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Sub mental: few centimeters behind the tip of the

mandible
Superficial cervical: superficial to the sternomastoid

Posterior cervical: along the anterior edge of the

trapezius
Deep cervical chain: deep under the

sternomastoid .Hook your thumb and fingers around

either side of the sternomastoid muscle to find
them.
 Supraclavicular—deep in the angle formed by the

clavicle
01/24/2025 and the sternomastoid
by Meron H. (BScN, MScN) 65
 2. Examination of the axillary lymph nodes
 The patient being best in sitting position

 Pectorals muscles should be relaxed by lifting the

hand to be examined.

 Examiner sit on the same side of the axilla

 Palpate systematically all the lymph nodes.

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 3. Examination of the inguinal lymph nodes
 The inguinal lymph nodes are found along the

inguinal canal.

 They often are affected from infection around the

lower extremity and the external genitalia and

some times malignant diseases.

 Palpate systematically as the above ones

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Lymph nodes are
characterized by:-
 Location

 Size: in centimeters

 Shape: round or cystic, disc like, or irregular

 Consistency: soft, hard

 Delimitation: well circumscribed or not

 Tenderness

01/24/2025
Mobility: in relation to the skin.
by Meron H. (BScN, MScN) 68
 2. Examination of the thyroid gland
Introduction:
 The thyroid gland is located in the anterior neck

attached to pre-tracheal fascia.

 It is composed of three lobes namely left lobe, right

lobe and connecting the two lobes is the isthmus

lobe.
 Found below the cricoid cartilage

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Common symptoms
Pain

Palpitation

Dyspnea

aggressiveness

hot or cold intolerance

Over/Loss of appetite

 over/Loss of weight
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 Examination
Inspect ion.

 Tilt the patient’s head back a bit.

 Ask the patient to sip some water and swallow.

 Watch for upward movement of the thyroid gland,

noting its contour and symmetry.

 The thyroid cartilage, the cricoid cartilage, and the

thyroid gland all rise with swallowing and then fall

to their resting positions.

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 Palpation
Steps for palpating the thyroid gland
 Move behind the person

 Ask the patient to flex the neck slightly forward to

relax the sternomastoid muscles.

 Use the fingers of your left hand to push the trachea

slightly to the right.

 Ask the patient to sip and swallow water.

 Feel for the thyroid isthmus and the lobes rising up

and down under your finger pads.

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 Cont.…
 Displace the trachea to the right with the fingers of

the left hand; with the right-hand fingers palpating.

 Palpate laterally for the right lobe of the thyroid in

the space between the displaced trachea and the

relaxed sternomastoid.
 In similar fashion, examine the left lobe.

Auscultation
 This is done for detecting bruit which may be heard

during hypervascularity of the thyroid gland.

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 3. Breast and axillae
 Lies against the anterior thoracic wall.

 Extends from the 2nd rib down to the 6th rib, and

from the sternum across to the midaxillary line.

 Overlies the pectoralis major and at its inferior
margin, the serratus anterior.
 Composed of glandular, suspensory ligaments and
fatty tissue
 The superior lateral corner of the breast tissue is

called axilary tail of Spence.

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 To describe clinical findings, the breast is often

divided into four quadrants based on horizontal

and vertical lines crossing at the nipple.

 The outer quadrant is the site of most breast

tumors (axillary tail of Spence)

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Lymphatic drainage

 Lymphatics from most of the breast drain

toward the axillae.

 Of the axillary lymph nodes, the central nodes

are palpable most frequently.

 They lie high in the axillae and midway between

the anterior and posterior axillary folds.

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 Axilary lymph nodes
 Central axillary node : lie high in the axillae and

midway between the anterior and posterior axillary

folds. Drain channels from three groups of lymph
nodes.
 Pectoral nodes: anterior, located along the lower

border of the pectoralis major inside the anterior

axillary fold. Drain the anterior chest wall and much
of the breast.
01/24/2025 by Meron H. (BScN, MScN) 79
 Lymph nodes con’t
 Sub-scapular nodes: posterior, located along the

lateral border of the scapula; palpated deep in the

posterior axillary fold. Drain the posterior chest

wall and a portion of the arm.

 Lateral nodes: located along the upper hummers.

Drain most of the arm.

01/24/2025 by Meron H. (BScN, MScN) 80
01/24/2025 by Meron H. (BScN, MScN) 81
01/24/2025 by Meron H. (BScN, MScN) 82
Common breast
complaints
 Lump in the breast
 Breast pain
 Nipple discharge and
 Ulceration

01/24/2025 by Meron H. (BScN, MScN) 83

Breast lump
 This is the commonest breast complaint.

 Ask about:

Duration

Any accompanying nipple discharged

How it was first noticed

Change in size \relation to menses.

01/24/2025 by Meron H. (BScN, MScN) 84

Breast pain
It is mostly of inflammatory origin.

 Ask about:

Site, which quadrant

Severity

Associated swelling, lump,

discharge
Relation to menses (cyclic or non

cyclic), Pregnancy, lactation

01/24/2025 by Meron H. (BScN, MScN) 85
 Nipple discharge
 Ask about:

color (bloody, serous, purulent, milky,

etc)
spontaneous Vs non-Spontaneous

 unilateral Vs bilateral

 relation to menstrual cycle

associated breast lump

01/24/2025 by Meron H. (BScN, MScN) 86
Ask for any risk factor s of cancer.
 family history of breast cancer, 1st
degree relation
 age at menarche (<12 years)
age at menopause (>55 years)
history of contra lateral breast cancer
Ask for symptoms of metastatic disease
Bone pain or swelling
Cough, dyspnea, hemoptysis
Jaundice
Neurological abnormalities
01/24/2025 by Meron H. (BScN, MScN) 87
 Physical examination
General principles
 Should be done in a private place with good

illumination.
 Is more informative if done just after the end of

menses.
 Expose the whole upper half of the body

 Always start from the normal breast as it is control

to the abnormal breast.

01/24/2025 by Meron H. (BScN, MScN) 88

Examination of the axillae
 Examine axillae while the woman is sitting.

 Inspect the skin , noting rash or infection

 Lift the woman’s arm and support it your self so

that her muscles are relaxed

 Use your right hand to palpate the left axillae

01/24/2025 by Meron H. (BScN, MScN) 89

 Axillae con’t
 Reach your fingers high in to the axillae and

move them in four directions ;

 Down the chest wall in a line from the

mid axillary
The anterior border of the axillae,

The posterior border and

The inner aspect of the upper arm.

 Usually nodes are not palpable

01/24/2025 by Meron H. (BScN, MScN) 90
 Inspection
Inspect the breasts and nipples with the patient in

the sitting position.

 Examination in the following four views:

 Arms at sides,
 Arms over head,
 Arms pressed against hips, and
 Leaning forward.
01/24/2025 by Meron H. (BScN, MScN) 91
 I. Arms at sides
Note the clinical features listed below
 The appearance of the skin (color, thickening etc.)

 The size and symmetry of the breasts- Some

difference in the size of the breasts common and is

usually normal.
 Look for changes such as masses, dimpling, or

flattening.
 Size, shape, direction in which nipples point etc.
01/24/2025 by Meron H. (BScN, MScN) 92
 II. Arms over Head; Hands Pressed
Against Hips; Leaning Forward.
To bring out dimpling or retraction that may

otherwise be invisible, ask the patient to raise her

arms over her head, then press her hands against
her hips to contract the pectoral muscles.
Inspect the breast contours carefully.

 Redness, thickening and flattening of the normally

convex breast, depression of the nipple may

suggest an underlying breast cancer.
01/24/2025 by Meron H. (BScN, MScN) 93
01/24/2025 by Meron H. (BScN, MScN) 94
Palpation

 Palpation is best performed when the breast

tissue is flattened.
 The patient should be supine.

 Use the finger pads of the 2nd, 3rd, and 4th

fingers, keeping the fingers slightly flexed.

 Technique for detecting breast masses.

 Circular

 vertical strip pattern/parallel lines

01/24/2025 by Meron H. (BScN, MScN) 95
 Palpation con’t

 To examine the lateral portion of the breast, ask

the patient to roll onto the opposite hip,

 Ask to place her hand on her forehead while

keeping the shoulders pressed against examining

table.

 This flattens the lateral breast tissue.

01/24/2025 by Meron H. (BScN, MScN) 96

 Palpation con’t

 Begin palpation in the axillae, moving in a straight

line down to the bra line,

 Then, move the fingers medially and palpate in a

vertical strip up the chest to the clavicle.

 Continue in vertical overlapping strips until you

reach the nipple,

01/24/2025 by Meron H. (BScN, MScN) 97

01/24/2025 by Meron H. (BScN, MScN) 98
 Palpation con’t
 To examine the medial portion of the breast , ask

the patient to lie with her shoulders flat against

the examining table
 Placing her hand at her neck and lifting up her

elbow until it is even with her shoulder.

 Palpate in a straight line down from the nipple to

the bra line, then back to the clavicle, continuing

in vertical overlapping strips to the midsternum.

01/24/2025 by Meron H. (BScN, MScN) 99

Lumps are characterized
as follows:-
 Location: by quadrant /clock, with Cm from the nipple

 Size: in centimeters

 Shape: round or cystic, disc like, or irregular

 Consistency: soft, hard

 Delimitation: well circumscribed or not

 Tenderness

 Mobility:
01/24/2025 in relation to
by Meron H. the
(BScN, skin, and chest wall.
MScN) 100
 Breast self-examination (BSE)
Lying supine
 Lie down with a pillow under your right shoulder.
 Place your right arm behind your head.
 Use the finger pads of the three middle fingers on
your left hand to feel for lumps in the right breast.
 Press firmly enough to know how your breast
feels.
 Check the entire breast area, and remember how
the breast feels from month to month.
 Repeat the examination on your left breast, using
the finger pads of the right hand.
 If any change is detected, health care provider
01/24/2025 by Meron H. (BScN, MScN) 101
BSE: Standing
 Repeat the examination of both breasts while

standing, with one arm behind your head.

 For added safety, you might want to check your

breasts by standing in front of a mirror each month.

 See if there are any changes such as dimpling of

the skin, changes in the nipple, redness, or swelling.

 If any change is detected, health care provider

need to be consulted.

01/24/2025 by Meron H. (BScN, MScN) 102

THANK YOU
01/24/2025 by Meron H. (BScN, MScN) 103