Chapter 17: Breasts and Axillae Flashcards
Montgomery tubercles are most prominent in the breasts of
a. adult males.
b. patients with lung disease.
c. pregnant women.
d. pubertal females.
ANS: C
Montgomery tubercles undergo hypertrophy and become more prominent in the breasts of
pregnant and lactating women.
Most women with breast cancer
a. lack the BRCA1 or BRCA2 gene.
b. risk increases with aging.
c. have a aunt who had breast cancer.
d. continue to menstruate after age 52.
ANS: B
Risk of breast cancer increases with aging. Female patient’s with inherited BRCA1 or BRCA2
mutation have a 45% to 80% chance of developing breast cancer during their lifetime. Having a first-degree relative with breast cancer doubles the risk. Menopause after the age of 55
slightly increases the risk
A 50-year-old woman presents as a new patient. Which finding in her personal and social
history would increase her risk profile for developing breast cancer?
a. Drinking three glasses of wine per week
b. Early menopause
c. Nulliparity
d. Late menarche
ANS: C
Nulliparity, or late age at the birth of the first child (after 30 years old), is a risk factor for
breast cancer. Other risk factors include late menopause, early menarche, and drinking more
than one alcoholic drink daily
If your patient has nipple discharge, you will most likely need a
a. Vacutainer tube.
b. glass slide and fixative.
c. specimen jar with formaldehyde.
d. tape strip to test pH.
ANS: B
A glass slide and fixative are used for microscopic examination of the discharge to identify its
cellular makeup.
While examining a 30-year-old woman, you note that one breast is slightly larger than the
other. In response to this finding, you should
a. note the finding in the patient’s record.
b. ask the patient if she has ever had breast cancer.
c. tell the patient to get a mammogram as soon as possible.
d. tell the patient to get a mammary sonogram as soon as possible
ANS: A
Often one breast is slightly larger than the other. This is a normal variation and no further
intervention is required.
A 23-year-old white woman has come to the clinic because she has missed two menstrual
periods. She states that her breasts have enlarged and that her nipples have turned a darker
color. Your response to this finding is to
a. instruct her that this is a side effect of birth control injection therapy.
b. suggest pregnancy testing.
c. question her use of tanning beds.
d. schedule an appointment with a surgeon.
ANS: B
In light-skinned women, pregnancy produces enlarged breasts with a darker areola. Neither
hormonal injections nor the use of tanning beds will change the color of the areola as does
pregnancy. Surgical consultation is not necessary.
In patients with breast cancer, peau d’orange skin is often first evident
a. in the axilla.
b. in the upper inner quadrant.
c. on or around the nipple.
d. at the inframammary ridge.
ANS: C
The areola is the most common initial site for visualization of peau d’orange skin.
A firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a
40-year-old patient’s breast. You should
a. ask the patient if she has a history of breast cancer.
b. refer the patient to a surgeon.
c. ask the patient to have a mammogram as soon as possible.
d. record the finding in the patient’s record.
ANS: D
The inframammary ridge thickens and can be felt more easily with age. It is an expected,
normal finding, without indications for further action.
DIF:Cognitive Level: Applying (Application)
When examining axillary lymph nodes, the patient’s arm is
a. raised fully above the head.
b. extended at the side.
c. flexed at the elbow.
d. crossed over the chest.
ANS: C
To examine the axilla, support the patient’s lower arm with the elbow flexed with one of your
hands and use your other hand to palpate the axilla
A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythemic
breasts bilaterally. You should advise the patient to
a. massage gently and continue nursing.
b. apply warm compresses and stop nursing.
c. monitor her temperature and restrict fluids.
d. sleep wearing a bra and wash her breasts with antibacterial soap.
ANS: A
This patient has mastitis. The aim of treatment is to promote breast drainage. You should not
advise the patient to apply warm compresses and stop nursing. Applying warm compresses
will not encourage breast milk flow, and stopping nursing will increase the risk of a breast
infection turning into a breast abscess. Monitoring her temperature and restricting fluids do
not encourage breast milk flow. Sleeping with a bra and washing the breasts with antibacterial
soap do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and
crack the nipple and compound infection.
You are conducting a clinical breast examination for your 30-year-old patient. Her breasts are
symmetric, with bilateral, multiple tender masses that are freely movable and with
well-defined borders. You recognize that these symptoms and assessment findings are
consistent with
a. fibroadenoma.
b. Paget disease.
c. cancer.
d. fibrocystic changes.
ANS: D
Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile,
well-delineated borders. A fibroadenoma is usually nontender. Paget disease is an eczema-like
condition of the nipple that signals an underlying cancer. Cancer is usually nontender.
Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is nontender and soft and has grown in size since she
started nursing. There are no other changes to the mole. This mole probably represents an
undiagnosed
a. Montgomery tubercle.
b. case of Paget disease.
c. supernumerary nipple.
d. fat necrosis.
ANS: C
Supernumerary nipples usually resemble moles and occur, as in this example, along the milk
line. Those that have glandular tissue may enlarge under hormonal influences. They may not
be recognized as extra nipples in infants because they are usually small and not well formed.
When conducting a clinical breast examination, the examiner should
a. forgo the examination if the patient has had a recent mammogram.
b. keep the patient’s breasts completely covered to respect modesty.
c. dim the lights to minimize anxiety.
d. inspect both breasts simultaneously.
ANS: D
Simultaneous observation of both breasts is essential to detect differences between breast size,
symmetry, contour, and skin color.
Mrs. Weber is a 65-year-old patient who has presented at the clinic with a complaint of a
tender breast mass that she discovered during breast self-examination. You have completed a physical examination on Mrs. Weber and have palpated a mass of the right breast in the lower
outer quadrant. When providing patient education to Mrs. Weber regarding the breast mass,
you will explain that the characteristics of a cancerous mass would be which of the following?
(Select all that apply.)
a. Immobile and firm
b. Pain on palpation
c. Irregular border edges
d. Mobile and rubbery
e. Nontender
ANS: A, C, E
Characteristics of cancerous breast masses are irregular or stellate, hard, fixed, nontender, and
poorly delineated.
Ms. Lawson is a 41-year-old patient who presents for a routine annual examination. During her breast examination, you are also completing a lymphatic examination. Which of the
following lymph nodes are examined during a breast examination? (Select all that apply.)
a. Supraclavicular
b. Lateral axillary nodes
c. Anterior cervical nodes
d. Anterior axillary nodes
e. Posterior cervical nodes
ANS: A, B, D
During a routine breast examination it is common practice to examine lymph nodes. When
enlarged and fixed, lymph nodes can indicate the presence of cancer. Common lymph nodes
included in this examination are the supraclavicular, lateral axillary, and posterior cervical
lymph nodes
