Chapter 17 (Exam 3)

Question 1

What breast structure drains milk from each lobe onto the surface of the nipple?
A. Alveolus
B. Lactiferous duct
C. Montgomery follicle
D. Tail of Spence
E. Cooper's ligamentANS:

Answer 1

B. Lactiferous duct

Question 2

The largest amount of glandular breast tissue lies in the 
A. upper inner quadrant
B. lower inner quadrant
C. tail of Spence
D. Upper outer quadrant
E. Lower outer quadrant

Answer 2

D. Upper outer quadrant

Question 3

For purposes of examination and communication of physical findings, the breast is divided into
A. Halves (upper and lower)
B. Thirds (left, middle, and right
C. Four quadrants plus a tail
D. Circles (six consecutive rings, each 1 inch farther away from the nipple)
E. Radial portions 1-6

Answer 3

C. Four quadrants plus a tail

Question 4

Contraction of breast smooth muscle results in
A. Benign breast lumps
B. Emptying of milk ducts
C. Nipple inversion
D. Nipple tenderness
E. Tension on the suspensory ligament of Cooper

Answer 4

B. Emptying of milk ducts

Contraction of the breast smooth muscle, as a result of tactile, sensory, or autonomic stimuli,
produces erection of the nipple and causes the milk ducts to empty.

Question 5

Montgomery tubercles are most prominent in the breast of 
A. Men
B. Patients with lung disease
C. Adolescent girls
D. Prepubertal girls
E. Pregnant women

Answer 5

E. Pregnant women

Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women.

Question 6

Approximately 75% of women are menstruating by which Tanner stage of breast development?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
E. Stage 5

Answer 6

D. Stage 4

About one fourth of women begin menstruation at stage 4. Approximately 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5

Question 7

During pregnancy, which of the following changes normally occurs in the breasts because of the effects of luteal and placental hormones?
A. The amount of connective tissue increases
B. Epithelial secretory activity decreases
C. Alveoli increase in size and number
D. Vascularization decreases
E. Lactiferous ducts diminish

Answer 7

C. Alveoli increase in size and number

Breast changes during pregnancy include lactiferous duct proliferation, an increase in alveoli and glandular tissue that displaces connective tissue, and an increase in mammary vascularization. As a result, the breasts are larger, softer, and looser with a blue venous network visible through the skin.

Question 8

Milk production usually begins during which period?
A. At conception
B. During the first trimester
C. During the second trimester
D. At delivery
E. 2-4 days after delivery

Answer 8

E. 2-4 days after delivery

Colostrum secretion begins after delivery and then is replaced with milk production within 2 to 4 days.

Question 9

Which breast change is typical after menopause?
A. Thickening of the inframammary ridge
B. Hypertrophy of glandular tissue
C. Increase in number of lactiferous ducts
D. Reduction of fat deposits
E. Shortening of Cooper’s ligaments

Answer 9

A. Thickening of the inframammary ridge

After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely as Cooper’s ligaments relax.

Question 10

In a woman complaining of a breast lump, it is most important to ask about
A. Its relationship to menses
B. Weight gain
C. Sleep patterns
D. Immunization status
E. Alcohol consumption

Answer 10

A. Its relationship to menses

Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation.

Question 11

When conducting a clinical breast exam, the examiner should
A. forgot the exam if the patient has had a recent mammogram
B. Keep the patient covered to respect modesty
C. Dim the lights to minimize anxiety
D. Inspect both breast simultaneously
E. Begin with palpation of the breasts

Answer 11

D. Inspect both breast simultaneously

Inspection with simultaneous observation of both breasts is essential in order to detect differences between the breast size, symmetry, contour, and skin color.

Question 12

A 50y/o 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
E. Young age at birth of first child

Answer 12

C. Nulliparity

Nulliparity or late age at birth of 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.

Question 13

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
E. Needle and syringe

Answer 13

B. Glass slide and fixative

A glass slide and fixative is used for microscopic examination of the discharge to identify the cellular makeup of the discharge. The other options are not used for this purpose.

Question 14

To begin the clinical breast exam (CBE) for a man, ask him to
A. Recline on the table with his arms over his head
B. Sit with his arms hanging at his sides
C. Sit with his hands on his hips
D. Stand with his arms clasped behind his back
E. Stand leaning forward

Answer 14

B. Sit with his arms hanging at his sides

Inspection begins the CBE. Ask the patient to sit with his arms hanging loosely at his sides. The technique is the same for both men and women.

Question 15

Inspection of the breast usually begins with the patient in which position?
A. Lateral
B. Sitting
C. Standing
D. Supine
E. Prone

Answer 15

B. Sitting

Question 16

While examining a 30y/o 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 ASAP
D. Tell the patient to get a mammary sonogram ASAP
E. Tell the patient to stop caffeine intake

Answer 16

A. Note the finding in the patient’s record

Question 17

Which finding, found on inspection, is related to fibrotic tissue changes that occur with breast carcinoma?
A. Convex or conical shape
B. Skin dimpling or retraction
C. Pendulous and loose breasts
D. Unequal shape or contour
E. Lifelong inverted nipple

Answer 17

B. Skin dimpling or retraction

Skin dimpling or retraction signifies the contraction of fibrotic tissue that occurs with carcinoma. The other choices are normal variations without significance to cancer development.

Question 18

Venous patterns on breasts are suggestive of pathology when they are
A. Bilaterally visible
B. Seen in obese patients
C. Unilateral
D. Observed during pregnancy
E. Associated with a long-standing unchanged nevus

Answer 18

C. Unilateral

Malignant tumors require more blood flow. Superficial veins dilate to provide more flow and can be assessed as unilateral venous patterns. Bilateral findings are of no concern and are more commonly seen in pregnant or obese women. Nevi that are long-standing, unchanging, or nontender are of little concern.

Question 19

Which of the following is a common benign variation in the breasts of a pregnant woman?
A. Unilateral leakage of bloody fluid
B. Bilateral leakage of bloody fluid
C. Bilateral pronounced venous patterns
D. Reddened areas in the tail of Spence
E. Peau d'orange appearance

Answer 19

C. Bilateral pronounced venous patterns

Bilateral venous patterns on the breast are commonly found in pregnant and obese women and are of no clinical concern. The other choices indicate either mastitis or breast cancer, which are not common findings.

Question 20

A 23y/o white woman has come to the clinic because she missed two menstrual periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further 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 appt with a surgeon
E. Recommend she remove caffeine from her diet

Answer 20

B. Suggest pregnancy testing

In light-skinned women, pregnancy produces enlarged breasts with darker areolae. Hormonal injections, caffeine, and the use of tanning beds will not change the color of the areolae as pregnancy does. Surgical consultation is not necessary.

Question 21

In patient 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
E. In the tail of Spence

Answer 21

C. On or around the nipple

The areola is the most common initial site to visualize peau d’orange skin.

Question 22

A peppering on contender, nonsuppurative Montgomery tubercles is considered to be a 
A. Normal finding
B. Sign of carcinoma
C. Skin disease
D. Symptom of malnutrition 
E. Sign of late menarche

Answer 22

A. Normal finding

Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage.

Question 23

Which of the following is most likely to be a variation of minor consequence?
A. Bilateral nipple inversion
B. Fixed stonelike nodule
C. Serous nipple drainage
D. Unequal nipple axis
E. Paget disease of the breast

Answer 23

A. Bilateral nipple inversion

Bilateral nipple inversion to the same extent on both breasts in not a concern. The other choices are a result of cancer growth, affecting the surrounding tissue.

Question 24

Recent unilateral inversion of a previously everted nipple suggests
A. Obesity
B. Cancer
C. Benign breast disease
D. Pregnancy
E. Mastitis

Answer 24

B. Cancer

Question 25

Which condition is more common in African American woman than in white women?
A. Light areolae
B. Nipple inversion
C. Retracted areolae
D. Supernumerary nipples
E. Nipple and areolar colors do not match

Answer 25

D. Supernumerary nipples

Question 26

When palpating breast tissue, the examiner should use the \_\_\_\_\_ at each site. 
A. Fingertips
B. Finger pads
C. Palms of the hands
D. Ulnar surface of the hands
E. Thumbs

Answer 26

B. Finger pads

Question 27

Documentation of a breast mass location is
A. According to illustration, without a narrative
B. According to clock positions from the nipple
C. Measured with calipers from the nipple
D. Measured in centimeters from the sternal notch
E. Measured in centimes from the axilla

Answer 27

B. According to clock positions from the nipple

Documenting a breast mass is described according to clock positions and distance from the nipple, or according to quadrants of the breast. An illustration should appear in the medical record as well.

Question 28

If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40y/o patient’s breast, you should
A. Ask the patient if she has a history of breast cancer
B. Refer the patient for biopsy
C. Ask the patient to have a mammogram ASAP
D. Record the finding in the patient’s record
E. Tell the patient to stop drinking alcohol

Answer 28

D. Record the finding in the patient’s record

The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action.

Question 29

During the palpation of a 30y/o woman's breast, she complains that the procedure is painful. You suspect this may be because she is 
A. Premenstrual
B. A heavy smoker
C. Perimenopausal
D. Mulitparous
E. An alcoholic

Answer 29

A. Premenstrual

Women’s breasts are more tender during the premenstrual and menstrual periods than during any other time of the menstrual cycle because hormone changes cause the breasts to swell and increase nodularity. Clinical breast examinations should be scheduled for 1 week after the start of the menstrual flow.

Question 30

A 12y/o boy is being seen because of right-sided breast tenderness. Your exam technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pea like mass under the areola. Recommendation to the child and parent are to
A. Apply an ace wrap compression bandage 6hrs/day
B. Return for eval in 6 months if the problem persists
C. Obtain a surgical referral for needle biopsy
D. Discontinue all contact sports
E. Administer urine screen for illicit drugs

Answer 30

B. Return for eval in 6 months if the problem persists

Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. Reassurance to the young man that this is a common occurrence is essential.

Question 31

The tail of Spence extends 
A. Into the midclavicular region
B. Toward the supraclavicular area
C. Down into the inframammary ridge
D. Into the axillae
E. Along the sternal border

Answer 31

D. Into the axillae

The tail of Spence extends from the upper outer breast quadrant into the axillae.

Question 32

To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with
A. Her arms straight alongside her body
B. Both arms overhead with her palms outward
C. Her hands clasped just above her umbilicus
D. One arm overhead and a pillow under her shoulder
E. Both hands pressed against her hips

Answer 32

D. One arm overhead and a pillow under her shoulder

Question 33

Palpation of the nipple is done by 
A. Depressing it behind the areola
B. Pressing it against the rib cage
C. Pulling it outward and releasing it
D. Rolling it in a clockwise motion
E. Inverting the nipple

Answer 33

A. Depressing it behind the areola

At the completion of the examination, return to the nipple and with two fingers gently depress the tissue inward into the well behind the areola. Your fingers and tissue should move easily inward, nipple compression to evoke discharge is no longer part of the clinical breast examination.

Question 34

When examining axillary lymph nodes, the patient's arm is 
A. Raised full above the head
B. Extended at the side
C. Pressed against the hip
D. Crossed over the chest
E. Flexed at the elbow

Answer 34

E. Flexed at the elbow

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.

Question 35

Lymphatic flow of the breast primarily drains
A. Inferiorly toward the abdomen
B. Laterally toward the corresponding arm
C. Radially
D. Medially toward the sternum
E. Inferomedially toward the xyphoid

Answer 35

C. Radially

Each breast contains a lymphatic network that drains the breast radially and deeply to underlying lymphatics.

Question 36

The greatest concern for breast cancer is when you palpate \_\_\_\_\_ nodes.
A. Anterior cervical 
B. Subscapular
C. Brachial 
D. Supraclavicular
E. Internal mammary

Answer 36

D. Supraclavicular

The supraclavicular and infraclavicular nodal areas are sentinel nodes; any enlargement in these areas is especially significant.

Question 37

You are performing a clinical breast exam for a 55y/o woman. While palpating the supraclavicular area, you suspect that you felt a node. To improve your hooked technique, you should
A. Apply lotion to your hands
B. Use both hands simultaneously
C. Ask the patient to press both palms together
D. Asked the patient to lower her shoulder on that side
E. Ask the patient to turn her head toward that side

Answer 37

E. Ask the patient to turn her head toward that side

Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa.

Question 38

The mother of a newborn boy tells you that her baby’s breasts are swollen and sometimes look as if they are leaking milk. It is most appropriate to tell her that the
A. Enlargement and leaking are caused by maternal hormones and will likely resolve without treatment
B. Infant may have a congenital heart defect
C. Infant may need genetic testing
D. Infant needs US of the breasts to exclude a pathologic cause
E. Infant may have mastitis

Answer 38

A. Enlargement and leaking are caused by maternal hormones and will likely resolve without treatment

Maternal passive transfer of estrogen to the infant can result in enlarged breasts of the newborn. Squeezed gently, the breast can excrete a small amount of clear or milky white fluid. This condition resolves spontaneously within 2 weeks and rarely lasts beyond 3 months.

Question 39

Male gynecomastia associated with illicit or prescription drug use can be expected to
A. Lessen when the body becomes accustomed to the drug
B. Resolve after the drug is discontinued
C. Leave permanent breast enlargement when the drug is discontinued
D. Cause purulent drainage if left untreated
E. Lead to an increased risk of breast cancer

Answer 39

B. Resolve after the drug is discontinued

Question 40

A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic 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 with a bra and wash her breasts with antibacterial soap
E. Stop nursing and restrict fluids

Answer 40

A. Massage gently and continue nursing

This patient has engorged breasts. The aim of treatment is to promote breast drainage. Stopping nursing will increase the risk that a breast infection will turn into a breast abscess. The other choices do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and crack the nipple and compound infection.

Question 41

You are conducting a clinical breast exam for a 30y/o patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely moveable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with
A. Fibroadenoma
B. Paget disease
C. Cancer
D. Mammary duct ectasia
E. Fibrocystic changes

Answer 41

E. Fibrocystic changes

Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, well-delineated borders. Fibroadenoma and cancer are usually nontender; Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women.

Question 42

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 in contender 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. Retention cyst
B. Case of Paget disease
C. Supernumerary nipple
D. Fat necrosis
E. Montgomery tubercle

Answer 42

C. Supernumerary nipple

Supernumerary nipples appear as one or more extra nipples located along the embryonic mammary ridge (the “milk line”). These nipples and areolae may be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples.

Question 43

The sensitivity of CBE in detecting breast cancer ranges from 
A. 10-20%
B. 20-29%
C. 40-69%
D. 70-89%
E. 88-99%

Answer 43

C. 40-69%

The sensitivity of CBE in detecting breast cancer ranges from 40% to 69%, and the specificity ranges from 88% to 99%. The sensitivity of the CBE combined with mammography is greater than that of mammography alone because CBE can detect cancer missed by mammography.