Unit 6 - Breast and Regional Lymphatics

Question 1

The breast is divided into how many quadrants?

Answer 1

4
Lower- Inner/outer
Upper - Inner/outer

Question 2

What quadrant is the Axillary tail of Spence found?

Answer 2

Upper outer quadrant (Projects up & lateral into axilla)

Question 3

What Axillary nodes are found in the breast structures?

Answer 3

Central axillary
Pectoral (Anterior)
Subscapular (Posterior)
Lateral (Humerus)

Question 4

Where does 75% of the lymph drain within the breasts?

Answer 4

Into the same side of the axillary nodes.

Left into the left, right into the right 25% Will go cross body.

Question 5

What is the function of the mammary glands of the breast?

Answer 5

Stimulate hormones associated with pregnancy and child birth.
Synthesis, secretion and ejection of milk (lactation)

Question 6

What is some subjective data that could be collected upon a breast examination?

Answer 6

Pain, Lumps, Discharge, Rash, Swelling, and Trauma to the Breasts.
HX of breast disease and risk factors
PX Surgery
Self care behaviours - BSE, Mammogram

Don’t forget to ask about the Axilla

Question 7

Upon inspection of the breasts - what are we looking for ?

Answer 7

General Appearance
Skin
Lymphatic drainage areas 
Nipple 
Screen for skin retraction - manoeuvres

Question 8

For objective data collected with the Axilla - what are we inspecting and palpating?

Answer 8

Skin, Palpating Lymph nodes

Question 9

What is a firm, transverse ridge of compressed tissue in the lower quadrants of the breast, especially noticeable when palpating large breasts?

Answer 9

Inframammary Ridge

Question 10

Excessive breast development in the male is known as ___________?

Answer 10

Gynecomastia

Question 11

What are Montgomery’s glands?

Answer 11

Sebaceous glands in the areola that secrete protective lipid during lactation; also called tubercles of Montgomery

Question 12

What is dimpling or puckering on the skin; usually resulting from fibrosis in the breast tissue, and may be related to a growing neoplasm.

Answer 12

Retraction

Question 13

What are atrophic pink, purple, or white linear streaks on the skin associated with pregnancy, excessive weight gain, or rapid growth during adolescence.

Answer 13

Striae

Purple is more recent, will fade to pink then to white over time

Question 14

What is a supernumerary nipple?

Answer 14

Extra nipple along the embryonic milk line.

Question 15

The onset of menstruation is know as _______?

Answer 15

Menarche

Question 16

The beginning of breast development is called ________?

Answer 16

Thelarche

Question 17

Mastitis is _____?

Answer 17

Inflammation of the breast tissue; often associated with breastfeeding.

Question 18

The reservoirs for storing milk in the breast are?
A) lobules
B) alveoli
C) Montgomery's glands
D) lactiferous sinuses

Answer 18

D) lactiferous sinuses

Question 19

The most common site of breast tumours is:
A) upper inner quadrant
B) upper outer quadrant
C) lower inner quadrant
D) lower outer quadrant

Answer 19

B) upper outer quadrant

Question 20

During a visit for a school physical, the 13-year-old girl being examined questions the asymmetry of her breasts. The best response is:
A) “One breast may grow faster than the other during development”
B) “I will give you a referral for a mammogram”
C) “ You will probably have fibrocystic disease when you are older.”
D) “This may be an indication of hormonal imbalance. We will check again in six months.”

Answer 20

A) “One breast may grow faster than the other during development”

Question 21

When teaching BSE, you would inform the woman that:
A) All women should perform BSE routinely.
B) there are no risks associated with doing BSE
C) the decision to do BSE is an individual one, based on individual risk factor assessment and comprehensive discussion with one’s health care provider.
D) BSE is the best way to assess a woman’s risk for breast cancer

Answer 21

C) the decision to do BSE is an individual one, based on individual risk factor assessment and comprehensive discussion with one’s health care provider.

Question 22

The Canadian Task Force on Preventative Health Care (2011) recommends a screening mammogram:
A) every year for women aged 40 to 65 years
B) every two to three years for women aged 50 to 69 years
C) twice a year for all women
D) Only the baseline examination is needed unless the woman has symptoms.

Answer 22

B) every two to three years for women aged 50 to 69 years

Question 23

The examiner is going to inspect the woman’s breasts for retraction. The best position for this part of the examination is:
A) lying supine with arms as the sides
B) leaning forward with hands outstretched
C) sitting with hands pushing onto hips.
D) one arm at the side, the other arm elevated

Answer 23

C) sitting with hands pushing onto hips.

Question 24

A bimanual technique may be the preferred approach for a woman:
A) who is pregnant
B) who is having the first breast examination by a health care provider.
C) with pendulous breasts
D) who has felt a change in the breast during self-examination

Answer 24

C) with pendulous breasts

Question 25

During the examination of a 70 year old man, you note gynecomastia. You would:
A) refer for a biopsy
B) refer for a mammogram
C) review his medications for agents that have gynecomastia as a side effect.
D) proceed with the examination. This is a normal part of the aging process.

Answer 25

C) review his medications for agents that have gynecomastia as a side effect.

Question 26

During a breast examination, you detect a mass. Identify the description that is more consistent with cancer rather than benign breast disease.
A) Round, firm, well demarcated
B) irregular, poorly defined, fixed
C) Rubber, mobile, tender
D) Lobular, clear margins, negative skin retraction.

Answer 26

B) irregular, poorly defined, fixed

Question 27

During the examination of the breasts of a pregnant woman, you would expect to find:
A) peau d’orange
B) nipple retraction
C) a unilateral, obvious venous pattern
D) a blue vascular pattern over both breasts

Answer 27

D) a blue vascular pattern over both breasts

Question 28

Which of the following women should not be referred to a physician for further evaluation?
A) A 26-year- old with multiple nodules palpated in each breast
B) A 48 year old who has a six month history of reddened and sore left nipple and areolar area
C) A 25 year old with asymmetrical breasts and inversion of nipples since adolescence
D) a 64 year old with an ulcerated area at the tip of the right nipple, no masses, tenderness, or lymph nodes palpated.

Answer 28

C) A 25 year old with asymmetrical breasts and inversion of nipples since adolescence

Question 29

Breast asymmetry: 
A) increases with age and parity
B) may be normal
C) indicates a neoplasm 
D) is accompanies by enlarged axillary lymph.

Answer 29

B) may be normal

Question 30

Any lump found in the breast should be referred for further evaluation. A benign lesion will usually have three of the following characteristic. Which one would is characteristic of a malignant lesion? 
A) Soft 
B) Well-defined margins
C) freely movable 
D) irregular shape

Answer 30

D) irregular shape

Question 31

Which is the first physical change associated with puberty in girls? 
A) Areolar elevation
B) Breast bud development
C) height spurt
D) Pubic hair development
E) Menarche

Answer 31

B) Breast bud development