Deck 16: Breasts and Axillae

Question 1

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

Answer 1

Nulliparity

Question 2

Montgomery tubercles are most prominent in the breasts of:

A) adult males.
B) patients with lung disease.
C) pregnant women.
D) pubertal females.

Answer 2

pregnant women.

Question 3

Milk production usually begins during which period?

A) At conception
B) During the first trimester of pregnancy
C) Immediately before delivery
D) Two to 4 days after delivery

Answer 3

Two to 4 days after delivery

Question 4

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 nipple).

Question 5

Mrs. Simmler brings in her adolescent daughter for a routine physical examination. As you are explaining the health promotion activities, you remind the patient that approximately 75% of females are menstruating by which Tanner stage of breast development?

A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4

Question 6

To begin the clinical breast examination (CBE) for a man, ask him to:

A) recline on the table, with his arms overhead.
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.

Question 7

Mrs. Jones, a 45-year-old patient, comes into the office today with a complaint of a breast lump. 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.

Question 8

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.

Question 9

Contraction of breast smooth muscle results in:

A) benign breast lumps.
B) the emptying of milk ducts.
C) nipple inversion.
D) nipple tenderness.

Question 10

Which finding, 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

Question 11

Mrs. Kemmerer is a 56-year-old patient who presents to the office for a routine annual examination. She states that she completed menopause 3 years ago and has not had further menses. 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

Question 12

Which breast structure drains milk from each lobe onto the surface of the nipple?

A) Axillary drain
B) Lactiferous duct
C) Latissimus dorsi
D) Tail of Spence

Question 13

While collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding her:

A) history of medication allergies.
B) alcohol, tobacco, and caffeine use.
C) level of personal education.
D) amount of personal income.

Question 14

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.

Question 15

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.

Question 16

Inspection of the breasts usually begins with the patient in which position?

A) Lateral
B) Sitting
C) Standing
D) Supine

Question 17

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) The epithelial secretory activity decreases.
C) The alveoli increase in size and number.
D) Vascularization decreases.

Question 18

Most women with breast cancer:

A) possess the BRCA1 or BRCA2 gene.
B) risk increases with aging.
C) have a mother who had breast cancer.
D) continue to menstruate after age 52.

Question 19

The largest amount of glandular breast tissue lies in the:

A) area next to the ribs.
B) lower half of chest.
C) tail of Spence.
D) upper outer quadrant.

Question 20

Which of the following arteries provides blood supply to the breast?

A) Retromammary and external mammary
B) Lateral thoracic and internal mammary
C) Medial thoracic and internal mammary
D) Lateral thoracic and external mammary

Question 21

Recent unilateral inversion of a previously everted nipple suggests:

A) mastitis.
B) cancer.
C) benign breast disease.
D) pregnancy.

Question 22

To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine, with:

A) her arms straight alongside of her body.
B) both arms overhead with palms upward.
C) her hands clasped just above the umbilicus.
D) one arm overhead and a pillow under her shoulder.

Question 23

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

Question 24

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.

Question 25

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?

A) Immobile and firm
B) Pain on palpation
C) Irregular border edges
D) Mobile and rubbery
E) Nontender

Question 26

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

Question 27

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.

Question 28

Which condition is more common in African American women than in white women?

A) Light areolae
B) Nipple inversion
C) Retracted areolae
D) Supernumerary nipples

Question 29

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.

Question 30

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.

Question 31

Documentation of a breast mass location is done:

A) according to illustration, without a narrative.
B) according to clock positions from the nipple.
C) by measuring with calipers from the nipple.
D) by measuring in centimeters from the sternal notch.

Question 32

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?

A) Supraclavicular
B) Lateral axillary nodes
C) Anterior cervical nodes
D) Anterior axillary nodes
E) Posterior cervical nodes

Question 33

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.

Question 34

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.

Question 35

Lymphatic flow of the breast primarily drains:

A) toward the abdomen.
B) to the corresponding arm.
C) radially.
D) across toward the sternum.

Question 36

A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a:

A) normal finding.
B) sign of carcinoma.
C) skin disease.
D) symptom of malnutrition.

Question 37

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.

Question 38

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.

Question 39

Palpation of the nipple is done by:

A) compressing it between the thumb and forefinger.
B) pressing it against the rib cage.
C) pulling it outward and releasing it.
D) rolling it in a clockwise motion.

Question 40

You are performing a clinical breast examination for a 55-year-old woman. While palpating the supraclavicular area, you suspect that you feel 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) ask the patient to turn her head toward that side.

Question 41

When palpating breast tissue, the examiner should use ______________ at each site.

Question 42

Which of the following muscles form the floor of the breast?

A) Pectoralis major
B) Pectoralis minor
C) Serratus posterior
D) Internal oblique
E) Rectus abdominis

Question 43

The greatest concern for breast cancer is when you palpate _______________ nodes.