Question 1

Recent unilateral inversion of a previously everted nipple suggests:
A) mastitis.
B) cancer.
C) benign breast disease.
D) pregnancy.

Accepted Answer

Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy, rather than a benign condition.

Question 2

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.

Accepted Answer

Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder.

Question 3

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

Accepted Answer

Bilateral venous patterns on the breast are commonly found in pregnant or obese women and are of no clinical concern.

Question 4

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.

Accepted Answer

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 5

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

Accepted Answer

Characteristics of cancerous breast masses are irregular or stellate, hard, fixed, nontender, and poorly delineated.

Question 6

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

Accepted Answer

Bilateral nipple inversion to the same extent on both breasts is not a concern. A fixed stone like a nodule, serous nipple drainage, and an unequal nipple axis are results of cancer growth.

Question 7

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.

Accepted Answer

The areola is the most common initial site for visualization of peau d'orange skin.

Question 8

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

Accepted Answer

The incidence of supernumerary nipples is higher in African American women than in white women.

Question 9

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.

Accepted Answer

Gynecomastia associated with illicit or prescription drug use (e.g., antihypertensive drugs, estrogens, steroids) usually resolves after the offending drug is discontinued and does not require further intervention.

Question 10

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.

Accepted Answer

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.

Question 11

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.

Accepted Answer

Documentation of a breast mass location is done 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 12

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

Accepted Answer

During a breast examination, the supraclavicular, lateral axillary, and anterior axillary nodes are typically examined as they are part of the lymphatic drainage system of the breast.

Question 13

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.

Accepted Answer

Simultaneous observation of both breasts is essential to detect differences between breast size, symmetry, contour, and skin color.

Question 14

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.

Accepted Answer

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

Question 15

Lymphatic flow of the breast primarily drains:
A) toward the abdomen.
B) to the corresponding arm.
C) radially.
D) across toward the sternum.

Accepted Answer

The primary direction of lymphatic flow of the breast is radially and deeply to the underlying lymphatics.

Question 16

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.

Accepted Answer

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 17

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.

Accepted Answer

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.

Question 18

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.

Accepted Answer

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

Question 19

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.

Accepted Answer

At the completion of a breast examination, the nipple is compressed by using two fingers gently (normally the thumb and first finger) to depress the tissue inward. Nipple compression to evoke discharge is no longer part of the clinical breast examination.

Question 20

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.

Accepted Answer

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.

Quiz 16: Breasts and Axillae

Recent unilateral inversion of a previously everted nipple suggests:

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

Which of the following is a common benign variation in the breasts of a pregnant woman?

When examining axillary lymph nodes, the patient's arm is:

Which of the following is most likely to be a variation of minor consequence?

In patients with breast cancer, peau d'orange skin is often first evident:

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

Male gynecomastia associated with illicit or prescription drug use can be expected to:

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:

Documentation of a breast mass location is done:

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?

When conducting a clinical breast examination, the examiner should:

A firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient's breast. You should:

Lymphatic flow of the breast primarily drains:

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

A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythemic breasts bilaterally. You should advise the patient to:

The tail of Spence extends:

Palpation of the nipple is done by:

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: