Question 1

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

Accepted Answer

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

Question 2

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 3

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 4

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.

Accepted Answer

Of all breast cancers, 77% occur in women older than 50 years. Most women with breast cancer do not possess the BRCA1 or BRCA2 gene. Only 5% to 10% of women with breast cancer are known to have either gene. Most women with breast cancer do not have a mother who had breast cancer. Familial breast cancers occur in 10% to 20% of breast cancer populations. Most women with breast cancer do not continue to menstruate after age 52. Having a later start of menopause does not overshadow the 77% of all breast cancers that occur in women older than 50 years.

Question 5

Montgomery tubercles are most prominent in the breasts of:
A) adult males.
B) patients with lung disease.
C) pregnant women.
D) pubertal females.

Accepted Answer

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

Question 6

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 7

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

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 8

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 9

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.

Accepted Answer

A glass slide and fixative are used for microscopic examination of the discharge to identify its cellular makeup.

Question 10

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.

Accepted Answer

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.

Question 11

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

Accepted Answer

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.

Question 12

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 13

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.

Accepted Answer

Supernumerary nipples usually resemble moles and occur, as this one does, 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.

Question 14

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 15

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.

Accepted Answer

Often one breast is slightly larger than the other. This is a normal variation and no further intervention is required.

Question 16

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.

Quiz 17: Breasts and Axillae

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

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

Most women with breast cancer:

Montgomery tubercles are most prominent in the breasts of:

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

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 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:

If your patient has nipple discharge, you will most likely need a:

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 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?

When conducting a clinical breast examination, the examiner should:

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:

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

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:

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