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?

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 2

Montgomery tubercles are most prominent in the breasts of:

Accepted Answer

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

Question 3

Milk production usually begins during which period?

Accepted Answer

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

Question 4

For purposes of examination and communication of physical findings, the breast is divided into:

Accepted Answer

The breast is referenced according to five segments: four quadrants and a tail.

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?

Accepted Answer

Approximately 75% are menstruating at stage 4, the stage at which the areola forms a second mound. About 25% of females begin menstruation at stage 3.

Question 6

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

Accepted Answer

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

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:

Accepted Answer

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

Question 8

Venous patterns on breasts are suggestive of pathology when they are:

Accepted Answer

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.

Question 9

Contraction of breast smooth muscle results in:

Accepted Answer

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 10

Which finding, on inspection, is related to fibrotic tissue changes that occur with breast carcinoma?

Accepted Answer

Skin dimpling or retraction signifies the contraction of fibrotic tissue that occurs with carcinoma.

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?

Accepted Answer

After menopause, the breast tissue atrophies and is replaced by fat deposits, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely.

Question 12

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

Accepted Answer

The lactiferous duct is the structure that drains milk from each lobe onto the surface of the nipple.

Question 13

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

Accepted Answer

Collecting information about the patient's alcohol, tobacco, and caffeine use can help identify potential risk factors for breast cancer and breast discomfort. It is not necessary to gather information about medication allergies, personal education level, or personal income for this particular complaint.

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:

Accepted Answer

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

Question 15

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

Accepted Answer

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

Question 16

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

Accepted Answer

Inspection of the breasts begins with the patient in a sitting position, with the arms hanging loosely at the sides.

Question 17

During pregnancy, which of the following changes normally occurs in the breasts because of the effects of luteal and placental hormones?

Accepted Answer

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

Question 18

Most women with breast cancer:

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 19

The largest amount of glandular breast tissue lies in the:

Accepted Answer

The greatest amount of glandular tissue in the breast lies in the upper outer quadrant.

Question 20

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

Accepted Answer

The lateral thoracic and internal mammary arteries provide most of the blood supply to the breast and nipple tissues.

Quiz 16: Breasts and Axillae