Deck 16: Breasts and Axillae

Question 1

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.
E)alcohol consumption.

Answer 1

its relationship to menses.

Question 2

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
E)Young age at birth of first child.

Answer 2

Nulliparity

Question 3

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
E)Shortening of Cooper's ligaments

Answer 3

Thickening of the inframammary ridge

Question 4

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 covered to respect modesty.
C)dim the lights to minimize anxiety.
D)inspect both breasts simultaneously.
E)begin with palpation of the breasts.

Question 5

Approximately 75% of women are menstruating by which Tanner stage of breast development?

A)Stage 1
B)Stage 2
C)Stage 3
D)Stage 4
E)Stage 5

Question 6

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.
E)associated with a long-standing unchanging nevus.

Question 7

Montgomery tubercles are most prominent in the breasts of

A)men.
B)patients with lung disease.
C)adolescent girls.
D)prepubertal girls.
E)pregnant women.

Question 8

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

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

Question 9

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

A)Alveolus
B)Lactiferous duct
C)Montgomery follicle
D)Tail of Spence
E)Coopers ligament

Question 10

Milk production usually begins during which period?

A)At conception
B)During the first trimester of pregnancy
C)During the second trimester of pregnancy
D)At delivery
E)2 to 4 days after delivery

Question 11

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
E)Peau d'orange appearance

Question 12

Contraction of breast smooth muscle results in

A)benign breast lumps.
B)emptying of milk ducts.
C)nipple inversion.
D)nipple tenderness.
E)tension on the suspensory ligaments of Cooper.

Question 13

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 further 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.
E)recommend she remove caffeine from her diet.

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.
E)tell the patient to stop caffeine intake.

Question 15

Which finding, found 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
E)Lifelong inverted nipple

Question 16

The largest amount of glandular breast tissue lies in the

A)upper inner quadrant.
B)lower inner
C)tail of Spence.
D)upper outer quadrant.
E)lower outer.

Question 17

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.
E)needle and syringe.

Question 18

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)Epithelial secretory activity decreases.
C)Alveoli increase in size and number.
D)Vascularization decreases.
E)Lactiferous ducts diminish.

Question 19

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.
E)stand leaning forward.

Question 20

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).
E)radial portions 1 through 6.

Question 21

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
E) Paget disease of the breast

Question 22

Palpation of the nipple is done by

A)depressing it behind the areola.
B)pressing it against the rib cage.
C)pulling it outward and releasing it.
D)rolling it in a clockwise motion.
E)inverting the nipple.

Question 23

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

A)raised full above the head.
B)extended at the side.
C)pressed against the hip.
D)crossed over the chest.
E)flexed at the elbow.

Question 24

A 12-year-old boy is being seen because of right-sided breast tenderness. Your examination technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pealike mass under the areola. Recommendations to the child and parent are to

A)apply an Ace wrap compression bandage for 6 hours a day.
B)return for evaluation in 6 months if the problem persists.
C)obtain a surgical referral for needle biopsy.
D)discontinue all contact sports.
E)administer urine screen for illicit drugs.

Question 25

During palpation of a 30-year-old woman's breast, she complains that the procedure is painful. You suspect that this may be because she is

A)premenstrual.
B)a heavy smoker.
C)perimenopausal.
D)multiparous.
E)an alcoholic.

Question 26

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

A)fingertips
B)finger pads
C)palms of the hands
D)ulnar surface of the hands
E)thumbs

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.
E)in the tail of Spence.

Question 28

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.
E)sign of late menarche.

Question 29

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.
E)along the sternal border.

Question 30

A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic 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 with a bra and wash her breasts with antibacterial soap.
E)stop nursing and restrict fluids.

Question 31

Documentation of a breast mass location is

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

Question 32

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

Question 33

The mother of a newborn boy tells you that her baby's breasts are swollen and sometimes look as if they are leaking milk. It is most appropriate to tell her that the

A)enlargement and leaking are caused by maternal hormones and will likely resolve without treatment.
B)infant may have a congenital heart defect.
C)infant may need genetic testing.
D)infant needs ultrasonography of the breasts to exclude a pathologic cause.
E)infant may have mastitis.

Question 34

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

A)anterior cervical
B)subscapular
C)brachial
D)supraclavicular
E)internal mammary

Question 35

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.
E)lead to an increased risk of breast cancer.

Question 36

Lymphatic flow of the breast primarily drains

A)inferiorly toward the abdomen.
B)laterally toward the corresponding arm.
C)radially.
D)medially toward the sternum.
E)inferomedially toward the xiphoid.

Question 37

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

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

Question 38

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
E)Nipple and areolar colors do not match.

Question 39

Recent unilateral inversion of a previously everted nipple suggests

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

Question 40

If 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 for biopsy.
C)ask the patient to have a mammogram as soon as possible.
D)record the finding in the patient's record.
E)tell the patient to stop drinking alcohol.

Question 41

The sensitivity of clinical breast exam (CBE) in detecting breast cancer ranges from

A)10% to 20%.
B)20% to 39%.
C)40% to 69%.
D)70% to 89%.
E)88% to 99%.