Breast Exam Practice Questions 2

Question 1

What does the circulus venosus do?

Answer 1

Drains blood from the breast to the internal mammary vein

Question 2

Where is the circulus venosus located?

Answer 2

Around the base of the nipple
- anastomotic venous circle

Question 3

What do the areolar glands do?

Answer 3

Serve to lubricate the nipple and areola during lactation

Question 4

What’s another name for areolar glands?

Answer 4

Glands of Montgomery

Question 5

What characteristics do normal lymph nodes demonstrate? (2)

Answer 5

1. Echogenic hilum
2. Wider than deep (oval shape)

Question 6

Where does the tail of spence extend from?

Answer 6

From the upper outer quadrant of the breast into the axilla

Question 7

Does the Tail of Spence have a higher or lower incidence of breast cancers? Why?

Answer 7

1. Higher
2. Lymphatic drains through that site

Question 8

What is oxytocin responsible for? (4)

Answer 8

1. Milk ejection reflex
2. Contraction of the lactiferous ducts
3. Contraction of the uterus
4. Enhancing milk outflow

Question 9

How does the deep pectoral fascia show up on US?

Answer 9

Hyperechoic, horizontal band

Question 10

What does the deep pectoral separate?

Answer 10

The pectoral muscle from the overlying glandular and fatty tissue

Question 11

Where is the most frequent zone for breast cancer?

Answer 11

Mammary zone

Question 12

What zone undergoes the most change during pregnancy?

Answer 12

Mammary zone

Question 13

What underlying condition is thought to be the primary cause of gynecomastia?

Answer 13

High concentration of estrogen

Question 14

What are possible causes of gynecomastia? (6)

Answer 14

1. Drugs (eg. marijuana, digitalis)
2. Liver cirrhosis
3. Hormone disorders
4. Hyperthyroidism
5. Chronic renal disease
6. Dialysis

Question 15

What is the most important route for lymphatic drainage for the breast?

Answer 15

To the axillary nodes vie the posterior intercostal nodes

Question 16

What % does most of the draining occur along the inferior border of the pectoralis major muscle from the posterior intercostal nodes to the axillary lymph nodes via the tail of Spence?

Answer 16

75%

Question 17

What type of breast tissue is post menopausal breast most composed of?

Answer 17

Fat

Question 18

Where do intramammary lymphatic drainage pathways converge at beneath the nipple?

Answer 18

Plexus of Sappey

Question 19

What is Plexus of Sappey also known as?

Answer 19

Subareolar Plexus

Question 20

What layer of the breast contains a large number of Cooper’s ligaments?

Answer 20

Subcutaneous layer

Question 21

What is the subcutaneous layer bounded by (anterior and posterior)?

Answer 21

1. Anteriorly by the dermis
2. Posteriorly by the superficial fascial plane

Question 22

What layer contains the most fat lobules?

Answer 22

Subcutaneous layer

Question 23

What % do the internal mammary chain of lymph nodes drains of breast lymph?

Answer 23

20-25%

Question 24

What structure in the breast are other structures compared to for echogenicity?

Answer 24

Fat
- medium grey

Question 25

What is colostrum?

Answer 25

Fatty degeneration of the solid content in the alveoli when lactation begins

Question 26

What technique is considered most useful when trying to confirm a suspected rib and not a malignant tumour?

Answer 26

Rotate the transducer 90deg to demonstrate elongation of the rib

Question 27

What is the principle course of blood to the breast?

Answer 27

The internal mammary artery

Question 28

What age do female breasts begin to atrophic?

Answer 28

40

Question 29

What are the stromal elements of the breast? (4)

Answer 29

1. Loose connective tissue 2. Dense connective tissue 3. Fat 4. Skin

Question 30

How many lobes do each breast contain?

Answer 30

15-20

Question 31

What is the basic functional component of the human breast?

Answer 31

Terminal duct lobular unit

Question 32

TDLU

Answer 32

Terminal duct lobular unit

Question 33

Small, hypoechoic spaces that may be identified when following lactiferous ducts to their origins, represent, what?

Answer 33

Acini or alveoli

Question 34

During the 4th week of gestation, where do the breasts initially develop from?

Answer 34

The ectoderm - as paired mammary ridges or milk lines

Question 35

What is the nipple composed of?

Answer 35

20 lactiferous ducts

Question 36

What is area called where the lymph nodes located medially along the inner aspect of the breast behind the sternum?

Answer 36

Internal mammary nodes

Question 37

What thickness of a lymph node should the cortex not exceed?

Answer 37

4mm

Question 38

What does each normal lobular unit, measure up to?

Answer 38

2mm

Question 39

What is area called where the lymph nodes located between the pectoralis minor and pectoralis major muscles?

Answer 39

Rotters nodes

Question 40

What is area called where the lymph nodes located inferior/medially?

Answer 40

Subcutaneous nodes

Question 41

What is area called where the lymph nodes located laterally?

Answer 41

Posterior intercostal nodes

Question 42

What does each TDLU consist of? (2)

Answer 42

1. Extralobular terminal duct 2. Lobule

Question 43

Why are extremely dense breasts on a mammo challenging for the radiologist to read?

Answer 43

The fibrous tissue masks possible lesions

Question 44

What is Witch's milk?

Answer 44

A liquid similar to colostrum

Question 45

How is Witch's milk secreted?

Answer 45

By the newborn

Question 46

What hormone is secreted from the anterior pituitary gland?

Answer 46

Prolactin

Question 47

What hormone is secreted from the posterior pituitary gland?

Answer 47

Oxytocin

Question 48

What hormone has to be high in order to produce milk?

Answer 48

Prolactin

Question 49

What hormone enhances milk outflow by contracting the lactiferous ducts?

Answer 49

Oxytocin

Question 50

What is the proper path milk travels through the ducts (starting with the basic functional unit)? ()

Answer 50

1. TDLU 2. Subsegmental ducts 3. Major subareolar ducts 4. Ampulla 5. Nipple

Question 51

How does ductal ectasia show on US?

Answer 51

Demonstrates ducts as anechoic or with fine internal echoes

Question 52

Approximately what percentage of patents that have ductal ectasia present with nipple discharge?

Answer 52

50%

Question 53

When US is used as a supplemental screening tool for women with dense breast, what is the approximate increase in breast cancer detection?

Answer 53

40%

Question 54

What do the Glands of Montgomery thicken?

Answer 54

Areolar

Question 55

What happens to the fat lobules in the subcutaneous layer compared to the retromammary layer?

Answer 55

They become larger than the lobules in the retromammary layer

Question 56

What are Rotter nodes also known as?

Answer 56

Interpectoral nodes

Question 57

What are the risk factors from male breast cancer? (5)

Answer 57

1. Advanced age 2. Radiation exposure 3. Occupational heat exposure 4. Family history of breast cancer 5. Treatment with estrogen hormones for prostate cancer

Question 58

What happens to the breast in the involution process, if a patient undergoes HRT?

Answer 58

It delays it

Question 59

How is blood supplied to the medial aspect of the breast through?

Answer 59

Perforating arteries

Question 60

The target zone in the TDLU is the site of what percentage of precancerous epithelial proliferations?

Answer 60

50%

Question 61

In a non-lactating patient, what size should the ducts not exceed?

Answer 61

2mm

Question 62

What does the male breast not contain? (3)

Answer 62

1. Cooper's ligaments 2. Acini 3. Lobules

Question 63

What is the common pathology of the male breast?

Answer 63

Gynecomastia

Question 64

Where is the most common location for male breast cancer?

Answer 64

Retroareolar

Question 65

Approximately what percentage of women have breasts that are considered mammographically dense?

Answer 65

40-43%

Question 66

Where is the mammary layer located between?

Answer 66

Between the superficial and deep layers of the superficial pectoral fascia

Question 67

In which situation is routine annual or biennial screening recommended for transgender women aged 50 years or older?

Answer 67

When the patient has been receiving hormone treatment for more than 5 years

Question 68

What is the 2nd most common pathology found in male breasts?

Answer 68

Pseudogynecomastia

Question 69

What hormone have to be high to produce milk? (1) What hormones have to be low? (2)

Answer 69

1. Prolactin 2. Estrogen 3. Progesterone

Question 70

What is another term of the anastomotic circle of venous drainage around the base of the nipper called?

Answer 70

Circulus venosus

Question 71

What is the most common reason for imaging the male breast?

Answer 71

Asymmetry or enlargement

Question 72

What week of gestation does the mammary bud become evident?

Answer 72

5th week

Question 73

What are parenchymal elements of the breast? (4)

Answer 73

1. Alveoli 2. Lobules 3. Lobes 4. Ducts