Chapter 17 (Exam 3) Flashcards by Cody Prentice

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. Cooper's ligamentANS:

B. Lactiferous duct

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The largest amount of glandular breast tissue lies in the 
A. upper inner quadrant
B. lower inner quadrant
C. tail of Spence
D. Upper outer quadrant
E. Lower outer quadrant

D. Upper outer quadrant

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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 the nipple)
E. Radial portions 1-6

C. Four quadrants plus a tail

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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 ligament of Cooper

B. Emptying of milk ducts

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.

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Montgomery tubercles are most prominent in the breast of 
A. Men
B. Patients with lung disease
C. Adolescent girls
D. Prepubertal girls
E. Pregnant women

E. Pregnant women

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

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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

D. Stage 4

About one fourth of women begin menstruation at stage 4. Approximately 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5

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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

C. Alveoli increase in size and number

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

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Milk production usually begins during which period?
A. At conception
B. During the first trimester
C. During the second trimester
D. At delivery
E. 2-4 days after delivery

E. 2-4 days after delivery

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

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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

A. Thickening of the inframammary ridge

After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely as Cooper’s ligaments relax.

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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

A. Its relationship to menses

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

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When conducting a clinical breast exam, the examiner should
A. forgot the exam 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 breast simultaneously
E. Begin with palpation of the breasts

D. Inspect both breast simultaneously

Inspection with simultaneous observation of both breasts is essential in order to detect differences between the breast size, symmetry, contour, and skin color.

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A 50y/o 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

C. Nulliparity

Nulliparity or late age at birth of 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.

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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

B. Glass slide and fixative

A glass slide and fixative is used for microscopic examination of the discharge to identify the cellular makeup of the discharge. The other options are not used for this purpose.

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To begin the clinical breast exam (CBE) for a man, ask him to
A. Recline on the table with his arms over his head
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

B. Sit with his arms hanging at his sides

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

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Inspection of the breast usually begins with the patient in which position?
A. Lateral
B. Sitting
C. Standing
D. Supine
E. Prone

B. Sitting

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While examining a 30y/o 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 ASAP
D. Tell the patient to get a mammary sonogram ASAP
E. Tell the patient to stop caffeine intake

A. Note the finding in the patient’s record

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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

B. Skin dimpling or retraction

Skin dimpling or retraction signifies the contraction of fibrotic tissue that occurs with carcinoma. The other choices are normal variations without significance to cancer development.

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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 unchanged nevus

C. Unilateral

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. Nevi that are long-standing, unchanging, or nontender are of little concern.

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

C. Bilateral pronounced venous patterns

Bilateral venous patterns on the breast are commonly found in pregnant and obese women and are of no clinical concern. The other choices indicate either mastitis or breast cancer, which are not common findings.

A 23y/o white woman has come to the clinic because she 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 appt with a surgeon
E. Recommend she remove caffeine from her diet

B. Suggest pregnancy testing

In light-skinned women, pregnancy produces enlarged breasts with darker areolae. Hormonal injections, caffeine, and the use of tanning beds will not change the color of the areolae as pregnancy does. Surgical consultation is not necessary.

In patient 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

C. On or around the nipple

The areola is the most common initial site to visualize peau d’orange skin.

A peppering on contender, 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

A. Normal finding

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.

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

A. Bilateral nipple inversion

Bilateral nipple inversion to the same extent on both breasts in not a concern. The other choices are a result of cancer growth, affecting the surrounding tissue.

Recent unilateral inversion of a previously everted nipple suggests
A. Obesity
B. Cancer
C. Benign breast disease
D. Pregnancy
E. Mastitis

B. Cancer

Which condition is more common in African American woman than in white women? A. Light areolae B. Nipple inversion C. Retracted areolae D. Supernumerary nipples E. Nipple and areolar colors do not match

D. Supernumerary nipples

``` 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 ```

B. Finger pads

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 centimes from the axilla

B. According to clock positions from the nipple Documenting a breast mass is described 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.

If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40y/o 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 ASAP D. Record the finding in the patient's record E. Tell the patient to stop drinking alcohol

D. Record the finding in the patient's record The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action.

``` During the palpation of a 30y/o woman's breast, she complains that the procedure is painful. You suspect this may be because she is A. Premenstrual B. A heavy smoker C. Perimenopausal D. Mulitparous E. An alcoholic ```

A. Premenstrual Women’s breasts are more tender during the premenstrual and menstrual periods than during any other time of the menstrual cycle because hormone changes cause the breasts to swell and increase nodularity. Clinical breast examinations should be scheduled for 1 week after the start of the menstrual flow.

A 12y/o boy is being seen because of right-sided breast tenderness. Your exam technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pea like mass under the areola. Recommendation to the child and parent are to A. Apply an ace wrap compression bandage 6hrs/day B. Return for eval 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

B. Return for eval in 6 months if the problem persists Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. Reassurance to the young man that this is a common occurrence is essential.

``` 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 ```

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

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 outward 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

D. One arm overhead and a pillow under her shoulder

``` 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 ```

A. Depressing it behind the areola At the completion of the examination, return to the nipple and with two fingers gently depress the tissue inward into the well behind the areola. Your fingers and tissue should move easily inward, nipple compression to evoke discharge is no longer part of the clinical breast examination.

``` 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 ```

E. Flexed at the elbow 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.

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 xyphoid

C. Radially Each breast contains a lymphatic network that drains the breast radially and deeply to underlying lymphatics.

``` The greatest concern for breast cancer is when you palpate _____ nodes. A. Anterior cervical B. Subscapular C. Brachial D. Supraclavicular E. Internal mammary ```

D. Supraclavicular The supraclavicular and infraclavicular nodal areas are sentinel nodes; any enlargement in these areas is especially significant.

You are performing a clinical breast exam for a 55y/o 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. Asked the patient to lower her shoulder on that side E. Ask the patient to turn her head toward that side

E. Ask the patient to turn her head toward that side 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.

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 US of the breasts to exclude a pathologic cause E. Infant may have mastitis

A. Enlargement and leaking are caused by maternal hormones and will likely resolve without treatment Maternal passive transfer of estrogen to the infant can result in enlarged breasts of the newborn. Squeezed gently, the breast can excrete a small amount of clear or milky white fluid. This condition resolves spontaneously within 2 weeks and rarely lasts beyond 3 months.

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

B. Resolve after the drug is discontinued

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

A. Massage gently and continue nursing This patient has engorged breasts. The aim of treatment is to promote breast drainage. Stopping nursing will increase the risk that a breast infection will turn into a breast abscess. The other choices do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and crack the nipple and compound infection.

``` You are conducting a clinical breast exam for a 30y/o patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely moveable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with A. Fibroadenoma B. Paget disease C. Cancer D. Mammary duct ectasia E. Fibrocystic changes ```

E. Fibrocystic changes Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, well-delineated borders. Fibroadenoma and cancer are usually nontender; Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women.

``` 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 in contender 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. Retention cyst B. Case of Paget disease C. Supernumerary nipple D. Fat necrosis E. Montgomery tubercle ```

C. Supernumerary nipple Supernumerary nipples appear as one or more extra nipples located along the embryonic mammary ridge (the “milk line”). These nipples and areolae may be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples.

``` The sensitivity of CBE in detecting breast cancer ranges from A. 10-20% B. 20-29% C. 40-69% D. 70-89% E. 88-99% ```

C. 40-69% The sensitivity of CBE in detecting breast cancer ranges from 40% to 69%, and the specificity ranges from 88% to 99%. The sensitivity of the CBE combined with mammography is greater than that of mammography alone because CBE can detect cancer missed by mammography.