PHYSICAL EXAMINATION OF THE BREASTS AND AXILLA

Question 1

What are paired mammary glands located on the anterior chest wall, superficial to the pectoralis major and serratus anterior muscles?

Answer 1

Breasts

Question 2

True or False

In women, the breast extends from the second or third rib to the sixth or seventh rib and from the sternal margin to the mid-axillary line

Answer 2

True

Question 3

What is composed of the following?

1. glandular and fibrous tissue (provides support for the breast)
2. fat (subcutaneous and retromammary)

Answer 3

Female breast

Question 4

The glandular tissue of the breast is arranged into how many lobes per breast that radiate about the nipple?

Answer 4

15-20 lobes

Question 5

Each lobe in the glandular tissue of the breast is composed of how many lobules; each lobule consisting of milk-producing acini cells that empty into lactiferous ducts during lactation?

Answer 5

20-40 lobules

Question 6

Lactiferous ducts drains milk from each lobe to where?

Answer 6

surface of the nipple

Question 7

What extends from the connective tissue layer through the breast and attach to the underlying muscle fascia, providing support?

Answer 7

suspensory ligaments

Question 8

What do these muscles form?

1. pectoralis major
2. pectoralis minor
3. serratus anterior
4. latissimus dorsi
5. subscapularis
6. external oblique
7. rectus abdominus

Answer 8

muscles forming the floor of the breast

Question 9

Vascular supply to the breast is primarily through branches of the ______ and the ______

Answer 9

internal mammary and the lateral thoracic artery

Question 10

The greatest amount of glandular tissue lies in the upper outer quadrant of the breast; breast tissue extends from this quadrant into the axilla, forming the what ?

Answer 10

Tail of spence

Question 11

In the axillae the mammary tissue is in direct contact with what?

Answer 11

axillary lymph nodes

Question 12

True or False

Contraction of the smooth muscle, induced by tactile, sensory, or autonomic stimuli, produces erection of the nipple and causes the lactiferous ducts to empty

Answer 12

True

Question 13

What are the 5 D’s as related to the inspection if the nipples?

Answer 13

1. Discharge
2. Depression or inversion
3. Discoloration
4. Dermatologic changes
5. Deviation

Question 14

What are the various positions you would inspect the breasts in?

Answer 14

1. Seated, arms over head
2. Seated, hands pressed against hips and shoulders rolled forward
3. Seated, and leaning forward at the waist

Question 15

What are the areas of palpation of the breast?

Answer 15

1. breast
2. axillae
3. supraclavicular
4. infraclavicular

Question 16

True or False

Nipple compression should be performed only if the patient reports spontaneous discharge

Answer 16

True

Question 17

Supernumerary nipples appear as one or more extra nipples located along the embryonic mammary ridge and are more common in what women?

Answer 17

black women

Question 18

How should normal breast tissue feel?

Answer 18

dense, firm, and elastic

Question 19

True or False

Venous networks may be visible, but are usually only pronounced in the breasts of pregnant or obese women

Answer 19

true

Question 20

After menopause, glandular tissue in the breast atrophies and is replaced by what?

Answer 20

fat

Question 21

What are benign cyst formations caused by ductal enlargement and is associated with a long follicular or luteal phase of the menstrual cycle?

Answer 21

Fibrocystic changes

Question 22

What are benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process; they account for the majority of breast tumors in young women?

Answer 22

Fibroadenoma

Question 23

Malignant breast tumors have peak incidence between what ages?

Answer 23

40-75 years old

normally occur in women older than 50 y/o

Question 24

These are all findings associated with what?

1. mass or thickening in the breast
2. marked asymmetry
3. prominent unilateral veins
4. discoloration
5. peau d’orange
6. ulcerations
7. dimpling
8. puckering
9. retraction of the skin
10. fixed inversion or deviation of the nipple

Answer 24

Malignant breast tumors

Question 25

What is a response to a local injury of the breast; a firm, irregular mass, often appearing as an area of discoloration?

Answer 25

Fat necrosis

Question 26

What are 2-3 cm benign tumors of the sub areolar ducts that occur singly or in multiples, a common cause of serous or bloody nipple discharge?

Answer 26

Intraductal papillomas or papillomatosis

Question 27

What is know as the surface manifestation of underlying ductal carcinoma; a red scaling, crusty patch forms on the nipple, areola, and surrounding skin; lesions appear eczematous and are usually unilateral?

Answer 27

Paget disease

Question 28

What is known as a smooth, firm, mobile tender disk of breast tissue located behind the areola in males; caused by hormone imbalances; by testicular, pituitary, or hormone secreting tumors; liver failure or antihypertensive meds?

Answer 28

Gynecomastia

Question 29

What is lactation not associated with childbearing and most commonly caused by pituitary tumors, Cushing’s syndrome and hypoglycemia, drugs such as phenothiazines, tricyclics, antidepressants and estrogen?

Answer 29

Galactorrhea

Question 30

What is inflammation and infection of the breast tissue characterized by sudden onset of swelling, tenderness, erythema, and heat; usually the result of a staph infection and most common in lactating women?

Answer 30

Mastitis

Question 31

What is when the sub areolar ducts become blocked with desquamating secretory epithelium, necrotic debris, and chronic inflammatory cells?

Answer 31

Mammary duct ectasia most common in menopausal women