Ch 16 Breasts and Axillae PDF

Preview

Summary

test bank...

Description

Ch 16 Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1.

What breast structure drains milk from each lobe onto the surface

of the nipple? Alveolus Lactiferous duct Montgomery follicle Tail of Spence Coopers ligament

a. b. c. d. e. ____ a. b. c. d. e.

2.

The largest amount of glandular breast tissue lies in the upper inner quadrant. lower inner tail of Spence. upper outer quadrant. lower outer.

3. 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.

____

____ a. b. c. d. e.

4.

Contraction of breast smooth muscle results in benign breast lumps. emptying of milk ducts. nipple inversion. nipple tenderness. tension on the suspensory ligaments of Cooper.

____ a. b. c. d. e.

5.

Montgomery tubercles are most prominent in the breasts of men. patients with lung disease. adolescent girls. prepubertal girls. pregnant women.

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

____

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

a. b. c. d. e.

____ 7. 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. ____ a. b. c.

8.

Milk production usually begins during which period? At conception During the first trimester of pregnancy During the second trimester of pregnancy At delivery 2 to 4 days after delivery

9.

Which breast change is typical after menopause? Thickening of the inframammary ridge Hypertrophy of glandular tissue Increase in number of lactiferous ducts Reduction of fat deposits Shortening of Cooper’s ligaments

10.

In a woman complaining of a breast lump, it is most important to

d. e. ____ a. b. c. d. e. ____

ask about its relationship to menses. weight gain. sleep patterns. immunization status. alcohol consumption.

a. b. c. d. e. ____

11.

When conducting a clinical breast examination, the examiner

should a. b. c.

forgo the examination if the patient has had a recent mammogram. keep the patient covered to respect modesty. dim the lights to minimize anxiety.

inspect both breasts simultaneously. begin with palpation of the breasts.

d. e.

____ 12. 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. ____ a. b. c. d. e.

13.

If your patient has nipple discharge, you will most likely need a Vacutainer tube. glass slide and fixative. specimen jar with formaldehyde. tape strip to test pH. needle and syringe.

____

14.

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

to recline on the table with his arms overhead. sit with his arms hanging at his sides. sit with his hands on his hips. stand with his arms clasped behind his back. stand leaning forward.

a. b. c. d. e. ____

15.

Inspection of the breasts usually begins with the patient in which

position? a. b. c. d. e.

Lateral Sitting Standing Supine Prone

____ 16. 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.

tell the patient to stop caffeine intake.

e.

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

____

17.

____

18.

Venous patterns on breasts are suggestive of pathology when they

are bilaterally visible. seen in obese patients. unilateral. observed during pregnancy. associated with a long-standing unchanging nevus.

a. b. c. d. e.

____ 19. 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 ____ 20. 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. ____

21.

In patients with breast cancer, peau d’orange skin is often first

evident a. b. c. d. e.

in the axilla. in the upper inner quadrant. on or around the nipple. at the inframammary ridge. in the tail of Spence.

22. 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.

____

____ 23. 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. b. c. d. e.

24.

Recent unilateral inversion of a previously everted nipple suggests obesity. cancer. benign breast disease. pregnancy. mastitis.

____ 25. 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. ____

26.

When palpating breast tissue, the examiner should use the _____

at each site. fingertips finger pads palms of the hands ulnar surface of the hands thumbs

a. b. c. d. e. ____ a. b.

27.

Documentation of a breast mass location is according to illustration, without a narrative. according to clock positions from the nipple.

measured with calipers from the nipple. measured in centimeters from the sternal notch. measured in centimeters from the axilla.

c. d. e.

____ 28. 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.

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. ____

29.

30. 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.

____

____ a. b. c. d. e.

31.

____

32.

The tail of Spence extends into the midclavicular region. toward the supraclavicular area. down into the inframammary ridge. into the axillae. along the sternal border. To spread the breast tissue evenly over the chest wall, you should

ask the woman to lie supine with her arms straight alongside her body. both arms overhead with her palms upward. her hands clasped just above her umbilicus. one arm overhead and a pillow under her shoulder. both hands pressed against her hips.

a. b. c. d. e. ____ a. b. c. d. e.

33.

Palpation of the nipple is done by depressing it behind the areola. pressing it against the rib cage. pulling it outward and releasing it. rolling it in a clockwise motion. inverting the nipple.

____ a. b. c. d. e.

34.

When examining axillary lymph nodes, the patient’s arm is raised full above the head. extended at the side. pressed against the hip. crossed over the chest. flexed at the elbow.

____ a. b.

35.

Lymphatic flow of the breast primarily drains inferiorly toward the abdomen. laterally toward the corresponding arm. radially. medially toward the sternum. inferomedially toward the xiphoid.

36.

The greatest concern for breast cancer is when you palpate _____

c. d. e. ____

nodes. a. b. c. d. e.

anterior cervical subscapular brachial supraclavicular internal mammary

____ 37. 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.

ask the patient to press both palms together. ask the patient to lower her shoulder on that side. ask the patient to turn her head toward that side.

c. d. e.

____ 38. 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. ____ 39. 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.

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. ____

40.

____ 41. You are conducting a clinical breast examination for a 30-year-old 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

fibroadenoma. Paget disease. cancer. mammary duct ectasia. fibrocystic changes.

a. b. c. d. e.

____ 42. 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 is nontender 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.

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%. ____

43.

Ch 16 Answer Section MULTIPLE CHOICE 1.

ANS: B

The lactiferous duct is the structure that drains milk from each lobe onto the surface of the nipple. PTS: 1 REF: p. 351 MSC: Organ System: Reproductive 2. ANS: D

TOP: Discipline: Gross Anatomy

The greatest amount of glandular tissue in the breast lies in the upper outer quadrant. PTS: 1 REF: p. 351 MSC: Organ System: Reproductive 3. ANS: C

TOP: Discipline: Gross Anatomy

The breast is referenced according to five segments: four quadrants and a tail. PTS: 1 REF: p. 351 MSC: Organ System: Reproductive 4. ANS: B

TOP: Discipline: Gross Anatomy

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. PTS: 1 REF: p. 351 MSC: Organ System: Reproductive 5. ANS: E

TOP: Discipline: Physiology

Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women. PTS: 1 REF: p. 353 MSC: Organ System: Reproductive 6. ANS: D

TOP: Discipline: Physiology

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. PTS: 1 REF: p. 352 MSC: Organ System: Reproductive 7. ANS: C

TOP: Discipline: Physiology

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. PTS: 1 REF: p. 353 MSC: Organ System: Reproductive 8. ANS: E

TOP: Discipline: Physiology

Colostrum secretion begins after delivery and then is replaced with milk production within 2 to 4 days. PTS: 1 REF: p. 353 MSC: Organ System: Reproductive 9. ANS: A

TOP: Discipline: Physiology

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. PTS: 1 REF: p. 353 MSC: Organ System: Reproductive 10. ANS: A

TOP: Discipline: Physiology

Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation. PTS: 1 REF: p. 363 MSC: Organ System: Reproductive 11. ANS: D

TOP: Discipline: Pathophysiology

Inspection with simultaneous observation of both breasts is essential in order to

detect differences between the breast size, symmetry, contour, and skin color. PTS: 1 REF: p. 357 MSC: Organ System: Reproductive 12. ANS: C

TOP: Discipline: Physiology

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. PTS: 1 REF: p. 354 MSC: Organ System: Reproductive 13. ANS: B

TOP: Discipline: Biostatistics

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. PTS: 1 REF: p. 355 MSC: Organ System: Reproductive 14. ANS: B

TOP: Discipline: Pathophysiology

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. PTS: 1 REF: p. 355 MSC: Organ System: Reproductive 15. ANS: B

TOP: Discipline: Physiology

Inspection begins with the patient in a sitting position with arms hanging loosely at the sides. PTS: 1 REF: p. 355 MSC: Organ System: Reproductive 16. ANS: A

TOP: Discipline: Physiology

Often one breast is slightly larger than the other. This is a normal variation, and no further intervention is required. PTS: 1 REF: p. 365 MSC: Organ System: Reproductive 17. ANS: B

TOP: Discipline: Physiology

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. PTS: 1 REF: p. 356 MSC: Organ System: Reproductive 18. ANS: C

TOP: Discipline: Pathophysiology

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.

PTS: 1 REF: p. 356 MSC: Organ System: Reproductive 19. ANS: C

TOP: Discipline: Pathophysiology

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. PTS: 1 REF: p. 364 MSC: Organ System: Reproductive 20. ANS: B

TOP: Discipline: Physiology

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. PTS: 1 REF: p. 364 MSC: Organ System: Reproductive 21. ANS: C

TOP: Discipline: Physiology

The areola is the most common initial site to visualize peau d’orange skin. PTS: 1 REF: p. 356 MSC: Organ System: Reproductive 22. ANS: A

TOP: Discipline: Pathophysiology

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. PTS: 1 REF: p. 356 MSC: Organ System: Reproductive 23. ANS: A

TOP: Discipline: Gross Anatomy

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. PTS: 1 REF: p. 356 MSC: Organ System: Reproductive 24. ANS: B

TOP: Discipline: Physiology

Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy rather than a benign condition. PTS: 1 REF: p. 357 MSC: Organ System: Reproductive 25. ANS: D

TOP: Discipline: Pathophysiology

The incidence of supernumerary nipples is higher in African American women than in white women. PTS: 1 REF: p. 357 MSC: Organ System: Reproductive 26. ANS: B

TOP: Discipline: Biostatistics

The finger pads are used for breast palpation because they are more sensitive than the fingertips. PTS: 1 REF: p. 361 MSC: Organ System: Reproductive 27. ANS: B

TOP: Discipline: Physiology

Documenting a breast mass is described according to clock positions and di...