NSG 507 Week 7 Breasts and Axillae

Student Name

University of Phoenix

NSG/507 Social Justice and Information Systems for Population Health

Prof. Name

Date

Chapter 18: Breasts and Axillae 

Question 1: Breast Cancer Screening (44-Year-Old Woman)

Scenario

A 44-year-old woman has a breast mass diagnosed as a benign breast cyst. She has no family history of breast cancer and had one screening mammogram at age 43.

Question

What advice regarding breast cancer screening is most appropriate?

Options

• A. Breast self-examination (BSE) should be routinely taught.

• B. Clinical breast examination (CBE) should begin annually at age 30.

• C. She was compliant with USPSTF recommendations for her age and risk factors. ✅

• D. Mammography is most accurate in women in their 40s.

• E. There is no controversy regarding breast cancer screening guidelines.

Correct Answer

✅ C

High-Yield Points

• Average-risk women should follow age-appropriate screening guidelines.

• Routine BSE is not universally recommended because it has not been shown to reduce breast cancer mortality.

• Breast cancer screening recommendations vary among professional organizations.

Question 2: Breast MRI Screening (42-Year-Old Woman)

Scenario

A healthy 42-year-old woman wants to replace mammography with MRI because she is worried about radiation exposure.

Question

Which statement about breast MRI screening is correct?

Options

• A. MRI is well studied for routine screening in average-risk women.

• B. MRI increases sensitivity but decreases specificity. ✅

• C. She is an ideal MRI screening candidate.

• D. MRI is recommended for women with a lifetime breast cancer risk below 20%.

• E. A BRCA mutation alone is insufficient for MRI screening.

Correct Answer

✅ B

High-Yield Points

• MRI has higher sensitivity than mammography.

• MRI has lower specificity, resulting in more false-positive findings.

• MRI screening is recommended primarily for high-risk women, including:

  • BRCA mutation carriers

  • Lifetime breast cancer risk ≥20%

  • Prior chest radiation

Question 3: Bilateral Milky Nipple Discharge

Scenario

A 35-year-old woman presents with:

• Bilateral milky nipple discharge

• Irregular menstrual cycles

• Negative pregnancy test

• Normal thyroid function

Question

What is the most likely diagnosis?

Options

• A. Mastitis

• B. Ductal carcinoma in situ

• C. Paget disease

• D. Occult pregnancy

• E. Prolactinoma ✅

Correct Answer

✅ E

High-Yield Points

• Bilateral milky discharge (galactorrhea) + menstrual irregularities strongly suggests hyperprolactinemia.

• Always exclude:

  • Pregnancy

  • Hypothyroidism

• Prolactinoma is the most common cause of persistent galactorrhea.

Question 4: Breast Self-Examination (22-Year-Old Woman)

Scenario

A young woman discovers a painless breast mass during self-examination.

Question

Which statement is correct?

Options

• A. Most self-detected masses are malignant.

• B. Fibroadenoma is more likely than breast cancer. ✅

• C. Breast abscess is the most likely diagnosis.

• D. Imaging is unnecessary because she is young.

• E. BSE has very high sensitivity and specificity.

Correct Answer

✅ B

High-Yield Points

• Fibroadenoma is the most common benign breast tumor in young women.

• Every persistent breast mass requires evaluation.

• Routine BSE has not been shown to improve survival.

Question 5: BRCA Testing

Scenario

A 48-year-old woman has:

• Multiple paternal relatives with breast cancer

• Father with breast cancer

• Ashkenazi Jewish ancestry

Question

Which statement is true?

Options

• A. Paternal family history is unimportant.

• B. Male breast cancer does not influence BRCA testing.

• C. BRCAPRO adds no clinical value.

• D. She has multiple indications for BRCA testing. ✅

• E. BRCA-positive patients do not require different screening.

Correct Answer

✅ D

High-Yield Points

Major BRCA risk factors include:

• Male breast cancer

• Multiple affected relatives

• Paternal family history

• Ashkenazi Jewish ancestry

Positive BRCA testing changes:

• Screening

• Surveillance

• Preventive management

Question 6: MRI Screening in a High-Risk Patient

Scenario

A 68-year-old woman has:

• Mother with breast cancer

• Cousin diagnosed before age 50

• Prior chest radiation

• Dense breasts

• Previous benign breast biopsies

• Prior hormone replacement therapy

Question

Which statement is correct?

Options

• A. No organization recommends MRI.

• B. USPSTF recommends against MRI.

• C. MRI has higher sensitivity but lower specificity than mammography. ✅

• D. Breast density does not affect mammography.

• E. Chest radiation is not a breast cancer risk factor.

Correct Answer

✅ C

High-Yield Points

• MRI detects more cancers but produces more false positives.

• Dense breasts reduce mammographic sensitivity.

• Prior chest radiation significantly increases breast cancer risk.

Question 7: Supraclavicular Lymphadenopathy

Scenario

A 66-year-old woman has a firm, non-tender right supraclavicular lymph node.

Question

Which statement is correct?

Options

• A. Breast cancer always spreads first to axillary nodes.

• B. Supraclavicular nodes are usually benign.

• C. Supraclavicular nodes lie along the anterior edge of the trapezius.

• D. Firm, rubbery nodes are generally benign.

• E. Breast cancer may spread directly to infraclavicular and supraclavicular nodes without obvious axillary involvement. ✅

Correct Answer

✅ E

High-Yield Points

• Enlarged supraclavicular nodes are highly suspicious for malignancy.

• Breast cancer may spread to:

  • Axillary nodes

  • Infraclavicular nodes

  • Supraclavicular nodes

• Hard, fixed, non-tender nodes suggest metastatic disease.

Question 8: Documenting Breast Mass Location

Scenario

A 24-year-old woman has a fibroadenoma located 3 cm superior and 3 cm medial to the right nipple.

Question

How should the location be documented?

Options

• A. Right breast, 10:30 position from the nipple. ✅

• B. Lower outer quadrant.

• C. Upper inner quadrant.

• D. Left upper outer quadrant.

• E. Right breast, 1:30 position.

Correct Answer

✅ A

High-Yield Points

Always document:

• Breast side

• Clock-face position

• Distance from nipple

• Size

• Mobility

• Consistency

• Tenderness

Question 9: Menopausal Breast Changes

Scenario

A 54-year-old postmenopausal woman notices her breasts feel less lumpy.

Question

Which statement is correct?

Options

• A. Fatty replacement decreases mammographic accuracy.

• B. Hormone replacement therapy has no effect on density.

• C. Breast glandular tissue atrophies because the number of lobules decreases. ✅

• D. Breast density has no genetic influence.

• E. Mammography performs worst after menopause.

Correct Answer

✅ C

High-Yield Points

Menopause causes:

• ↓ Lobules

• ↓ Glandular tissue

• ↑ Fat replacement

Fatty breasts improve mammographic sensitivity.

Question 10: Bloody Nipple Discharge

Scenario

A 72-year-old woman has spontaneous unilateral bloody nipple discharge and a hard, fixed axillary node.

Correct Answer

✅ Breast cancer

High-Yield Points

Highly suspicious findings include:

• Bloody unilateral discharge

• Hard fixed lymph node

• Possible absence of a palpable mass

Question 11: Paget Disease

Scenario

A 44-year-old woman has an eczema-like nipple lesion with an underlying breast mass.

Correct Answer

✅ Paget disease

High-Yield Points

Features:

• Persistent scaly nipple rash

• Crusting

• Possible ulceration

• Frequently associated with underlying breast carcinoma

Question 12: Nipple Retraction

Scenario

A 56-year-old woman develops nipple flattening with an underlying breast mass.

Correct Answer

✅ Nipple retraction

High-Yield Points

• Late sign of breast cancer

• Caused by fibrosis pulling the nipple inward

Question 13: Clear Nipple Discharge

Scenario

A 19-year-old woman has clear discharge only when the nipple is squeezed.

Correct Answer

✅ Benign breast abnormality

High-Yield Points

Usually benign if:

• Only expressed with compression

• No mass

• Non-bloody

• Unilateral

Question 14: Acanthosis Nigricans

Scenario

An obese woman with irregular menses has dark velvety axillary skin.

Correct Answer

✅ Acanthosis nigricans

High-Yield Points

Associated with:

• Insulin resistance

• Obesity

• PCOS

• Type 2 diabetes

Question 15: Infectious Axillary Lymphadenopathy

Scenario

Painful, warm, movable axillary node after a hand injury.

Correct Answer

✅ Infectious lymphadenopathy

High-Yield Points

Infectious nodes are:

• Tender

• Warm

• Mobile

• Erythematous

Always inspect the drainage area for wounds.

Question 16: Palpable Male Breast Mass

Scenario

A 30-year-old man has a 2-cm mass beneath the areola.

Correct Answer

✅ Normal breast tissue

High-Yield Points

• Approximately one-third of adult men have palpable subareolar breast tissue.

• Male breast cancer is uncommon.

Question 17: Axillary Nodes in Breast Cancer

Question

Which lymph node group is most commonly involved?

Correct Answer

✅ Central axillary nodes

Question 18: Timing of Breast Self-Examination

Correct Answer

✅ 5–7 days after menstruation begins (or immediately after menses ends)

High-Yield Points

Breasts are:

• Least tender

• Least swollen

• Easier to examine

Question 19: Risk That a Breast Mass Is Malignant

Correct Answer

✅ Approximately 10%

High-Yield Points

• About 1 in 10 women presenting with a breast mass have breast cancer.

• Every new breast mass requires evaluation.

Question 20: Clinical Breast Examination

Correct Answer

✅ Every 3 years (older Bates recommendation)

High-Yield Points

Current recommendations differ among organizations.

Question 21: Benign Breast Finding

Correct Answer

✅ One breast larger than the other

High-Yield Points

Common benign finding:

• Mild breast asymmetry

Concerning findings:

• Peau d’orange

• Skin dimpling

• Recent nipple inversion

Question 22: Best Palpation Technique

Correct Answer

✅ Vertical strip (“lawn-mower”) pattern

High-Yield Points

Highest detection rate.
Always examine the Tail of Spence.

Question 23: Breast Examination After Mastectomy

Correct Answer

✅ Carefully examine the surgical scar for recurrence.

High-Yield Points

Continue lifelong surveillance by examining:

• Surgical scar

• Remaining breast

• Axillary lymph nodes

Question 24: Breast Self-Examination

Correct Answer

✅ Many breast masses are first detected during BSE.

High-Yield Points

• BSE increases awareness.

• It has not been shown to reduce mortality.

• Recommendations vary among organizations.

Question 25: Breast Anatomy

Correct Answer

✅ Fibrous, glandular, and adipose tissue

High-Yield Points

Breast consists of:

• Lobes and lobules

• Cooper ligaments

• Fat

• Very little muscle

Question 26: Upper Outer Quadrant

Correct Answer

✅ Most breast tumors occur here.

High-Yield Points

Includes the Tail of Spence, extending into the axilla.

Question 27: Axillary Lymph Node Groups

Correct Answer

✅ Central, lateral, pectoral, and subscapular

Question 28: Breast Infection

Correct Answer

✅ Ipsilateral axillary lymph nodes

High-Yield Points

Over 75% of breast lymph drains to the ipsilateral axillary nodes.

Question 29: Breast Development in a 9-Year-Old

Correct Answer

✅ Breast development usually begins between ages 8–10 years.

Question 30: Unilateral Breast Enlargement During Puberty

Correct Answer

✅ Temporary asymmetry is usually normal.

High-Yield Points

• One breast often develops before the other.

• Mild tenderness is common.

Question 31: Delayed Menarche

Correct Answer

✅ Age breast development began

High-Yield Points

Menarche usually occurs about 2 years after breast budding.

Question 32: Cyclic Breast Changes

Correct Answer

✅ Hormonal changes during the menstrual cycle cause cyclic breast changes.

High-Yield Points

Premenstrual changes include:

• Fullness

• Tenderness

• Heaviness

Breasts are least swollen 4–7 days after menstruation begins.

Exam Pearls

Breast Cancer Red Flags

• Unilateral bloody nipple discharge

• Hard, fixed lymph nodes

• Paget disease

• Peau d’orange

• Skin dimpling

• New nipple inversion or retraction

• Supraclavicular lymphadenopathy

Benign Findings

• Fibroadenoma

• Mild breast asymmetry

• Clear discharge only with nipple compression

• Temporary pubertal asymmetry

• Tender, warm, mobile lymph nodes (infection)

• Normal palpable tissue beneath the male areola

MRI Screening

• ↑ Sensitivity

• ↓ Specificity

• Reserved for high-risk women (BRCA mutation, prior chest radiation, lifetime risk ≥20%)

Breast Examination

• Use the vertical strip palpation pattern.

• Include the Tail of Spence.

• Document masses using:

  • Right/Left breast

  • Clock-face position

  • Distance from the nipple

  • Size

  • Consistency

  • Mobility

  • Tenderness

Menopausal Changes

• ↓ Lobules

• ↓ Glandular tissue

• ↑ Fat replacement

• ↓ Breast density

• Mammography becomes more accurate after menopause.

BRCA Testing

Consider testing for patients with:

• Male breast cancer in the family

• Multiple affected relatives

• Paternal family history

• Ashkenazi Jewish ancestry