MEDICINE I

Breast and Lymph Node

Samplex Rationale

Questions Answers Rationale

TEST TYPE (MULTIPLE CHOICE)
S.Y. 2014-2015

1.Physical examination of the breast includes

A. Inspection and palpation
B. Inspection, palpation and percussion A
C. Inspection, palpation and auscultation
D. Palpation only

2. Peau d’ orange change in the breast is noted during:

A. Inspection
B. Palpation A
C. Both
D. Neither

Dimpling or Retraction is caused by the shortening of the cooper’s

3. Dimpling in the skin of the breast is:
A. Always a sign of cancer even without an underlying
breast mass
B. Results from shortening of cooper’s ligament secondary
to tumor involvement
C. Is noted during palpation of the breast
D. Is noted with patient on supine position
4. Maneuvers that can be done to elicit skin dimpling:
A. Ask the patient to raise both arms
B. Ask the patient to bend on a chair
C. Ask the patient to press on her hips
D. All of the above
5. The first thing to do when performing a breast examination
A. Put the patient on supine position
B. Establish rapport
C. Apply disinfectant on the whole area being examined
D. Wash your hands
ligament secondary to tumor ligament. (page 1 trans)
A tumor infiltrating the breast tissue can deform, shorten, and
retract the Cooper ligaments and lead to dimpling of the skin.
B
Source: https://www.amboss.com/us/knowledge/The_breasts
Skin Dimpling is seen with the patient’s arm at rest, during special
positioning, and on moving or compressing the breast. (So it is
seen during inspection) Source: Bates’s Guide to Physical
Examination and History Taking 11th Ed. P 431
Manuevers that can be done:
-Patient seated, arms at the sides
D -Raise both arms over head
-Press hands over hips
-Stand, lean forward
(page 1 Trans)
B Establish rapport to make sure patient is comfortable.

6. Pathologic nipple discharge is:

A. Yellowish in color
B. Unilateral and bloody B
C. Bilateral and milky character
D. All of the above

Spontaneous unilateral bloody discharge from one or two ducts

warrants further evaluation for intraductal papilloma, ductal
carcinoma in situ, or Paget’s disease of the breast.

Clear, serous, green, black, or non bloody discharges that are

multiductal are usually benign

Source: Bates’ Guide to Physical Examination and History Taking

11th edition page426

Sibulo, Singzon, Soledad, Solomon, Sotelo, Sta. Ana, Sua, Suganob, Sumague
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7. Palpation of the breast may be done with this method:
A. Radial palpation
B. Longitudinal palpation D
C. Horizontal palpation
D. All of the above

8. Most common quadrant for breast cancer occurrence:

A. Upper inner quadrant Upper outer quadrant:
B. Upper outer quadrant B Highest incidence of breast CA (80%)
C. Lower inner quadrant
D. Lower outer quadrant

9. A 2-cm breast mass that is malignant is usually: Nodes that are large (more than or equal to 1 cm) and firm or
A. Firm and well delineated hard, matted together, or fixed to the skin or to the
B. Hard, well delineated and tender C underlying tissues suggest MALIGNANCY
C. Hard and non tender Source: Bates’
D. All of the above

Self Breast Examination

10. Best time to do palpation of the breast to note for masses:
A. A week before the expected menstrual cycle
B. A week after the menstrual cycle
C. No time preference
D. During menstrual cycle
• Done monthly
o 1 week to 10 days after menstrual period
B
• Because breasts tend to swell and become more nodular before
menses as a result of increasing estrogen stimulation. Best time
for examination is after menstrual period (Bates’)

SY 2016-2017
1. Fibrous tissue that anchors the breast to the skin and chest wall
A. Intermammary ligament
B. Ligament of berry C
C. Cooper’s ligament
D. Interspinous ligament

LYMPH NODES
Pectoral Nodes
2. Lymphatic drainage of the breast comprise the following - drain the anterior chest wall and most of the breast
EXCEPT: - feel inside the anterior axillary folds with your finger while your
A. Posterior subscapular nodes thumb stabilizes the tissue in front
D
B. Anterior pectoral nodes Lateral Nodes
C. Axillary nodes - drain most of the arm
D. Intercostal nodes - feel high in the axilla along the upper humerus
Subscapular Nodes
- drain the posterior chest wall and some of the arm

3. The examination of breasts include the following EXCEPT:

A. inspection
B. percussion B
C. palpation
D. examination of supraclavicular nodes

Self Breast Examination

4. Breast self-exam is recommended in this period EXCEPT: • Done monthly
A. one week after menstrual period o 1 week to 10 days after menstrual period
B. one week before menstrual period B
C. same day for every month for menopausal women • Because breasts tend to swell and become more nodular before
D. starting at age 20 menses as a result of increasing estrogen stimulation. Best time
for examination is after menstrual period (Bates’)

5. Raising the arms of a patient is done to elicit Bates’ Guide to Physical Examination and History Taking p.
A. nipple retraction 436:
B. skin dimpling B To bring out dimpling or retraction that may otherwise be invisible,
C. nipple discharge ask the patient to raise her arms over her head
D. breast symmetry

Sibulo, Singzon, Soledad, Solomon, Sotelo, Sta. Ana, Sua, Suganob, Sumague
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 Cancers with fibrous strands attached to the skin and fascia over
the pectoral muscles may cause inward dimpling of the skin during
muscle contraction.

Bates’ Guide to Physical Examination and History Taking

6. Peau de ‘orange is
p. 446:
A. large axillary lymph node
Edema of the skin is produced by lymphatic blockade. It appears
B. ulceration in the breast skin C
C. change in breast skin color due to cancer as thickened skin with enlarged pores—the so-called peau
d’orange (orange peel) sign. It is often seen first in the lower
D. Paget’s disease of the nipple
portion of the breast or areola.

Bates’ Guide to Physical Examination and History Taking

p. 438

7. This is NOT a description of a breast mass finding

A. Mobile ASSESS AND DESCRIBE
B. Intra-areolar C Location - by quadrant or clock, with cm from the nipple
C. Creasing Size - in cm
D. 2.5 cm from the nipple Shape - round or cystic, disclike, or irregular in contour
Consistency - soft, firm, or hard
Delimitation - well circumscribed or not
Tenderness
Mobility - in relation to the skin, pectoral fascia, and chest wall

MATCHING TYPE
A. Breast Mass

A. Malignant Breast Mass

1.B
B. Benign Breast Mass
2.A
C. Both
3.A
4.C
1. associated with tenderness on palpation 5.B
2. irregular in shape
3. associated with skin dimpling
4. mobile
5. yellowish nipple discharge

B. PE of the Breast

A. Inspection
B. Palpation
1.B
C. Both
2.B
D. Neither
3.A
4. B
1. axillary tail of spence
2. axillary nodes
3. nipple retraction
4. nipple discharge

S.Y. 2017-2018
TRUE or FALSE
1. Breast may be tender, swollen, or lumpy during
TRUE
menstrual period

2. Malignant breast tumors are usually non-tender, firm and Malignant: firm or hard, usually non tender
fixed TRUE Benign: mobile, usually nontender
Fibrocystic changes: mobile, often tender (Source: Bates’)
3. Peau d’ orange is a normal finding
FALSE
To examine the lateral portion of the breast, ask patient to roll
onto the opposite hip, placing her hand on her forehead but
4. Axillary nodes are not commonly palpated during breast
keeping the shoulders pressed against bed or examining table.
exam FALSE
This flattens lateral breast tissue then begin palpating in the
axilla.

Sibulo, Singzon, Soledad, Solomon, Sotelo, Sta. Ana, Sua, Suganob, Sumague
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 Nodules in the tail of the breast in the axilla are sometimes
mistaken for enlarged lymph nodes.
Source: Bates
5. Examination of the breast can be done on sitting,
TRUE
standing, or supine position
6. When locating the breast mass, clock method or
TRUE
quadrant method is acceptable
7. Unilateral venous prominence is a normal finding FALSE
Self Breast Examination
8. Breast -exam is recommended in this period, EXCEPT:
• Done monthly
A. One week after menstrual period
o 1 week to 10 days after menstrual period
B. One week before menstrual period
D
C. Same day for every month for menopausal
• Because breasts tend to swell and become more nodular before
women
menses as a result of increasing estrogen stimulation. Best time
D. Starting at age 20
for examination is after menstrual period (Bates’)

Bates’ Guide to Physical Examination and History Taking p.

436:
9. Asking the patient to lean forward and let the breasts To bring out dimpling or retraction that may otherwise be invisible,
hang is done to elicit: ask the patient to raise her arms over her head
A. Nipple retraction
B
B. Skin dimpling
C. Nipple discharge Cancers with fibrous strands attached to the skin and fascia over
D. Breast symmetry the pectoral muscles may cause inward dimpling of the skin during
muscle contraction.

Bates’ Guide to Physical Examination and History Taking

10. Which of the following best describes peau d’ orange?
A. Large axillary lymph node
B. Yellowish/orange tinge ulceration in the skin
C. Dermal lymphatic invasion
D. Pagets disease of the nipple
p. 446:
Edema of the skin is produced by lymphatic blockade. It appears
C as thickened skin with enlarged pores—the so-called peau
d’orange (orange peel) sign. It is often seen first in the lower
portion of the breast or areola.

Sibulo, Singzon, Soledad, Solomon, Sotelo, Sta. Ana, Sua, Suganob, Sumague
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