ARDMS BR 2026 STUDY GUIDE Breast
Sonography Specialty Practice Questions with
Answer Explanations Breast Anatomy •
Pathology • Ultrasound Imaging Techniques •
Exam Preparation
SECTION 1: BREAST ANATOMY & PHYSIOLOGY (Questions 1–20)
Question 1. What is the functional microscopic unit of the breast where the vast
majority of benign and malignant pathology originates?
A) The lactiferous sinus
B) The Terminal Duct Lobular Unit (TDLU)
C) The nipple-areolar complex
D) The retromammary bursa
E) Cooper's ligament
Rationale: The TDLU comprises the terminal duct and its multiple small acini. It
is the primary site of origin for normal glandular activity as well as proliferative
disorders, in-situ carcinomas, and invasive breast cancers.
Question 2. What is the primary anatomical function of Cooper's ligaments
(suspensory ligaments) in the breast?
A) To provide structural support and maintain breast contour by extending
from the prepectoral fascia through the fat to the dermis of the skin
B) To produce and secrete milk during lactation
C) To drain lymphatic fluid directly into the internal mammary chain
D) To regulate blood flow through the lateral thoracic artery
E) To anchor the nipple to the pectoralis muscle
,Rationale: Cooper's ligaments compartmentalize the breast parenchyma. When
infiltrated or shortened by malignant tumors, they contract, producing the classic
clinical sign of skin dimpling or retraction.
Question 3. How are the three primary anatomical layers of the female breast
arranged from the skin surface inward toward the chest wall?
A) Subcutaneous layer, mammary (parenchymal) layer, retromammary layer
B) Mammary layer, subcutaneous layer, retromammary layer
C) Retromammary layer, mammary layer, subcutaneous layer
D) Pectoralis muscle, subcutaneous layer, mammary layer
E) Skin, retromammary layer, mammary layer
Rationale: The breast is divided from anterior to posterior into the subcutaneous
layer (skin and superficial fat), the central mammary layer (glandular tissue and
TDLUs), and the retromammary layer (deep fat and posterior).
Question 4. How many lobes does each breast typically contain?
A) 5–8
B) 10–15
C) 15–20
D) 20–25
E) 25–30
Rationale: Each breast contains 10 to 15 lobes. Each lobe is drained by a
lactiferous duct that opens onto the nipple surface.
Question 5. Which artery provides the PRIMARY blood supply to the breast?
A) Lateral thoracic artery
B) Thoracoacromial artery
C) Internal mammary (thoracic) artery
D) Posterior intercostal artery
E) Subscapular artery
,Rationale: The breast is primarily supplied by branches of the internal mammary
(thoracic) artery and the lateral thoracic artery. The internal mammary artery
provides the dominant blood supply.
Question 6. What is the sonographic appearance of Cooper's ligaments?
A) Hypoechoic
B) Bright linear echoes
C) Low to medium level echoes
D) Anechoic tubular structures
E) Complex echotexture
Rationale: Cooper's ligaments appear as bright, linear echoes on ultrasound. They
extend from the prepectoral fascia to the dermis and are important landmarks for
identifying skin retraction or dimpling associated with malignancy.
Question 7. Which hormone stimulates the breast's secretory system after
childbirth?
A) Estrogen
B) Progesterone
C) Oxytocin
D) Prolactin
E) Growth hormone
Rationale: Oxytocin stimulates the release of milk during nursing by causing
contraction of myoepithelial cells around the alveoli. Prolactin stimulates milk
production. Estrogen and progesterone are involved in breast development.
Question 8. What type of gland is the breast?
A) Endocrine gland
B) Modified sweat gland
C) Sebaceous gland
D) Mucous gland
E) Serous gland
, Rationale: The breast is a modified sweat gland located in the superficial fascia of
the anterior chest wall. It is a specialized apocrine gland that produces milk during
lactation.
Question 9. The mammary layer of the breast contains all of the following
EXCEPT:
A) Connective tissue
B) Lobes
C) Ducts
D) Fat
Rationale: The mammary (parenchymal) layer contains glandular tissue, including
lobes, ducts, and connective tissue. Fat is predominantly found in the subcutaneous
and retromammary layers, not the mammary layer.
Question 10. Which lymph node group is the most common site of breast cancer
metastasis?
A) Internal mammary nodes
B) Axillary lymph nodes
C) Supraclavicular nodes
D) Infraclavicular nodes
E) Mediastinal nodes
Rationale: The axillary lymph nodes are the most common site of breast cancer
metastasis, receiving approximately 75% of lymphatic drainage from the breast.
Sentinel lymph node biopsy typically targets the axillary nodes.
Question 11. Which quadrant of the breast contains the highest volume of
glandular tissue?
A) Upper inner quadrant
B) Lower inner quadrant
C) Upper outer quadrant
D) Lower outer quadrant
E) Central quadrant
Sonography Specialty Practice Questions with
Answer Explanations Breast Anatomy •
Pathology • Ultrasound Imaging Techniques •
Exam Preparation
SECTION 1: BREAST ANATOMY & PHYSIOLOGY (Questions 1–20)
Question 1. What is the functional microscopic unit of the breast where the vast
majority of benign and malignant pathology originates?
A) The lactiferous sinus
B) The Terminal Duct Lobular Unit (TDLU)
C) The nipple-areolar complex
D) The retromammary bursa
E) Cooper's ligament
Rationale: The TDLU comprises the terminal duct and its multiple small acini. It
is the primary site of origin for normal glandular activity as well as proliferative
disorders, in-situ carcinomas, and invasive breast cancers.
Question 2. What is the primary anatomical function of Cooper's ligaments
(suspensory ligaments) in the breast?
A) To provide structural support and maintain breast contour by extending
from the prepectoral fascia through the fat to the dermis of the skin
B) To produce and secrete milk during lactation
C) To drain lymphatic fluid directly into the internal mammary chain
D) To regulate blood flow through the lateral thoracic artery
E) To anchor the nipple to the pectoralis muscle
,Rationale: Cooper's ligaments compartmentalize the breast parenchyma. When
infiltrated or shortened by malignant tumors, they contract, producing the classic
clinical sign of skin dimpling or retraction.
Question 3. How are the three primary anatomical layers of the female breast
arranged from the skin surface inward toward the chest wall?
A) Subcutaneous layer, mammary (parenchymal) layer, retromammary layer
B) Mammary layer, subcutaneous layer, retromammary layer
C) Retromammary layer, mammary layer, subcutaneous layer
D) Pectoralis muscle, subcutaneous layer, mammary layer
E) Skin, retromammary layer, mammary layer
Rationale: The breast is divided from anterior to posterior into the subcutaneous
layer (skin and superficial fat), the central mammary layer (glandular tissue and
TDLUs), and the retromammary layer (deep fat and posterior).
Question 4. How many lobes does each breast typically contain?
A) 5–8
B) 10–15
C) 15–20
D) 20–25
E) 25–30
Rationale: Each breast contains 10 to 15 lobes. Each lobe is drained by a
lactiferous duct that opens onto the nipple surface.
Question 5. Which artery provides the PRIMARY blood supply to the breast?
A) Lateral thoracic artery
B) Thoracoacromial artery
C) Internal mammary (thoracic) artery
D) Posterior intercostal artery
E) Subscapular artery
,Rationale: The breast is primarily supplied by branches of the internal mammary
(thoracic) artery and the lateral thoracic artery. The internal mammary artery
provides the dominant blood supply.
Question 6. What is the sonographic appearance of Cooper's ligaments?
A) Hypoechoic
B) Bright linear echoes
C) Low to medium level echoes
D) Anechoic tubular structures
E) Complex echotexture
Rationale: Cooper's ligaments appear as bright, linear echoes on ultrasound. They
extend from the prepectoral fascia to the dermis and are important landmarks for
identifying skin retraction or dimpling associated with malignancy.
Question 7. Which hormone stimulates the breast's secretory system after
childbirth?
A) Estrogen
B) Progesterone
C) Oxytocin
D) Prolactin
E) Growth hormone
Rationale: Oxytocin stimulates the release of milk during nursing by causing
contraction of myoepithelial cells around the alveoli. Prolactin stimulates milk
production. Estrogen and progesterone are involved in breast development.
Question 8. What type of gland is the breast?
A) Endocrine gland
B) Modified sweat gland
C) Sebaceous gland
D) Mucous gland
E) Serous gland
, Rationale: The breast is a modified sweat gland located in the superficial fascia of
the anterior chest wall. It is a specialized apocrine gland that produces milk during
lactation.
Question 9. The mammary layer of the breast contains all of the following
EXCEPT:
A) Connective tissue
B) Lobes
C) Ducts
D) Fat
Rationale: The mammary (parenchymal) layer contains glandular tissue, including
lobes, ducts, and connective tissue. Fat is predominantly found in the subcutaneous
and retromammary layers, not the mammary layer.
Question 10. Which lymph node group is the most common site of breast cancer
metastasis?
A) Internal mammary nodes
B) Axillary lymph nodes
C) Supraclavicular nodes
D) Infraclavicular nodes
E) Mediastinal nodes
Rationale: The axillary lymph nodes are the most common site of breast cancer
metastasis, receiving approximately 75% of lymphatic drainage from the breast.
Sentinel lymph node biopsy typically targets the axillary nodes.
Question 11. Which quadrant of the breast contains the highest volume of
glandular tissue?
A) Upper inner quadrant
B) Lower inner quadrant
C) Upper outer quadrant
D) Lower outer quadrant
E) Central quadrant
