N607- Exam 2
Page 1 of 138
N607 Exam 2 Study Guide (Modules 5-9)
Examination Techniques of Organ Systems
Breast Examination
Breast Self-Exam (BSE): Should be performed monthly, best done one week after
menstruation.
o Technique: Use the pads of three fingers in a circular motion, checking for
lumps or changes.
o Example: A 35-year-old woman notices a firm, immobile mass in her upper
outer quadrant. Next step: refer for mammography and biopsy.
* When should a woman conduct breast self-examination with respect to her menses?
A) Five to seven days following her menses
B) Midcycle
C) Immediately prior to menses
D) During her menses
Ans: A
Feedback: The breast examination should be conducted during the time with the least estrogen
stimulation of the breast tissue. This corresponds to five to seven days following menses.
* Which is the most effective pattern of palpation for breast cancer?
A) Beginning at the nipple, make an ever-enlarging spiral.
B) Divide the breast into quadrants and inspect each systematically.
C) Examine in lines resembling the back and forth pattern of mowing a lawn.
D) Beginning at the nipple, palpate outward in a stripe pattern.
Ans: C
Feedback: The vertical strip pattern has been shown to be the most effective pattern for
palpation of the breast. The most important aspect, however, is to be systematic. The tail of
Spence, located on the upper anterior chest, is an area commonly missed on examination.
Breast Cancer High-Risk Factors
o Family history (BRCA1/BRCA2 mutations).
, N607- Exam 2
Page 2 of 138
* A 40-year-old mother of two presents to your office for consultation. She is interested in
knowing what her relative risks are for developing breast cancer. She is concerned because her
sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that
she began having periods at age 11 and has been fairly regular ever since, except during her
two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise
she has had no health problems. Her father has high blood pressure. Her mother had unilateral
breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law
attorney and is married. Her examination is essentially unremarkable.
Which risk factor of her personal and family history most puts her in danger of getting breast
cancer?
A) First-degree relative with premenopausal breast cancer
B) Age at menarche of less than 12
C) First live birth between the ages of 25 and 29
D) First-degree relative with postmenopausal breast cancer
Ans: A
Chapter: 10
Page and Header: 393, Health Promotion and Counseling
Feedback: Having a first-degree relative with cancer before menopause gives a relative risk of
3.1.
o Late menopause, early menarche, nulliparity.
o Example: A 55-year-old woman with a family history of breast and ovarian
cancer—high risk and needs early screening.
* A 72-year-old retired saleswoman comes to your office, complaining of a bloody discharge
from her left breast for 3 months. She denies any trauma to her breast. Her past medical
history includes high blood pressure and abdominal surgery for colon cancer. Her aunt died of
ovarian cancer and her father died of colon cancer. Her mother died of a stroke. The patient
denies tobacco, alcohol, or drug use. She is a widow and has three healthy children. On
examination her breasts are symmetric, with no skin changes. You are able to express
bloody discharge from her left nipple. You feel no discrete masses, but her left axilla has a
hard, 1-cm fixed node. The remainder of her heart, lung, abdominal, and pelvic examinations
are unremarkable.
What cause of nipple discharge is the most likely in her circumstance?
A) Benign breast abnormality
B) Breast cancer
C) Galactorrhea
, N607- Exam 2
Page 3 of 138
Ans: B
Chapter: 10
Feedback: Nipple discharge in breast cancer is usually unilateral and can be clear or bloody.
Although a breast mass is not palpated, in this case a fixed lymph node is palpated. Other forms
of breast cancer can be presented as a chronic rash on the breast.
* A 44-year-old female comes to your clinic, complaining of severe dry skin in the area over
her right nipple. She denies any trauma to the area. She noticed the skin change during a self-
examination 2 months ago. She also admits that she had felt a lump under the nipple but kept
putting off making an appointment. She does admit to 6 months of fatigue but no weight loss,
weight gain, fever, or night sweats. Her past medical history is significant for hypothyroidism.
She does not have a history of eczema or allergies. She denies any tobacco, alcohol, or drug
use. On examination you find a middle-aged woman appearing her stated age. Inspection of her
right breast reveals a scaly eczema-like crust around her nipple. Underneath you palpate a
nontender 2-cm mass. The axilla contains only soft, moveable nodes. The left breast and axilla
examination findings are unremarkable.
What visible skin change of the breast does she have?
A) Nipple retraction
B) Paget's disease
C) Peau d'orange sign
Ans: B
Chapter: 10
Page and Header: 402, Techniques of Examination
Feedback: This uncommon form of breast cancer starts as an eczema-like, scaly skin change
around the areola. The lesion may weep, crust, or erode. It can be associated with an underlying
mass, but the skin change can also be found alone. Any eczema-like area around the nipple that
does not respond to topical treatment needs to be evaluated for breast cancer
* A 56-year-old female comes to your clinic, complaining of her left breast looking unusual.
She says that for 2 months the angle of the nipple has changed direction. She does not do self-
examinations, so she doesn't know if she has a lump. She has no history of weight loss, weight
gain, fever, or night sweats. Her past medical history is significant for high blood pressure.
She smokes two packs of cigarettes a day and has three to four drinks per weekend night. Her
paternal aunt died of breast cancer in her forties. Her mother is healthy but her father died of
prostate cancer. On examination you find a middle-aged woman appearing older than her
stated age. Inspection of her left breast reveals a flattened nipple deviating toward the lateral
side. On palpation the nipple feels thickened. Lateral to the areola you palpate a nontender
, N607- Exam 2
Page 4 of 138
4cm mass. The axilla contains several fixed nodes. The right breast and axilla examinations
are unremarkable.
What visible skin change of the breast does she have?
A) Nipple retraction
B) Paget's disease
C) Peau d'orange sign
Ans: A
Chapter: 10
Page and Header: 402, Techniques of Examination
Feedback: A retracted nipple is flattened or pulled inward or toward the medial, lateral,
anterior, or posterior side of the breast. The surrounding skin can be thickened. This is a
relatively late finding in breast cancer.
Breast Masses:
o Fibroadenoma – mobile, rubbery, common in young women.
o Fibrocystic changes – painful, cyclic lumps.
o Mastitis – redness, tenderness, fever (common in lactating women).
Lymph Nodes in Breast Cancer
o Axillary nodes – common site for metastasis.
o Example: A patient with hard, fixed axillary lymph nodes should be evaluated
for malignancy.
* Which of the following lymph node groups is most commonly involved in breast cancer?
A) Lateral
B) Subscapular
C) Pectoral
D) Central
Ans: D
Feedback: The central nodes at the apex of the axilla are most commonly involved in breast
cancer. The axilla can be viewed roughly as a four-sided pyramid. An examination covering all
sides and the apex is unlikely to miss a significant node.
* A 43-year-old store clerk comes to your office upset because she has found an enlarged
lymph node under her left arm. She states she found it yesterday when she was feeling pain
under her arm during movement. She states the lymph node is about an inch long and is very
Page 1 of 138
N607 Exam 2 Study Guide (Modules 5-9)
Examination Techniques of Organ Systems
Breast Examination
Breast Self-Exam (BSE): Should be performed monthly, best done one week after
menstruation.
o Technique: Use the pads of three fingers in a circular motion, checking for
lumps or changes.
o Example: A 35-year-old woman notices a firm, immobile mass in her upper
outer quadrant. Next step: refer for mammography and biopsy.
* When should a woman conduct breast self-examination with respect to her menses?
A) Five to seven days following her menses
B) Midcycle
C) Immediately prior to menses
D) During her menses
Ans: A
Feedback: The breast examination should be conducted during the time with the least estrogen
stimulation of the breast tissue. This corresponds to five to seven days following menses.
* Which is the most effective pattern of palpation for breast cancer?
A) Beginning at the nipple, make an ever-enlarging spiral.
B) Divide the breast into quadrants and inspect each systematically.
C) Examine in lines resembling the back and forth pattern of mowing a lawn.
D) Beginning at the nipple, palpate outward in a stripe pattern.
Ans: C
Feedback: The vertical strip pattern has been shown to be the most effective pattern for
palpation of the breast. The most important aspect, however, is to be systematic. The tail of
Spence, located on the upper anterior chest, is an area commonly missed on examination.
Breast Cancer High-Risk Factors
o Family history (BRCA1/BRCA2 mutations).
, N607- Exam 2
Page 2 of 138
* A 40-year-old mother of two presents to your office for consultation. She is interested in
knowing what her relative risks are for developing breast cancer. She is concerned because her
sister had unilateral breast cancer 6 years ago at age 38. The patient reports on her history that
she began having periods at age 11 and has been fairly regular ever since, except during her
two pregnancies. Her first child arrived when she was 26 and her second at age 28. Otherwise
she has had no health problems. Her father has high blood pressure. Her mother had unilateral
breast cancer in her 70s. The patient denies tobacco, alcohol, or drug use. She is a family law
attorney and is married. Her examination is essentially unremarkable.
Which risk factor of her personal and family history most puts her in danger of getting breast
cancer?
A) First-degree relative with premenopausal breast cancer
B) Age at menarche of less than 12
C) First live birth between the ages of 25 and 29
D) First-degree relative with postmenopausal breast cancer
Ans: A
Chapter: 10
Page and Header: 393, Health Promotion and Counseling
Feedback: Having a first-degree relative with cancer before menopause gives a relative risk of
3.1.
o Late menopause, early menarche, nulliparity.
o Example: A 55-year-old woman with a family history of breast and ovarian
cancer—high risk and needs early screening.
* A 72-year-old retired saleswoman comes to your office, complaining of a bloody discharge
from her left breast for 3 months. She denies any trauma to her breast. Her past medical
history includes high blood pressure and abdominal surgery for colon cancer. Her aunt died of
ovarian cancer and her father died of colon cancer. Her mother died of a stroke. The patient
denies tobacco, alcohol, or drug use. She is a widow and has three healthy children. On
examination her breasts are symmetric, with no skin changes. You are able to express
bloody discharge from her left nipple. You feel no discrete masses, but her left axilla has a
hard, 1-cm fixed node. The remainder of her heart, lung, abdominal, and pelvic examinations
are unremarkable.
What cause of nipple discharge is the most likely in her circumstance?
A) Benign breast abnormality
B) Breast cancer
C) Galactorrhea
, N607- Exam 2
Page 3 of 138
Ans: B
Chapter: 10
Feedback: Nipple discharge in breast cancer is usually unilateral and can be clear or bloody.
Although a breast mass is not palpated, in this case a fixed lymph node is palpated. Other forms
of breast cancer can be presented as a chronic rash on the breast.
* A 44-year-old female comes to your clinic, complaining of severe dry skin in the area over
her right nipple. She denies any trauma to the area. She noticed the skin change during a self-
examination 2 months ago. She also admits that she had felt a lump under the nipple but kept
putting off making an appointment. She does admit to 6 months of fatigue but no weight loss,
weight gain, fever, or night sweats. Her past medical history is significant for hypothyroidism.
She does not have a history of eczema or allergies. She denies any tobacco, alcohol, or drug
use. On examination you find a middle-aged woman appearing her stated age. Inspection of her
right breast reveals a scaly eczema-like crust around her nipple. Underneath you palpate a
nontender 2-cm mass. The axilla contains only soft, moveable nodes. The left breast and axilla
examination findings are unremarkable.
What visible skin change of the breast does she have?
A) Nipple retraction
B) Paget's disease
C) Peau d'orange sign
Ans: B
Chapter: 10
Page and Header: 402, Techniques of Examination
Feedback: This uncommon form of breast cancer starts as an eczema-like, scaly skin change
around the areola. The lesion may weep, crust, or erode. It can be associated with an underlying
mass, but the skin change can also be found alone. Any eczema-like area around the nipple that
does not respond to topical treatment needs to be evaluated for breast cancer
* A 56-year-old female comes to your clinic, complaining of her left breast looking unusual.
She says that for 2 months the angle of the nipple has changed direction. She does not do self-
examinations, so she doesn't know if she has a lump. She has no history of weight loss, weight
gain, fever, or night sweats. Her past medical history is significant for high blood pressure.
She smokes two packs of cigarettes a day and has three to four drinks per weekend night. Her
paternal aunt died of breast cancer in her forties. Her mother is healthy but her father died of
prostate cancer. On examination you find a middle-aged woman appearing older than her
stated age. Inspection of her left breast reveals a flattened nipple deviating toward the lateral
side. On palpation the nipple feels thickened. Lateral to the areola you palpate a nontender
, N607- Exam 2
Page 4 of 138
4cm mass. The axilla contains several fixed nodes. The right breast and axilla examinations
are unremarkable.
What visible skin change of the breast does she have?
A) Nipple retraction
B) Paget's disease
C) Peau d'orange sign
Ans: A
Chapter: 10
Page and Header: 402, Techniques of Examination
Feedback: A retracted nipple is flattened or pulled inward or toward the medial, lateral,
anterior, or posterior side of the breast. The surrounding skin can be thickened. This is a
relatively late finding in breast cancer.
Breast Masses:
o Fibroadenoma – mobile, rubbery, common in young women.
o Fibrocystic changes – painful, cyclic lumps.
o Mastitis – redness, tenderness, fever (common in lactating women).
Lymph Nodes in Breast Cancer
o Axillary nodes – common site for metastasis.
o Example: A patient with hard, fixed axillary lymph nodes should be evaluated
for malignancy.
* Which of the following lymph node groups is most commonly involved in breast cancer?
A) Lateral
B) Subscapular
C) Pectoral
D) Central
Ans: D
Feedback: The central nodes at the apex of the axilla are most commonly involved in breast
cancer. The axilla can be viewed roughly as a four-sided pyramid. An examination covering all
sides and the apex is unlikely to miss a significant node.
* A 43-year-old store clerk comes to your office upset because she has found an enlarged
lymph node under her left arm. She states she found it yesterday when she was feeling pain
under her arm during movement. She states the lymph node is about an inch long and is very
