ARDMS Breast Sonography Exam Review | Anatomy,
Pathology, BI-RADS & Ultrasound Practice Questions and
answers 2026/2027
Question 1
What is the functional microscopic unit of the breast where the vast
majority of benign and malignant pathology originates?
• A. The Terminal Duct Lobular Unit (TDLU)
• B. The lactiferous sinus
• C. The nipple-areolar complex
• D. The retromammary bursa
Correct Answer: A. The Terminal Duct Lobular Unit (TDLU)
Detailed 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.
Correct Answer: A. To provide structural support and maintain breast
contour by extending from the prepectoral fascia through the fat to the
dermis of the skin.
Detailed 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
Correct Answer: A. Subcutaneous layer, mammary (parenchymal) layer,
retromammary layer
Detailed 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 fascia).
,Question 4
What is the typical sonographic appearance of normal subcutaneous
and retromammary fat in the breast?
• A. Hypoechoic tissue interrupted by bright echogenic linear
echoes representing Cooper's ligaments and connective tissue
septa.
• B. Completely anechoic fluid-filled spaces with posterior
enhancement.
• C. Dense, highly echogenic solid masses with extensive posterior
shadowing.
• D. Uniform bright reflectors without any internal texture.
Correct Answer: A. Hypoechoic tissue interrupted by bright echogenic
linear echoes representing Cooper's ligaments and connective tissue
septa.
Detailed Rationale: Normal fat lobules are darker (hypoechoic)
compared to the surrounding connective tissue network, which
produces distinct echogenic linear interfaces.
Question 5
What are the two primary arterial blood supplies to the breast?
• A. Branches of the internal mammary (thoracic) artery and the
lateral thoracic artery.
• B. The subclavian vein and cephalic vein exclusively.
• C. The intercostal nerves and brachial plexus.
• D. The superficial temporal and facial arteries.
, Correct Answer: A. Branches of the internal mammary (thoracic) artery
and the lateral thoracic artery.
Detailed Rationale: The breast receives dual arterial blood supply,
predominantly medially via perforating branches of the internal
mammary artery and laterally via branches of the lateral thoracic and
axillary arteries.
Question 6
Approximately what percentage of lymphatic drainage from the breast
tissue flows toward the ipsilateral axillary lymph node chain?
• A. Approximately 75 percent
• B. Less than 10 percent
• C. Exactly 50 percent
• D. 100 percent
Correct Answer: A. Approximately 75 percent
Detailed Rationale: The majority of lymphatic fluid from the breast
drains into the axillary lymph nodes, making axillary staging a critical
component in breast cancer evaluation and management.
Question 7
What is the typical sonographic appearance of the normal adult male
breast?
• A. A small, thin, echogenic retroareolar button of residual ductal
tissue surrounded by fat, lacking complex TDLUs.
• B. Fully developed lobules and acini identical to a lactating female
breast.
Pathology, BI-RADS & Ultrasound Practice Questions and
answers 2026/2027
Question 1
What is the functional microscopic unit of the breast where the vast
majority of benign and malignant pathology originates?
• A. The Terminal Duct Lobular Unit (TDLU)
• B. The lactiferous sinus
• C. The nipple-areolar complex
• D. The retromammary bursa
Correct Answer: A. The Terminal Duct Lobular Unit (TDLU)
Detailed 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.
Correct Answer: A. To provide structural support and maintain breast
contour by extending from the prepectoral fascia through the fat to the
dermis of the skin.
Detailed 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
Correct Answer: A. Subcutaneous layer, mammary (parenchymal) layer,
retromammary layer
Detailed 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 fascia).
,Question 4
What is the typical sonographic appearance of normal subcutaneous
and retromammary fat in the breast?
• A. Hypoechoic tissue interrupted by bright echogenic linear
echoes representing Cooper's ligaments and connective tissue
septa.
• B. Completely anechoic fluid-filled spaces with posterior
enhancement.
• C. Dense, highly echogenic solid masses with extensive posterior
shadowing.
• D. Uniform bright reflectors without any internal texture.
Correct Answer: A. Hypoechoic tissue interrupted by bright echogenic
linear echoes representing Cooper's ligaments and connective tissue
septa.
Detailed Rationale: Normal fat lobules are darker (hypoechoic)
compared to the surrounding connective tissue network, which
produces distinct echogenic linear interfaces.
Question 5
What are the two primary arterial blood supplies to the breast?
• A. Branches of the internal mammary (thoracic) artery and the
lateral thoracic artery.
• B. The subclavian vein and cephalic vein exclusively.
• C. The intercostal nerves and brachial plexus.
• D. The superficial temporal and facial arteries.
, Correct Answer: A. Branches of the internal mammary (thoracic) artery
and the lateral thoracic artery.
Detailed Rationale: The breast receives dual arterial blood supply,
predominantly medially via perforating branches of the internal
mammary artery and laterally via branches of the lateral thoracic and
axillary arteries.
Question 6
Approximately what percentage of lymphatic drainage from the breast
tissue flows toward the ipsilateral axillary lymph node chain?
• A. Approximately 75 percent
• B. Less than 10 percent
• C. Exactly 50 percent
• D. 100 percent
Correct Answer: A. Approximately 75 percent
Detailed Rationale: The majority of lymphatic fluid from the breast
drains into the axillary lymph nodes, making axillary staging a critical
component in breast cancer evaluation and management.
Question 7
What is the typical sonographic appearance of the normal adult male
breast?
• A. A small, thin, echogenic retroareolar button of residual ductal
tissue surrounded by fat, lacking complex TDLUs.
• B. Fully developed lobules and acini identical to a lactating female
breast.
