Chapter 16: Breast Surgery

Chapter 16: Breast Surgery

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. Identify the marginal boundaries of the breasts.

a.	Second to fifth rib horizontally, lateral edge of sternum to mid-clavicular line
b.	Second to sixth rib horizontally, mid-sternum to mid-clavicular line
c.	Second to sixth rib horizontally, lateral edge of sternum to anterior axillary line
d.	Second to fifth rib horizontally, lateral edge of sternum to mid-axillary line

 

 

ANS:  C

The breasts extend from the second to the sixth rib horizontally and from the lateral edge of the sternum to the anterior axillary line.

 

REF:   Page 558

 

2. The internal thoracic lymph nodes, which drain the inner half of the breast, can also be a channel for the:

a.	secretion of estrogen.
b.	spread of metastasis.
c.	drainage of the outer half of the breast.
d.	spread of infections.

 

 

ANS:  B

Lymph drainage generally follows the course of the vessels. Lymphatics drain into two main areas represented by the axillary nodes and the internal thoracic chain of nodes (see Figure 16-3). The internal thoracic nodes are few, but are responsible for most lymph drainage from the inner half of the breast. Thus the lymph system can also be a channel for the spread of malignant disease from the breast to associated areas of the chest wall or to the axilla.

 

REF:   Page 588

 

3. The mammary glands are affected by physiologic changes throughout a woman’s life span. Select the option that best reflects the life cycle events that impact the anatomy and physiology of the breasts.

a.	Growth and development, menstruation, and menopause
b.	Menstruation, pregnancy, and lactation
c.	Hormone development, pregnancy, and menopause
d.	Growth and development, menstruation, and pregnancy and lactation

 

 

ANS:  D

The mammary glands are affected by three types of physiologic changes: (1) those related to growth and development, (2) those related to the menstrual cycle, and (3) those related to pregnancy and lactation.

 

REF:   Page 588

 

4. Fibrocystic changes in the breast describe many different breast changes. These changes affect almost all women at some time in their lives. Nipple discharge is more commonly associated with benign lesions than with cancer; however, discharge is usually significant only if it is spontaneous, persistent, and:

a.	chronic.
b.	unilateral.
c.	bloody.
d.	All of the options are significant.

 

 

ANS:  D

Discharge is usually significant only if it is spontaneous and persistent. Chronic unilateral nipple discharge, especially if bloody, should prompt an investigation for occult carcinoma.

 

REF:   Pages 589-590 (See Table 16-1)

 

5. In the past, radical procedures, which involved removal of the affected breast and all axillary and thoracic lymph nodes, were used to treat breast cancer. These procedures did not significantly lower mortality. What factor(s) may have contributed to mortality after these procedures?

a.	Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection.
b.	Early pathology techniques for frozen section and histology microexamination could not define margins.
c.	Breast cancer was believed to spread by direct extension from its initial site in the breast to adjacent lymph nodes.
d.	Tumor size was not usually correlated with involvement of lymph nodes and cancer spread.

 

 

ANS:  A

Breast cancer may be a systemic condition at the time of diagnosis (History box). Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection. External physical changes, such as dimpling of the skin, can also indicate the presence of a benign or malignant pathologic process. The older the patient, the more likely it is that a mass is malignant. The most common form of breast cancer is infiltrating ductal carcinoma (see Table 16-2). The cause of breast cancer remains unknown. The belief that breast cancer spreads by direct extension from its initial site in the breast to adjacent lymph nodes may not always be correct. This could explain why radical breast surgery of the past, which involved removal of the affected breast and all axillary and thoracic lymph nodes, did not greatly lower mortality. Tumor size can usually be correlated with involvement of lymph nodes. The larger a tumor is, the more likely it is that lymph nodes are involved.