TEST BANK FOR BATES' GUIDE TO PHYSICAL EXAMINATION AND HISTORY TAKING 12TH EDITION BY
BICKLEY
Bates’ Guide to Physical Examination and History Taking, 12th Edition
Chapter 10: The Breasts and Axillae
Multiple Choice
1. 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 NURSINGTB.COM
C) Galactorrhea
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 present as a chronic rash on the breast.
2. 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.
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, TEST BANK FOR BATES' GUIDE TO PHYSICAL EXAMINATION AND HISTORY TAKING 12TH EDITION BY
BICKLEY
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
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.
3. 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
NU reveals
RSINaGflattened
TB.COnipple
M deviating toward the lateral
side. On palpation the nipple feels thickened. Lateral to the areola you palpate a nontender 4-cm
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
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.
4. A 19-year-old female comes to your office, complaining of a clear discharge from her right
breast for 2 months. She states that she noticed it when she and her boyfriend were “messing
around” and he squeezed her nipple. She continues to have this discharge anytime she squeezes
that nipple. She denies any trauma to her breasts. Her past medical history is unremarkable. She
NURSINGTB.COM
BICKLEY
Bates’ Guide to Physical Examination and History Taking, 12th Edition
Chapter 10: The Breasts and Axillae
Multiple Choice
1. 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 NURSINGTB.COM
C) Galactorrhea
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 present as a chronic rash on the breast.
2. 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.
NURSINGTB.COM
, TEST BANK FOR BATES' GUIDE TO PHYSICAL EXAMINATION AND HISTORY TAKING 12TH EDITION BY
BICKLEY
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
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.
3. 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
NU reveals
RSINaGflattened
TB.COnipple
M deviating toward the lateral
side. On palpation the nipple feels thickened. Lateral to the areola you palpate a nontender 4-cm
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
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.
4. A 19-year-old female comes to your office, complaining of a clear discharge from her right
breast for 2 months. She states that she noticed it when she and her boyfriend were “messing
around” and he squeezed her nipple. She continues to have this discharge anytime she squeezes
that nipple. She denies any trauma to her breasts. Her past medical history is unremarkable. She
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