TECHTALK QUIZ: Breast Anatomy and Pathology

OBJECTIVES:

Every once in a while it is advisable to test ourselves on our retained knowledge. We work hard and often our information, hard won by hours of study, fades and gets lost. Here is a quick simple review of some of our breast anatomy and of a few of the common pathologies that plague the breast.

Good luck and I hope this turns out to be a good review for everyone. Please choose the BEST answer.

QUIZ

1. A lesion located in the upper
   outer quadrant of the R breast would be described as being at:
   

   1. 5 o’clock

   2. 2 o’clock

   3. 10 o’clock

   4. 7 o’clock

   5. 8 o’clock

   
   

2. Montgomery’s tubercles are usually found:

   1. On the nipple

   2. On the lateral border of the
      breast

   3. In the TLDU

   4. On the skin of the areola

   5. In the Ampulla

   
   

3. An inverted nipple
   

   1. Always indicates breast cancer

   2. Sometimes indicates breast
      cancer

   3. Never indicates breast cancer

   4. Usually indicates breast cancer

   5. Is a rare occurrence

   
   

4. Compression of the breast is most effective when applied to the

   1. Medial/Lateral aspect

   2. Inferior/Superior aspect

   3. Medial/Superior aspect

   4. Inferior/Lateral aspect

   5. Lateral/Superior aspect

   
   

5. The normal breast may have

   1. 5-10 lobes

   2. 15-20 lobes

   3. 25-30 lobes

   4. 30-40 lobes

   5. More than 40 lobes

   
   

6. The structure that gives the breast its support and shape is called the

   1. Montgomery ligament

   2. Cooper’s ligament

   3. Fibroglandular tissue

   4. Adipose tissue

   5. Pectoral Fascia

   
   

7. The breast extends vertically from the
   

   1. 1^st to 9^th rib

   2. 2^nd to 9^th rib

   3. 2^nd to 6^th rib

   4. 3^rd to 10^th rib

   5. Manubrium to Xiphoid process

   
   

8. The thickest portion of the breast is the

   1. Areola

   2. Nipple

   3. Tail-of-Spence

   4. IMF

   5. Deep Fascia

   
   

9. Cooper’s Ligaments attach anteriorly to

   1. Deep Fascia

   2. Fascia of the skin

   3. Posterior breast surface

   4. Parenchyma

   5. Fatty tissue

   
   

10. The fatty tissue of the breast is generally………… and appears on the mammogram as areas of………….OD

    1. Radiolucent/lower

    2. Radiopaque/higher

    3. Radiolucent/higher

    4. Radiopaque/lower

    5. Fatty tissue does not image well in film/screen mammography

    
    

11. Typically, a patient with dense fibro-glandular tissue throughout the entire breast is age

    1. Under 20 yrs.

    2. Over 50 yrs.

    3. Over 70 yrs.

    4. Under 40 yrs.

    5. Between 50 and 69 yrs.

    
    

12. Typically, glandular tissue is mainly in the…………..of the breast tissue

    1. Medial/LI quadrant

    2. Central/UO quadrant

    3. Medial/LO quadrant

    4. Central/UI quadrant

    5. Central/LI quadrant

13. Lymph drainage from the medial ½ of the breast tends to be through the

    1. Sternal nodes

    2. Transpectoral nodes

    3. Axillary nodes

    4. Apical nodes

    5. Cutaneous plexus

    
    

14. Immediately behind the nipple the main duct widens to form the

    1. Lobule

    2. Ampulla
       

    3. TLDU

    4. Segmental duct

    5. Branching duct

    
    

15. The anatomy of the breast which acts as the milk-producing element is the

    1. Ampulla

    2. Segmental duct

    3. Lobule

    4. Lactiferous sinus

    5. Montgomery’s tubercles

    
    

16. In the image below we are visualizing

1. Calcified vessels
2. DCIS
3. Egg shell calcification
4. Casting calcifications
5. Calcified fibroadenoma

17. The TLDU consists of
    

    1. Mammary ducts/extralobular terminal duct

    2. Intralobular terminal duct/segmental ducts

    3. Extralobular terminal duct/lactiferous duct

    4. Acini/lactiferous duct

    5. Extralobular terminal duct/Intralobular terminal duct

    
    

18. A patient begins HRT 6 months before her current mammogram. The image
    is likely to be

    1. Unchanged

    2. Higher in glandular tissue

    3. Lower in glandular tissue

    4. Higher in adipose tissue

    5. Easier to interpret

    
    

19. If the mammogram shows the patient’s breast tissue is less than 25% mammographically dense, this patient is most likely

    1. Taking estrogen

    2. Older than 60yrs.

    3. Younger than 20yrs.

    4. Older than 35yrs.

    5. A low cancer risk

    
    
    

20. A lactating patient is scheduled for a routine screening mammogram
    

    1. The test should be postponed because of breast sensitivity

    2. Radiation does not affect lactation the test should be done

    3. The patient should come fully involuted and the test should be done

    4. The test should be rescheduled because of increased cancer risk

    5. The test should be rescheduled because of the greatly increased density of involuted
       breasts

    
    

21. A patient that is not on HRT has gone through the onset of menopause 1 year prior to her current mammogram. The current mammogram is most likely to be

    1. Unchanged

    2. Higher in glandular tissue

    3. Lower in glandular tissue

    4. Lower in adipose tissue

    5. Easier to interpret

    
    

22. Which of the following will affect the ratio of glandular tissue to the total breast tissue

    1. Genetic predisposition

    2. Body Fat : Body Weight

    3. Weight gain and/or Weight loss

    
    

1. I

2. I & II

3. II & III

4. I, II & III

23. A lactating patient is scheduled for diagnostic mammogram to assess a symptom

    1. The test should be postponed until the patient stops breast feeding

    2. The patient should wean her child and have the test

    3. The mammographer should perform spot views only

    4. The test should be rescheduled due to highly dense breast tissue

    5. The patient should breast feed immediately before the appointment and the test should be done

    
    

24. A nulliparous patient has
    

    1. Never given birth to a child

    2. Had 1 child

    3. Never produced viable offspring

    4. Had 1 full pregnancy

    5. Had at least 1 miscarriage

    
    

25. An asymptomatic patient presents with an oval, lobulated, indistinct mass with no halo

    1. If the lesion is lucent it likely benign

    2. The lesion is suspicious of malignancy

    3. All oval lesions are benign

    4. The absence of a halo indicates cancer

    5. All lobulated lesions are suspicious

    
    

26. The lesion in the following image suggests

1. DCIS

2. A malignant type tumor

3. A cystic type lesion

4. A benign type lesion

5. A smooth mobile lesion

27. The calcifications in the image bellow:

1. Are typically benign
2. Are egg shell type
3. Are typical of fibroadenoma
4. Are smooth
5. Are typically malignant

28. The characteristics of a malignant stellate tumor include

    1. Spicules bunched together

    2. A central dense mass

    3. Tumor and spicules similar in size (e.g. Larger tumor/longer spicules)

    4. Long wispy spicules

1. I

2. I, II & IV

3. II & III

4. I, II, & III

5. II & IV

29. The calcifications in the image below have the typical appearance of

1. An oil cyst

2. Plasma cell mastitis

3. DCIS

4. Lipoma

5. Calcified artery

30. The calcifications in the imagebelow have the typical appearance of

1. An oil cyst
2. Plasma cell mastitis
3. DCIS
4. Lipoma
5. Calcified artery

31. A mammogram shows a low density radiopaque lesion. It is lobulated and has a halo demonstrated along one border only. The next step should be

• Pneumocystography
• U/S
• Biopsy
• Nothing, the lesion is benign
• FNA

32. The lesion in the image below has the typical appearance of

1. A Cyst
2. LCIS
3. An Oil Cyst
4. Invasive Ductal Ca
5. A Lymph node





CONCLUSION:


Have fun, refresh your knowledge. If you want the explanation and references for any of the answers to the Quiz, feel free to get in touch and I will email them to you.








ANSWER KEY



1. Three, 2. Four, 3. Two, 4. Four, 5. Two, 6. Two, 7. Three, 8. Three, 9. Two, 10. One, 11. Four, 12. Two, 13. One, 14. Two, 15. Three, 16. One, 17. Five, 18. Two, 19. Two, 20. Five, 21. Three, 22. Four, 23. Five, 24. One, 25. Two, 26. Two, 27. Five, 28. Three, 29. One, 30. Two, 31. Two, 32. Five.