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Quizzes > Health & Medicine

Breast and Lymphatics 3.0 Test: Axillary Lymphatics Quiz

Quick, free axillary lymphatics quiz to check your knowledge. Instant results.

Editorial: Review CompletedCreated By: Butchay SuanicoUpdated Aug 25, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration for Breast Lymphatics 3.0 quiz header showing breast anatomy and axilla lymphatics on teal background

Use this quiz to check your understanding of breast anatomy and axillary lymphatics, including key nodes and drainage routes. For broader review, try the chest anatomy quiz, refresh structures with the upper limb anatomy quiz, and locate landmarks across the body in the anatomical regions quiz.

What is the primary arterial blood supply to the breast?
Posterior intercostal artery
Internal thoracic artery
Thoracoacromial artery
Lateral thoracic artery
The breast receives its main blood supply from perforating branches of the internal thoracic (internal mammary) artery. The lateral thoracic artery is a secondary contributor arising from the axillary artery. Thoracoacromial and posterior intercostal arteries provide minor collateral flow. .
Which quadrant of the breast contains the greatest amount of glandular tissue?
Lower inner quadrant
Upper inner quadrant
Lower outer quadrant
Upper outer quadrant
The upper outer quadrant of the breast has the highest concentration of glandular tissue and is the most common site for breast lesions. The other quadrants contain less glandular tissue. .
What structure provides fibrous support to the breast, helping maintain its shape?
Suspensory ligaments of Cooper
Retinacula cutis
Cooper's ligaments
Scarpa's fascia
Cooper's ligaments are fibrous septa that extend from the skin to the deep fascia, supporting the breast tissue and maintaining its contour. They are sometimes referred to as suspensory ligaments of Cooper but that term is redundant. Retinacula cutis refers generally to skin ligaments elsewhere, and Scarpa's fascia is in the abdomen. .
The nipple is typically located at which dermatome level?
T10
T2
T4
T6
Sensory innervation of the nipple corresponds to the T4 dermatome. Dermatomal mapping places the nipple at approximately the fourth thoracic level. Other levels correspond to different regions of the trunk. .
The breast is classified as which type of gland?
Sebaceous gland
Endocrine gland
Modified sweat gland
Salivary gland
The mammary gland is a modified sweat gland specialized for milk production. It is not an endocrine gland because it secretes milk via ducts, and it is distinct from sebaceous or salivary glands. .
Where is the retromammary space located?
Between ribs and intercostal muscles
Between skin and subcutaneous fat
Between pectoralis major and minor
Between breast tissue and pectoral fascia
The retromammary space is a fascial plane located between the deep surface of the breast and the pectoral fascia overlying the pectoralis major muscle. It allows some mobility of the breast. .
Approximately what percentage of lymph from the breast drains to axillary lymph nodes?
50%
95%
75%
25%
About 75% of lymph from the breast drains to the axillary lymph nodes, primarily via lymphatic vessels in the upper outer quadrant. The remaining lymph drains to parasternal or clavicular nodes. .
Medial lymphatic drainage of the breast primarily goes to which nodal group?
Parasternal (internal mammary) nodes
Supraclavicular nodes
Inguinal nodes
Axillary level I nodes
Lymph from the medial breast drains primarily to the parasternal or internal mammary nodes along the internal thoracic vessels. Axillary nodes handle lateral drainage. Supraclavicular nodes receive efferent flow mainly from apical axillary nodes. .
Which fascial layer directly invests the pectoralis major muscle under the breast?
Pectoral (deep) fascia
Endothoracic fascia
Superficial fascia
Clavipectoral fascia
The pectoral or deep fascia covers the pectoralis major and provides the deep boundary of the breast. Superficial fascia contains fat and connective tissue above the breast. Clavipectoral fascia lies deep to pectoralis minor, and endothoracic fascia lines the thoracic cavity. .
Which structure forms the tail of Spence in the breast?
Accessory nipple
Axillary vein branch
Extension of breast tissue into the axilla
Pectoral fascia fold
The tail of Spence is the extension of breast glandular tissue that projects into the axilla along the lateral border of the pectoralis major. It is not a vascular structure or an accessory nipple. .
Which axillary lymph node level lies lateral to the lateral border of pectoralis minor?
Level I
Infraclavicular
Level III
Level II
Level I (low) axillary lymph nodes lie lateral to the lateral border of pectoralis minor. Level II nodes lie posterior to the muscle, and Level III nodes lie medial to its medial border. Infraclavicular nodes are part of the deltopectoral group. .
Through which anatomical space does the tail of Spence pass into the axilla?
Along the clavipectoral fascia
Superior thoracic aperture
Lateral mammary extension
Between pectoralis major and minor
The tail of Spence is the lateral extension of breast tissue that passes above the lateral border of the pectoralis major into the axilla. It does not traverse between the pectoral muscles or the superior thoracic aperture. .
Which embryologic layer gives rise to the mammary glands?
Ectoderm
Endoderm
Mesoderm
Neural crest
Mammary glands develop from the ectodermal layer, forming mammary ridges that later canalize into ducts. The mesoderm forms connective tissue and muscle around them. Endoderm does not contribute to skin structures, and neural crest cells give rise to peripheral nerves. .
What structure contains the lactiferous ducts before they open at the nipple?
Montgomery gland
Areolar tubercle
Lactiferous sinus
Cooper's ligament
The lactiferous sinus is a dilation of each lactiferous duct just beneath the areola, which temporarily stores milk. Montgomery glands are sebaceous glands in the areola, not ducts. Cooper's ligaments are supportive fibrous bands. .
Which lymph nodes lie between pectoralis major and minor muscles?
Rotter's (interpectoral) nodes
Sentinel nodes
Infraclavicular nodes
Apical nodes
Rotter's or interpectoral nodes are small lymph nodes located in the interpectoral space between pectoralis major and minor. They can be involved in breast cancer spread. Sentinel, apical, and infraclavicular nodes are in different locations. .
Which vessel provides the main venous drainage of the lateral breast?
Internal thoracic vein
Thoracoacromial vein
Lateral thoracic vein
Axillary vein
The lateral thoracic vein accompanies the artery of the same name and drains the lateral aspects of the breast into the axillary vein. The internal thoracic vein drains medial portions. The thoracoacromial vein is a minor tributary. .
Which fascial layer is immediately superficial to the mammary gland tissue?
Superficial (Camper's) fascia
Endothoracic fascia
Pectoral fascia
Clavipectoral fascia
Superficial fascia, also known as Camper's fascia in the trunk, lies between the skin and the glandular tissue of the breast. It contains fat and fibrous septa. Pectoral fascia is deep to the gland. Clavipectoral fascia lies deep to pectoralis minor. .
Which nerve provides most of the sensory innervation to the lateral breast skin?
Intercostobrachial nerve
Lateral cutaneous branches of T4 - T6
Long thoracic nerve
Medial pectoral nerve
Lateral cutaneous branches of intercostal nerves T4 to T6 supply the lateral skin of the breast. The intercostobrachial nerve supplies the axilla and medial arm. Medial pectoral nerve is motor to pectoralis minor and major, and the long thoracic nerve innervates serratus anterior. .
Which lymphatic trunk drains efferent lymph from the apical axillary nodes?
Subclavian trunk
Intestinal trunk
Jugular trunk
Bronchomediastinal trunk
The subclavian trunk receives lymph from the upper limbs and the apical axillary lymph nodes. The bronchomediastinal trunk drains thoracic viscera, the jugular trunk drains head and neck, and the intestinal trunk drains abdominal organs. .
Between which rib levels does the breast commonly extend vertically?
4th to 8th ribs
3rd to 7th ribs
2nd to 6th ribs
1st to 4th ribs
The breast typically spans from the level of the 2nd to the 6th ribs vertically on the chest wall. This anatomical range is important for surgical and imaging planning. .
Interpectoral (Rotter's) nodes lie in which anatomical space?
Superficial to pectoral fascia
Deep to clavipectoral fascia
Between pectoralis major and minor
Between pectoralis minor and serratus anterior
Interpectoral or Rotter's nodes are found in the space between the pectoralis major and minor muscles, along the lateral thoracic vessels. They can be pathways for breast cancer spread. .
Which structure forms the anterior boundary of the axillary inlet?
Clavicle
Coracoid process
Pectoralis minor tendon
First rib
The clavicle forms the anterior boundary of the thoracic outlet or axillary inlet, along with the first rib posteriorly and the superior border of the scapula laterally. The pectoralis minor tendon lies within the axilla but does not form its boundary. .
Which vessel does the lateral thoracic artery typically arise from?
Third part of axillary artery
Second part of axillary artery
Internal thoracic artery
Subclavian artery
The lateral thoracic artery usually branches from the second part of the axillary artery, running along the lateral border of pectoralis minor to supply the lateral breast. It does not arise from the subclavian or internal thoracic arteries. .
Which cell type lines the lymphatic capillaries in the breast stroma?
Fibroblasts
Endothelial cells
Keratinocytes
Adipocytes
Lymphatic capillaries are lined by a single layer of specialized endothelial cells that facilitate unidirectional fluid uptake. Keratinocytes line the skin, fibroblasts produce connective tissue, and adipocytes store fat. .
Which group of axillary lymph nodes lies along the lateral thoracic vessels on the chest wall?
Central nodes
Pectoral (anterior) nodes
Subscapular (posterior) nodes
Brachial (lateral) nodes
Pectoral or anterior axillary lymph nodes lie along the lateral thoracic vessels on the chest wall and receive lymph from the anterior thoracic wall and breast. Subscapular nodes lie along the posterior axillary fold, brachial nodes along the humeral vessels, and central nodes deep within the axilla. .
Damage to which nerve during axillary dissection can cause loss of sensation over the medial arm?
Medial pectoral nerve
Intercostobrachial nerve
Long thoracic nerve
Thoracodorsal nerve
The intercostobrachial nerve, a lateral cutaneous branch of T2, supplies sensation to the skin of the medial arm and can be injured during axillary lymph node dissection. The long thoracic and thoracodorsal nerves are motor nerves, and the medial pectoral nerve innervates pectoral muscles. .
Which anatomical landmark defines the transition from Level II to Level III axillary lymph nodes?
Lateral border of pectoralis minor
Inferior border of teres minor
Superior border of latissimus dorsi
Medial border of pectoralis minor
Level III axillary nodes lie medial to the medial border of pectoralis minor, whereas Level II nodes lie posterior to the muscle. The lateral border defines Level I. Other landmarks do not correspond to nodal levels. .
What is the clinical significance of lymphedema after axillary lymph node dissection?
Increased arterial inflow causes pain
Impaired lymph return leads to chronic arm swelling
Venous thrombosis results in edema
Neuropathic pain reduces lymph flow
Axillary lymph node dissection disrupts lymphatic drainage from the upper limb, leading to accumulation of interstitial fluid and chronic arm swelling known as lymphedema. It is neither caused by arterial inflow nor venous thrombosis directly. Neuropathic pain does not primarily affect lymph flow. .
Which immunohistochemical marker is most specific for identifying lymphatic endothelium in breast tissue?
VEGFR2
LYVE-1
CD34
CD31
LYVE-1 is a lymphatic vessel endothelial hyaluronan receptor selectively expressed on lymphatic endothelium, making it a specific marker for lymphatic channels. CD31 and CD34 label all endothelium, and VEGFR2 is an angiogenic receptor. .
Which layer of fascia must be incised to reach the axillary lymph nodes in an axillary clearance procedure?
Deep investing fascia of pectoralis major
Endothoracic fascia
Superficial fascia
Clavipectoral fascia
The clavipectoral fascia lies deep to the pectoralis minor and must be incised to access the deeper axillary contents including lymph nodes. The investing fascia of pectoralis major is superficial to this layer, while superficial and endothoracic fasciae are not directly involved. .
What tracer combination is commonly used for sentinel lymph node mapping in breast cancer?
Technetium-99m sulfur colloid and blue dye
Iodine-125 and fluorescein
Gadolinium and methylene blue
Fluorine-18 FDG and indocyanine green
Sentinel lymph node biopsy in breast cancer commonly uses a radiocolloid tracer such as Technetium-99m sulfur colloid combined with a visual blue dye to identify the first draining lymph node. Other combinations are less standard or used in research. .
Which collateral lymphatic pathway can develop in breast cancer obstructing the ipsilateral axillary nodes?
Mediastinal lymphatics via deep intercostal channels
Hepatic lymphatics via thoracic duct
Inguinal lymphatics via superficial trunk
Contralateral breast lymphatics via superficial network
When ipsilateral axillary drainage is obstructed, collateral lymphatic channels can form across the midline superficial to drain into contralateral breast or axillary nodes. Mediastinal, hepatic, or inguinal pathways are not typical collateral routes in this scenario. .
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Study Outcomes

  1. Understand Breast Glandular Structure -

    Grasp the layers, lobes, and ducts of the breast to build a solid foundation for further lymphatic studies.

  2. Identify Axillary Lymph Node Groups -

    Recognize and name the major lymph node clusters in the axilla, including levels I, II, and III, for precise anatomical localization.

  3. Analyze Lymphatic Drainage Pathways -

    Trace the flow of lymph from breast tissue into axillary and supraclavicular nodes, highlighting common drainage routes.

  4. Apply Anatomical Landmarks to Clinical Scenarios -

    Use your knowledge of breast and lymphatic anatomy to predict lymphatic involvement in clinical cases.

  5. Evaluate Clinical Implications of Lymphatic Flow -

    Assess how disruptions in lymphatic drainage can impact breast pathology, including lymphedema and metastatic spread.

  6. Reinforce Learning with Interactive Flashcards -

    Engage with breast anatomy flashcards to strengthen recall of key structures and lymphatic connections.

Cheat Sheet

  1. Breast Lobular Architecture and Ductal System -

    The adult female breast contains 15 - 20 lobes arranged radially, each drained by a single lactiferous duct that opens at the nipple. A handy mnemonic from Gray's Anatomy is "Lil Ducks Dabble" (Lobes → Ducts → Drainage) to recall this. Reviewing ductal structure is crucial for the breast and lymphatics 3.0 test as ductal carcinomas originate here.

  2. Blood Supply and Anastomoses -

    The breast receives arterial blood mainly from the internal thoracic, lateral thoracic, and thoracoacromial arteries, creating a rich anastomotic network. Understanding this network is vital for surgical planning and interpreting imaging studies (Radiopaedia). Remember the phrase "IT's Late Today" (Internal thoracic, Lateral thoracic, Thoracoacromial) to keep vessels straight.

  3. Lymphatic Drainage Pathways -

    About 75% of breast lymph drains to the axillary nodes, while the rest goes to parasternal (internal mammary) chains; some also reach interpectoral (Rotter's) nodes. Sappey's plexus in the subareolar space serves as a central collecting ditch - think "Sub-Areolar Subway" for quick recall. This knowledge underpins questions on the breast quiz and axilla anatomy quiz.

  4. Axillary Lymph Node Levels -

    Level I nodes lie lateral to the pectoralis minor, Level II are directly behind it, and Level III sit medial to the muscle's medial border. Use the mnemonic "Little Bears Munch" (Lateral, Behind, Medial) to sequence Levels I - III. Mastering these levels is essential for the axillary lymphatics test and sentinel node biopsy mapping.

  5. Clinical Significance: Sentinel Node Biopsy -

    Sentinel lymph node biopsy identifies the first draining node(s) using radiotracer or dye, guiding breast cancer staging and treatment. The American Cancer Society highlights its high sensitivity and reduced morbidity versus full axillary dissection. Keep in mind "Sentinel Stops Spread" when reviewing breast anatomy flashcards for clinical exams.

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