Question 1

A 45-year-old female patient presents in the emergency department due to multiple chest injuries resulting from a motor vehicle accident. There is a palpable, tender, irregular 3 cm soft mass located in the left breast, with erythema and swelling of the breast. Which of the following is indicated?

Accepted Answer

B

Question 2

A 23-year-old female presents with episodic bilateral breast tenderness. On palpation, there are multiple areas of nodularity with no dominant breast mass and no tenderness. There are no nipple or skin changes. It is best to recommend:

Accepted Answer

Given the patient's age and symptoms, the most appropriate recommendation is to keep a diary of the menstrual cycle and breast symptoms. This approach helps in identifying any correlation between the symptoms and the menstrual cycle, suggesting a benign, hormonal cause such as fibrocystic breast changes, which are common and not a cause for immediate concern in young women with these symptoms.

Question 3

Which of the following variables is not a component of the Gail model?

Accepted Answer

The Gail model includes factors such as age at menarche, number of breast biopsies, and age at first live birth to estimate a woman's risk of developing breast cancer, but it does not include the number of live births as a component.

Question 4

A 23-year-old woman is concerned about a mass she found on palpation. On examination of the patient, the mass feels cystic, round, and mobile with discrete borders. The diagnostic study that is recommended is:

Accepted Answer

Ultrasound is the recommended diagnostic study for a young woman with a palpable, cystic, and mobile mass. It helps differentiate solid from cystic masses and is preferred due to the dense breast tissue commonly found in younger women, which can limit the effectiveness of mammograms.

Question 5

Your patient, a 46-year-old woman suffering from psychosis, complains of milky discharge from both breasts. On examination, there are no significant findings and the patient is not pregnant, breastfeeding, or in the postpartum period. You should:

Accepted Answer

The milky discharge (galactorrhea) could be a side effect of medications, especially antipsychotics, which can increase prolactin levels. Obtaining a complete list of medications is crucial to identify any that might be causing this side effect.

Question 6

A 62-year-old female presents with a singular, hard, 1 cm, nontender, nonmobile mass in the right breast. There are no nipple or skin changes, however, you palpate an enlarged right-sided supraclavicular lymph node. The clinician should recognize these are signs of:

Accepted Answer

A hard, nonmobile mass in the breast, especially when associated with enlarged supraclavicular lymph nodes, is highly suggestive of malignancy. Fibroadenomas are usually mobile and not associated with lymph node enlargement, breast cysts are typically tender and fluid-filled, and Paget's disease of the breast presents with nipple changes.

Question 7

A condition that increases risk of breast cancer in a male is:

Accepted Answer

Both BRCA1 and 2 mutations and Klinefelter's syndrome are associated with an increased risk of breast cancer in males. BRCA mutations increase the risk of several cancers, including male breast cancer. Klinefelter's syndrome, a condition where males have an extra X chromosome, also increases the risk of male breast cancer. Pseudogynecomastia, which is characterized by increased fat deposition without glandular tissue proliferation, does not increase breast cancer risk.

Question 8

Bloody breast discharge is associated with which of the following?

Accepted Answer

Bloody breast discharge is most commonly associated with malignancy, although it can also be a symptom of benign conditions. Bleeding disorders and the use of nonsteroidal anti-inflammatory drugs are not typically associated with bloody breast discharge.

Question 9

Your 50-year-old patient has a rubbery, firm, mobile breast mass. In order to completely exclude the possibility of cancer, the triple test is necessary, which includes:

Accepted Answer

A biopsy is the only method among the options that can definitively exclude the possibility of cancer by providing a histopathological diagnosis.

Question 10

Your patient is a 36-year-old woman who complains of milky discharge from both breasts, episodes of headache, and menstrual irregularity. The patient is on no medications. On examination, there are no significant findings, and the patient is not pregnant, breastfeeding, or in the postpartum period. It is important to:

Accepted Answer

The symptoms suggest hyperprolactinemia, which can cause galactorrhea, headaches, and menstrual irregularities. Measuring prolactin levels is the first step in evaluating these symptoms.

Question 11

When examining the breasts of a 45-year-old female patient, you note nodularity throughout both breasts. There is no dominant mass, tenderness, nipple change, or skin change. Which of the following conditions is most likely?

Accepted Answer

The answer of When examining the breasts of a 45-year-old...

Question 12

A 34-year-old female who gave birth 2 weeks ago developed fever and pain in the right breast while nursing her baby. The patient has tenderness, erythema, and swelling of the nipple on the right breast. Which of the following diagnostic studies is indicated?

Accepted Answer

The answer of A 34-year-old female who gave birth 2...

Question 13

Your patient is a 64-year-old female who presents with complaints of a red, scaly rash on the nipple and areola of one breast. It has been present for a few months. There is no mass or nipple discharge. You should be suspicious of:

Accepted Answer

Paget's disease of the breast presents with eczema-like changes to the nipple and areola, often mistaken for dermatitis or eczema, but is associated with underlying breast cancer. The absence of a mass does not rule it out, and the chronicity and presentation are characteristic.

Question 14

A 12-year-old boy is brought into the clinic by his mother. The teen boy is embarrassed because he has developed breast tissue and would like to know if there is any treatment. The physical examination reveals early stages of puberty, otherwise it is normal. This presentation is:

Accepted Answer

This presentation is most often due to altered hormonal levels in puberty, a condition known as gynecomastia. It is common during puberty due to fluctuations in hormones, particularly the imbalance between estrogen and testosterone levels. This condition is usually benign and can resolve on its own as hormone levels stabilize.

Question 15

A 52-year-old female complains of discharge from one breast. There is no pain, no mass, and no skin changes. The physical examination is normal. When putting pressure on the affected breast, the nipple expresses a small amount of thick, white discharge. These findings are consistent with:

Accepted Answer

Duct ectasia typically presents with nipple discharge that can be white, green, or black. It occurs due to dilation of the ducts and is common in perimenopausal women. The absence of pain, mass, or skin changes, along with the presence of thick, white discharge upon expression, supports this diagnosis.

Quiz 9: Breasts