Question 1

A 23-year-old woman is concerned about a mass she found on palpation.Upon 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 best choice because it is a non-invasive and effective method for evaluating cystic masses, especially in young women. It can show the internal characteristics of the mass, such as fluid content and thickness of the wall, which helps differentiate between a benign and malignant mass. CT scan and mammogram are not the optimal choices for a young woman with a cystic breast mass, and biopsy is not necessary at this point since ultrasound can provide more information about the mass.

Question 2

Your patient is a 36-year-old woman who complains of milky discharge from both her breasts,episodes of headache,and menstrual irregularity.The patient is on no medications.Upon 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 patient's symptoms are consistent with hyperprolactinemia, which is characterized by milky discharge from the breasts, menstrual irregularity, and headaches. In this case, ordering a prolactin level assay is the best choice as it can help confirm the diagnosis of hyperprolactinemia. An MRI of the head can be done if the prolactin level is high or if the patient has other symptoms that suggest a pituitary tumor. Keeping a menstrual cycle diary can be helpful in tracking menstrual irregularities, and a mammogram is not necessary at this time, as there are no breast abnormalities or risk factors for breast cancer.

Question 3

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 condition is most likely?

Accepted Answer

A

Question 4

Bloody breast discharge is associated with which of the following?

Accepted Answer

Bloody breast discharge is a concerning symptom and is most commonly associated with malignancy, such as breast cancer. While bleeding disorders and excessive use of non-steroidal anti-inflammatories can cause bleeding, they are not typically associated with breast discharge.

Question 5

Your 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

The triple test for breast cancer includes clinical exam, imaging (usually mammography and/or ultrasound), and biopsy. A CT scan or MRI may provide further information but are not typically included in the triple test. The biopsy is necessary to confirm or exclude the presence of cancer.

Question 6

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

Accepted Answer

As there are no significant findings on examination, it is more likely that the milky discharge is caused by medication-induced hyperprolactinemia. Therefore, obtaining a complete list of the patient's current medications is the best choice as certain medications such as antipsychotics can cause hyperprolactinemia. Once identified, the medication can be adjusted or changed to resolve the issue. A CT scan of the head would be appropriate if other symptoms or signs of pituitary tumor are present. Keeping a menstrual cycle diary is unnecessary in this case, as the patient is not exhibiting any menstrual cycle-associated symptoms. Referral for mammogram is also not indicated, as there are no signs of breast disease.

Question 7

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 consistent with gynecomastia, which is most often due to altered hormonal levels in puberty. It is not typically associated with malignancy or indicative of a pituitary tumor. A mammogram or biopsy is typically not necessary for diagnosis.

Question 8

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,eythema,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 9

A 52-year-old female complains of discharge from one of her breasts.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

The presence of discharge without any other accompanying symptoms or clinical findings is highly suggestive of duct ectasia, which is a benign condition characterized by dilation of breast ducts and accumulation of secretions. The discharge is typically thick and white or green, and can sometimes be expressed by manual pressure on the breast. Mastitis is associated with breast redness, swelling, warmth, and tenderness, and is more commonly seen in lactating or breastfeeding women. Fibroadenoma and fibrocystic breasts are also benign breast conditions, but they do not typically present with discharge as the primary symptom.

Question 10

A 45-year-old female patient presents in the emergency department due to multiple chest injuries as a result of 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

The answer of A 45-year-old female patient presents in the...

Question 11

A 62-year-old female presents with a singular,hard,1 cm,non-tender,non-mobile 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

The presence of a hard, non-tender, non-mobile breast mass in a female over the age of 50, along with an enlarged supraclavicular lymph node, is highly concerning for malignancy. Further diagnostic testing, such as imaging and biopsy, should be performed to confirm a diagnosis and guide management. Fibroadenomas and breast cysts usually present as well-circumscribed, mobile masses without lymphadenopathy. Paget's disease may present with nipple or skin changes, but typically also involves an underlying mass.

Question 12

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

Accepted Answer

BRCA1 and 2 mutations and Klinefelter's syndrome are both conditions that increase the risk of breast cancer in males. Pseudogynecomastia is not a condition that increases the risk of breast cancer.

Question 13

Your patient is a 64-year-old female who presents with complaints of a red,scaly rash on her 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 is a rare form of breast cancer that can present with a red, scaly rash on the nipple and areola. It may also be associated with itching, burning, or pain. Mastitis, contact dermatitis, and eczema can also present with similar symptoms, but the absence of a mass or nipple discharge makes them less likely.

Question 14

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

Accepted Answer

The patient's symptoms suggest cyclic mastalgia, which is a common breast symptom that is associated with hormonal changes during the menstrual cycle. It is not necessary to do any imaging or biopsy at this time. Instead, the patient should keep a diary of her menstrual cycle and breast symptoms to see if there is any correlation between the two. If necessary, the patient can be managed with over-the-counter analgesics and/or hormonal therapy.

Question 15

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

Accepted Answer

The Gail Model includes age at menarche, number of breast biopsies, and age at first live birth, but not the number of live births.

Quiz 9: Breasts