Deck 9: Breasts

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?

A) Compression wrap for chest and breast trauma
B) Mammogram
C) Reevaluation following complete resolution of obvious injuries
D) Ultrasound

Answer 1

Mammogram

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:

A) Ultrasound of the breasts
B) Mammogram of the breasts
C) Fine needle aspiration of one nodule within a breast
D) Diary of menstrual cycle and breast symptoms

Answer 2

Diary of menstrual cycle and breast symptoms

Question 3

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

A) Age at menarche
B) Number of breast biopsies
C) Age at first live birth
D) Number of live births

Answer 3

Number of live births

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:

A) Computed tomography scan
B) Mammogram
C) Biopsy
D) Ultrasound

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:

A) Order computed tomography scan of head to rule out pituitary tumor
B) Obtain a complete list of the patient's medications
C) Have the patient keep a menstrual cycle diary
D) Refer the patient for mammogram

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:

A) Fibroadenoma
B) Breast cyst
C) Malignancy
D) Paget's disease

Question 7

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

A) Pseudogynecomastia
B) BRCA1 and 2
C) Klinefelter's syndrome
D) B and C

Question 8

Bloody breast discharge is associated with which of the following?

A) Bleeding disorder, such as von Willebrand disease
B) Malignancy
C) Excessive nonsteroidal anti-inflammatories
D) A and C

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:

A) Computed tomography scan
B) Magnetic resonance imaging
C) Biopsy
D) Ultrasound

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:

A) Order prolactin level
B) Obtain magnetic resonance imaging of the head
C) Have the patient keep a menstrual cycle diary
D) Refer the patient for mammogram

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?

A) Multiple fibroadenomas
B) Fibrocystic breasts
C) Mastalgia
D) Mastitis

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?

A) White blood cell (WBC) count
B) Breast milk culture
C) Ultrasound
D) Fine needle biopsy

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:

A) Contact dermatitis
B) Mastitis
C) Paget's disease
D) Eczema

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:

A) Associated with a high rate of malignancy
B) Most often due to altered hormonal levels in puberty
C) Commonly indicative of pituitary tumor triggered by puberty
D) Too dense for a mammogram and requires biopsy

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:

A) Duct ectasia
B) Mastitis
C) Fibroadenoma
D) Fibrocystic breasts