Question 1
CHAPTER 18: Breasts & Axillae
A 44-year-old female mathematician presents to clinic with a complaint of a mass in the
right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty because
she has only had one mammogram and does not engage in breast self-examination (BSE) on
any regular basis. She has no family history of breast cancer, and her prior mammogram was
ordered as a routine screening test at age 43 years after a brief discussion with her primary
care provider. After a thorough investigation reveals a benign cyst, what advice should be
given to this patient about screening for breast cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught and
reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of annual
examinations starting at age 30 years.
c. This patient was in compliance with the
CORRECT ANSWER
c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors prior to her current complaint.
Question 2
CHAPTER 18: Breasts & Axillae
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@THE STUDY VAULT
,A 42-year-old female website developer presents for an annual preventive examination with
questions about breast cancer screening. She is concerned about the radiation exposure
associated with mammography and is interested in magnetic resonance imaging (MRI) as a
possible alternative for routine screening. She is otherwise healthy with no family history of
breast, ovarian, or colon cancer. Which of the following is true about MRI as a screening
modality for breast cancer in the general population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of
specificity.
c. This patient is an ideal candidate for screening via breast MRI based on current evidence.
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo
screening MRI.
e. Known BRCA1 or B
CORRECT ANSWER
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of
specificity.
Question 3
CHAPTER 18: Breasts & Axillae
A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple discharge.
This discharge started several weeks ago and has occurred at irregular intervals since that
time. She does not complain of local tenderness, redness, fever, or any other systemic
symptoms aside from slightly irregular periods over the last few months. On examination,
she is able to express a small amount of discharge, which is sent to the laboratory and found
to be consistent with breast milk but without any signs of blood or pus. Screening
laboratories are also sent, which reveal a normal blood count, metabolic panel, thyroid-
stimulating hormone, and human chorionic gonadotropin (HCG) level. Further laboratories
are still pending. Which of the following is the most likely diagnosis?
a. Mastitis
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@THE STUDY VAULT
,b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma
CORRECT ANSWER
e. Prolactinoma
Question 4
CHAPTER 18: Breasts & Axillae
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on
breast self-examination (BSE) at home. The mass is nontender without skin changes,
erythema, or overlying swelling. She has heard that most breast cancers are found by
patients themselves, and she is very concerned that she may have breast cancer. Which of
the following is true about BSE and self-detection of breast cancer?
a. Most masses that women find at home and bring to a provider's attention turn out to be
malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess
complicating underlying mastitis.
d. Because of this patient's age, breast masses should not be pursued with imaging and
diagnosis because the risk of cancer is so low.
e. BSE is universally recommended b
CORRECT ANSWER
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
Question 5
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@THE STUDY VAULT
, CHAPTER 18: Breasts & Axillae
A 48-year-old female psychologist presents to clinic with concerns about her breast cancer
risk after an age-matched cousin was recently diagnosed with this disease. This cousin is the
third family member on her father's side in as many years to be diagnosed with breast
cancer, including the patient's own father, who had surgery and subsequent treatment 3
years ago for breast cancer. The patient has little other knowledge of her family history, only
that her grandparents independently arrived from Eastern Europe near the end of World
War II and were among very few members of their family that survived the war. The patient
has read about testing for the breast cancer genes (BRCA1 and BRCA2) and desires further
information about whether this would be appropriate for her. Which of the following is true
about this patient's indications for BRCA testing?
a. Her familial lineage is irrelevan
CORRECT ANSWER
d. This patient carries several risk factors that together justify BRCA testing.
Question 6
CHAPTER 18: Breasts & Axillae
A 68-year-old former paleontologist presents to clinic with concerns about her breast cancer
risk. Her mother developed the disease in her 50s and died from it in her 60s. A younger
cousin developed the disease a few years ago before the age of 50 years, but this individual
was not tested for the BRCA1 and
BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s and had radiation
to the chest. She did take hormone replacement therapy for a few years before data
emerged that this may contribute to breast cancer risk. She has had several abnormal
mammograms in her 50s for persistently dense breasts with subtle findings, but follow-up
biopsies never showed any malignant pathology. Which of the following is true regarding
magnetic resonance imaging (MRI) screening of this patient?
4
@THE STUDY VAULT
CHAPTER 18: Breasts & Axillae
A 44-year-old female mathematician presents to clinic with a complaint of a mass in the
right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty because
she has only had one mammogram and does not engage in breast self-examination (BSE) on
any regular basis. She has no family history of breast cancer, and her prior mammogram was
ordered as a routine screening test at age 43 years after a brief discussion with her primary
care provider. After a thorough investigation reveals a benign cyst, what advice should be
given to this patient about screening for breast cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught and
reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of annual
examinations starting at age 30 years.
c. This patient was in compliance with the
CORRECT ANSWER
c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors prior to her current complaint.
Question 2
CHAPTER 18: Breasts & Axillae
1
@THE STUDY VAULT
,A 42-year-old female website developer presents for an annual preventive examination with
questions about breast cancer screening. She is concerned about the radiation exposure
associated with mammography and is interested in magnetic resonance imaging (MRI) as a
possible alternative for routine screening. She is otherwise healthy with no family history of
breast, ovarian, or colon cancer. Which of the following is true about MRI as a screening
modality for breast cancer in the general population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of
specificity.
c. This patient is an ideal candidate for screening via breast MRI based on current evidence.
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo
screening MRI.
e. Known BRCA1 or B
CORRECT ANSWER
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of
specificity.
Question 3
CHAPTER 18: Breasts & Axillae
A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple discharge.
This discharge started several weeks ago and has occurred at irregular intervals since that
time. She does not complain of local tenderness, redness, fever, or any other systemic
symptoms aside from slightly irregular periods over the last few months. On examination,
she is able to express a small amount of discharge, which is sent to the laboratory and found
to be consistent with breast milk but without any signs of blood or pus. Screening
laboratories are also sent, which reveal a normal blood count, metabolic panel, thyroid-
stimulating hormone, and human chorionic gonadotropin (HCG) level. Further laboratories
are still pending. Which of the following is the most likely diagnosis?
a. Mastitis
2
@THE STUDY VAULT
,b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma
CORRECT ANSWER
e. Prolactinoma
Question 4
CHAPTER 18: Breasts & Axillae
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on
breast self-examination (BSE) at home. The mass is nontender without skin changes,
erythema, or overlying swelling. She has heard that most breast cancers are found by
patients themselves, and she is very concerned that she may have breast cancer. Which of
the following is true about BSE and self-detection of breast cancer?
a. Most masses that women find at home and bring to a provider's attention turn out to be
malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess
complicating underlying mastitis.
d. Because of this patient's age, breast masses should not be pursued with imaging and
diagnosis because the risk of cancer is so low.
e. BSE is universally recommended b
CORRECT ANSWER
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
Question 5
3
@THE STUDY VAULT
, CHAPTER 18: Breasts & Axillae
A 48-year-old female psychologist presents to clinic with concerns about her breast cancer
risk after an age-matched cousin was recently diagnosed with this disease. This cousin is the
third family member on her father's side in as many years to be diagnosed with breast
cancer, including the patient's own father, who had surgery and subsequent treatment 3
years ago for breast cancer. The patient has little other knowledge of her family history, only
that her grandparents independently arrived from Eastern Europe near the end of World
War II and were among very few members of their family that survived the war. The patient
has read about testing for the breast cancer genes (BRCA1 and BRCA2) and desires further
information about whether this would be appropriate for her. Which of the following is true
about this patient's indications for BRCA testing?
a. Her familial lineage is irrelevan
CORRECT ANSWER
d. This patient carries several risk factors that together justify BRCA testing.
Question 6
CHAPTER 18: Breasts & Axillae
A 68-year-old former paleontologist presents to clinic with concerns about her breast cancer
risk. Her mother developed the disease in her 50s and died from it in her 60s. A younger
cousin developed the disease a few years ago before the age of 50 years, but this individual
was not tested for the BRCA1 and
BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s and had radiation
to the chest. She did take hormone replacement therapy for a few years before data
emerged that this may contribute to breast cancer risk. She has had several abnormal
mammograms in her 50s for persistently dense breasts with subtle findings, but follow-up
biopsies never showed any malignant pathology. Which of the following is true regarding
magnetic resonance imaging (MRI) screening of this patient?
4
@THE STUDY VAULT
