Multiple Chioce On Breast Cancer

1. A 21-year-old female presents to your clinic for her annual exam. She informs you that for the last 3 months, she has felt a lump in her left breast above the nipple. She has had no discharge from the nipple. Her past medical history is nonsignificant. She has not been sexually active and is on no medication. She denies any tobacco, alcohol, or drug use. Her paternal grandmother had breast cancer in her seventies and did well with surgery and radiation. On physical exam, you feel a firm disc like lump at 12 o'clock on the left breast. It is easily delineated, mobile, and is nontender. The patient only has shoddy nodes in the left axilla. There are no unusual skin changes. The right breast and the remainder of her heart, lung, abdominal, and pelvic exam are unremarkable. What form of breast mass is she most likely to have?

(A) Fibroadenoma

(C) Cancer

2. A 48-year-old homemaker comes to your office complaining of a breast lump she found under her right arm while showering. She says it hasn't been there during past checks and it doesn't hurt when she examined it. She admits she hadn't done a self-breast exam in almost 1 year. She states she has had three normal mammograms during the last 8 years. The last mammogram was 18 months ago. Her past medical history is significant for one spontaneous vaginal delivery at age 38. She went through menopause 3 years ago and is on estrogen and progesterone replacement. She has smoked one pack of cigarettes daily for the past 25 years but denies any alcohol or drug abuse. Past medical history reveals that her maternal aunt had breast cancer in her thirties and her maternal grandmother had ovarian cancer in her seventies. Review of systems is noncontributory. On exam, you feel a hard, approximately 2-cm lump in the tail of Spence under the patient's right arm. The lump is nontender, and you have difficulty finding the borders. It is not adherent to anything, and you feel no lymphadenopathy in the axilla or supraclavicular areas. The skin over the breast appears normal. Examination of the left breast is unremarkable. What type of breast mass is the patient most likely to have?

(A) Fibroadenoma

(C) Cancer

3. A 31-year-old nurse presents to your office complaining about a painful lump in her right breast next to the nipple. She states it has been there for several months and won't go away. She recently started taking birth control pills after remarrying. Her past medical history is significant for asthma and two spontaneous vaginal deliveries. Family history reveals no breast or ovarian disorders. She denies any tobacco or drug use and drinks alcohol socially. On exam, you feel a 1-cm lump medial to her areola. It is round soft and very tender. There are no skin retractions and no palpable lymph nodes in the axilla. Her left breast also has a !4-cm soft lump medial to the areola that is not quite as tender. The patient states she hadn't noticed that area before. What type of breast mass is the most likely cause of her pain?

(A) Fibroadenoma

(C) Cancer

4. A 22-year-old woman comes to your office complaining of a white discharge from her breasts, which has been occurring for 2 months. She also states that she hasn't had her period in 6 months. She denies any chance of pregnancy since she hasn't been sexually active in over 1 year. She is on no medications except a multivitamin. Her past medical history is significant for allergies only. Past medical history reveals a mother with cystic breasts and a great aunt with breast cancer. Review of systems is noncontributory. On exam, her breasts are symmetrical, with no skin changes. You are able to express milky discharge from each nipple. You feel no discrete masses, and her axillae are normal. The remainder or her heart, lung, abdominal, and pelvic exam are unremarkable. What cause of nipple discharge is the most likely in her circumstance?

(A) Benign breast abnormality

(B) Breast cancer

(C) Nonpuerperal galactorrhea

5. A 76-year-old widow comes to your clinic to establish care. She admits that she hasn't seen a clinician in over 5 years, but her daughter has been nagging her to be seen. She states she has noticed that an area to the outside of her left breast feels enlarged, and there are some different changes to the skin in the area. Her past medical history is significant for two spontaneous vaginal deliveries and diet-controlled diabetes. She denies any tobacco or drug use and no alcohol abuse. Her review of systems is remarkable for a 10-pound weight loss in the last 6 months and some recent fatigue. On exam, you find an elderly woman appearing her stated age. Inspection of her left breast reveals some thickening of the skin lateral to her areola, with enlarged pores. You feel a nontender 5-cm mass. The axilla has at least two enlarged lymph nodes, which are adherent to the underlying ribs. The right breast and axilla are unremarkable. What visible skin change of the breast does she have?

(A) Nipple retraction

(B) Paget's disease

(C) Peau d'orange sign

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