Medicine > QUESTIONS & ANSWERS > (USMLE)United States Medical Licensing Examination |QUESTIONS AND ANSWERS | GRADED A (All)

(USMLE)United States Medical Licensing Examination |QUESTIONS AND ANSWERS | GRADED A

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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 t... he 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 (B) Cysts (C) Cancer Correct Answer: (A) Fibroadenoma Fibroadenomas often start during puberty and young adulthood. They may be single or multiple and are often round or disc-like. They can be soft but are usually firm. They are very mobile and delineated from the surrounding tissue. They are generally non-tender and show no signs of skin retraction. 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 [Show More]

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