Bates The Breasts and Axillae Verified Case Study
1. A 72-year-old woman presents with a bloody discharge from her left breast for three months. She
denies trauma to the area and has a family history of cancer. What is the most likely cause of the nipple
discharge?
A) Benign breast abnormal...
1. A 72-year-old woman presents with a bloody discharge from her left breast for three months. She
denies trauma to the area and has a family history of cancer. What is the most likely cause of the nipple
discharge?
A) Benign breast abnormality
B) Breast cancer
C) Galactorrhea
Correct answer: B) Breast cancer
2. A 44-year-old woman comes to your clinic with dry skin on her right nipple and a palpable lump
underneath. She has no other symptoms and denies trauma to the area. What is the most likely
diagnosis?
A) Paget's disease
B) Eczema
C) Psoriasis
D) Contact dermatitis
Correct answer: A) Paget's disease
3. A 56-year-old woman presents with an unusual change in the direction of her left nipple and a
palpable mass lateral to the areola. She has no other symptoms and smokes two packs of cigarettes a
day. What is the most likely diagnosis?
A) Nipple retraction
B) Inverted nipple
C) Breast cancer
D) Fibroadenoma
, Correct answer: A) Nipple retraction
A 19-year-old female comes to your office, complaining of a clear discharge from her right breast for 2
months. She states that she noticed it when she and her boyfriend were "messing around" and he
squeezed her nipple. She continues to have this discharge anytime she squeezes that nipple. She denies
any trauma to her breasts. Her past medical history is unremarkable. She denies any pregnancies. Both
of her parents are healthy. She denies using tobacco or illegal drugs and drinks three to four beers a
week. On examination her breasts are symmetric with no skin changes. You are able to express clear
discharge from her right nipple. You feel no discrete masses and her axillae are normal. The remainder
of her heart, lung, abdominal, and pelvic examinations are unremarkable. A urine pregnancy test is
negative.What cause of nipple discharge is the most likely in her circumstance?
A) Benign breast abnormality
B) Breast ca ✔️A) Benign breast abnormality
Nipple discharge in benign breast abnormalities tends to be clear and unilateral. The discharge is usually
not spontaneous. This patient needs to be told to stop compressing her nipple. If the problem still
persists after the patient has stopped compressing the nipple, further workup is warranted.
A 23-year-old computer programmer comes to your office for an annual examination. She has recently
become sexually active and wants to be placed on birth control. Her only complaint is that the skin in
her armpits has become darker. She states it looks like dirt, and she scrubs her skin nightly with soap
and water but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods
have been irregular for 3 years. Her mother has type 2 diabetes and her father has high blood pressure.
The patient denies using tobacco but has four to five drinks on Friday and Saturday nights. She denies
any illegal drug use. On examination you see a mildly obese female who is breathing comfortably. Her
vital signs are unremarkable. Looking under her axilla, you see dark, velvet-like skin. Her annual
examination is otherwise unremarkable.What disorder of the breast or axilla is she most likely to have?
A) Peau d ✔️B) Acanthosis nigricans
Acanthosis nigricans can be associated with an internal malignancy, but in most cases it is a benign
dermatologic condition associated with polycystic ovarian syndrome, consisting of acne, hirsutism,
obesity, irregular periods, infertility, ovarian cysts, and early onset type 2 diabetes. It is also known to
correlate with insulin resistance.
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