1. A 44-year-old female mathematician presents to clin- ic 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-ex- amination (BSE) on any regular basis. She h...
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1. A 44-year-old female mathematician presents to
c. This patient
clin- ic with a complaint of a mass in the right
was in
breast.
compliance
Her partner noticed this mass 2 days ago, and the
with the U.S.
patient feels guilty because she has only had one
Pre- ventive
mammogram and does not engage in breast self-ex-
Services Task
amination (BSE) on any regular basis. She has no
Force (USP-
family history of breast cancer, and her prior mam-
mogram was ordered as a routine screening test at STF)
recommen-
dations for her
age group and
risk fac-
age 43 years after a brief discussion with her primary tors prior to her
care provider. After a thorough investigation mography and
reveals a benign cyst, what advice should be given is interested i
to this patient about screening for breast cancer in magnetic
her age group? resonance
imaging (MRI)
a. BSE is well evidenced, and all recommending as a possible
agen- cies agree that it should be taught and alternative for
reinforced. routine
b. Clinical breast examination (CBE) is superior to screening. Sh
BSE and should be a routine part of annual is otherwise
examina- tions starting at age 30 years. healthy with n
c. This patient was in compliance with the U.S. Pre- family history
ventive Services Task Force (USPSTF) of breast,
recommenda- tions for her age group and risk ovarian, or
factors prior to her current complaint. colon cancer.
d. Mammography is most sensitive and specific for Which of the
women in their 40s, when breast tissue is still following is
dense enough to image accurately. true about MR
e. Breast cancer screening is extremely well stud- as a screenin
ied, and no controversy exists on the modal-
recommended norms for screening and follow-up.
2. 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 mam-
1/
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current complaint.
b. Sensitivity of screening for breast cancer
increases with breast MRI at the expense of speci-
ficity.
2/
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ity for breast cancer in the general population? 4. A 22-year-old
G0P0
a. Breast cancer screening by MRI has been undergraduat
well studied in the general population. student
b. Sensitivity of screening for breast cancer presents to
increas- es with breast MRI at the expense of clinic after
specificity. finding a
c. This patient is an ideal candidate for screening breast mass
via breast MRI based on current evidence. on breast
d. Women at low lifetime risk of breast cancer self-
(<20%) are recommended to undergo screening examination
MRI. (BSE) at hom
e. Known BRCA1 or BRCA2 mutation is The mass is
insufficient criteria to justify screening with breast non-
MRI.
3. A 35-year-old G0P0 woman presents to clinic
with a complaint of bilateral nipple discharge.
This dis-
charge 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 irreg-
ular periods over the last few months. On examina-
tion, she is able to express a small amount of dis-
charge, 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
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma
3/
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e. Prolactinoma
b. This patient is more likely to
find a fibroadeno-
4/
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