1: Breast Exam

Question 1

Organization of breast

Answer 1

1. Clusters of secretory cells and myoepithelial cells in lobules
2. Lobules in 12-20 lobes

Question 2

Major role of E and progesterone in breast

Answer 2

1. E: growth of adipose tissue and lactiferous ducts

2. Pro: growth of lobules and alveolar budding

Question 3

Two most common breast complaints

Answer 3

Breast pain, mass

Question 4

Next step if pt has a palpable mass

Answer 4

Biopsy - fine needle aspiration, core biopsy, or excision biopsy

Question 5

How much sooner can a mass be seen on mammography vs palpable

Answer 5

2 years on average

Question 6

Screening vs diagnostic mammogram

Answer 6

1. Screening: no complaints -> 4 images (2 craniocaudal, 2 mediolateral)
2. Diagnostic: complaint or mass -> screening mammo + contralateral breast imaging

Question 7

BI-RADS category 0, 1, 2, 3, 4, 5, 6

Answer 7

0: need additional imaging
1: negative
2: benign
3: probably benign
4: suspicious
5: highly suggestive of Malignancy
6: known malig (Bx-proven)

Question 8

What is breast US useful for (4 things)

Answer 8

1. Inconclusive mammo
2. Age <40 or with dense breast tissue
3. Differentiate cystic vs solid lesions
4. Guidance during core needle biopsy

Question 9

Breast MRI: two major uses

Answer 9

1. Post-CA dx for further eval of staging

2. Women at high risk, Iike BRCA carriers

Question 10

Fine needle aspiration bx: what to do if clear vs bloody fluid

Answer 10

1. Clear: no further eval

2. Bloody: sent for cytology, need mammo or US

Question 11

Sx relief n pts with mastalgia

Answer 11

Proper fitting bra, weight reduction, exercise, decrease caffeine, vitamin E supplements, primrose oil

Question 12

Three things that can cause bloody nipple discharge

Answer 12

Intraductal carcinoma, invasive ductal carcinoma, benign intraductal papilloma