Physical exam

Question 1

Tenderness suggests which type of breast lesion?

Answer 1

Cystic or inflammatory lesion

Breast cancer typically isn’t tender, although inflammatory breast cancer is associated with tenderness.

Question 2

What is involved in the ‘triple assessment’ of breast cancer screening?

Answer 2

1. History and PE
2. Imaging (mammography, ultrasound)
3. Biopsy

Question 3

List 3 characteristics of a BENIGN breast lump

Answer 3

• Absence of a discrete lump
• Tender
• Mobile
• Soft
• Smooth borders

Question 4

List 3 characteristics of a MALIGNANT breast lump

Answer 4

• Discrete lump
• Non-tender
• Fixed
• Firm
• Irregular borders

Question 5

A smooth, hard, mobile lump in a young woman is most likely to be caused by?

Answer 5

Fibroadenoma / ‘breast mouse’

Question 6

Skin dimpling (peau d’orange), nipple retraction, bloody nipple discharge, and palpable lymph nodes are suggestive of what type of breast cancer?

Answer 6

Malignant

Question 7

An erythematous, bleeding plaque in the areola is suggestive of what pathophysiological process?

Answer 7

Paget’s disease of the breast:

Paget cells (cancer cells) migrating along the lactiferous duct, through the pore, and onto the skin

Question 8

Why does skin dimpling / peau d’orange occur?

Answer 8

Oedematous skin due to pitted sweat glands in advanced breast cancer

Question 9

What is the purpose of asking the patient to place their hands on their hips and push down?

Answer 9

Accentuates TETHERING: indicates spread to pectoral muscles