Painful Breast Lump? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 03-25-2010
USMLE Forums Scout
 
Steps History: Not yet
Posts: 69
Threads: 16
Thanked 45 Times in 21 Posts
Reputation: 83
Send a message via Yahoo to mosallam Send a message via Skype™ to mosallam
Question Painful Breast Lump?

23 y female patient complains of dull aching breast pain and breast lump in the left breast , pain increases pre-menstrually and decreases with onset of the menstruation, what is the most possible diagnosis?

A- Fibroadenoma
B- Ductal papilloma
C- Fibroadenosis
D- Breast cancer
E- Duct papilloma
Reply With Quote Quick reply to this message



  #2  
Old 03-25-2010
ath.pantelis's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 187
Threads: 4
Thanked 368 Times in 121 Posts
Reputation: 398
Default

Fibroadenoma is the most common breast tumor found in adolescent and young females.

You definitely don't expect Breast Ca in a 23yo female, so choice D is wrong.

Intraductal papilloma usually presents as bloody nipple discharge and is expected in clearly older women, thus A should also be incorrect.

Fibroadenosis is a more generalized condition than fibroadenoma (probably a "reactive" pattern of the breast in response to aging of the tissue) and one should expect its peak incidence around 35-50yo.

This clinical presentation in a woman around 30-40yo would indicate fibrocystic disease (cyclical pain pattern), but this is not the case here.

So, I think that the correct answer is A-fibroadenoma.
Reply With Quote Quick reply to this message
  #3  
Old 03-25-2010
YoramFishke's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 248
Threads: 11
Thanked 307 Times in 127 Posts
Reputation: 337
Default

You are right the clinical scenario is suggestive of fibrocystic changes. But it's there in the options. Fibroadenosis is one of the histopathologic features of fibrocystic disease of the breast.
Reply With Quote Quick reply to this message
  #4  
Old 03-25-2010
ath.pantelis's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 187
Threads: 4
Thanked 368 Times in 121 Posts
Reputation: 398
Default

I totally agree with you, Dr. YoramFishke, but the age of this patient is not consistent with fibrocystic disease. After having taken both Step 1 & 2CK, I have figured out that the examiners put extra weight in the demographic parameters of the presented cases. Even though the clinical presentation per se is strongly indicative of fibrocystic disease, I think that we should take into serious consideration that she is only 23.
Reply With Quote Quick reply to this message
  #5  
Old 03-25-2010
YoramFishke's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 248
Threads: 11
Thanked 307 Times in 127 Posts
Reputation: 337
Default It's still fibrocystic

Quote:
Originally Posted by ath.pantelis View Post
I think that we should take into serious consideration that she is only 23.
Fibrocystic disease is seen between 20-50 years of age
Ref: Kaplan Step 1 Notes
Reply With Quote Quick reply to this message
  #6  
Old 03-25-2010
ath.pantelis's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 187
Threads: 4
Thanked 368 Times in 121 Posts
Reputation: 398
Default

Fibrocystic disease: most common cause of "breast lumps" from age 25 to menopause (...) --> First Aid Step 1 2008, p. 451.

Mammary dysplasia (fibrocystic disease, cystic mastitis) is seen in the thirties and forties (goes away with menopause)(...) -- Kaplan Notes 08-09, Surgery, p. 41.

Fibrocystic Change: (...) It is common in women 35 to 55 years of age but rare in postmenopausal women not taking hormone therapy(...) --> Novak Gynecology 14th Ed. 2007, p. 652

After all, we may both be right! Many sample questions are not well designed!
Reply With Quote Quick reply to this message
The above post was thanked by:
YoramFishke (03-25-2010)
  #7  
Old 01-25-2011
USMLE Forums Scout
 
Steps History: ---
Posts: 82
Threads: 22
Thanked 33 Times in 14 Posts
Reputation: 36
Default

i have not seen anywhere in Goljan / FA / KAPLAN mentioning that fibradenomas change by mensturation cycle. I wonder why FCD is not in options.
either the q is not well written or i am missing something here
Reply With Quote Quick reply to this message
  #8  
Old 02-20-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 351 Times in 169 Posts
Reputation: 374
Default

Fibroadenoma is a painless condition to my knowledge.
Reply With Quote Quick reply to this message
  #9  
Old 02-20-2011
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 590
Threads: 31
Thanked 1,227 Times in 410 Posts
Reputation: 1251
Default

Quote:
Originally Posted by hana View Post
i have not seen anywhere in Goljan / FA / KAPLAN mentioning that fibradenomas change by mensturation cycle. I wonder why FCD is not in options...
Hana, meet YoramFishke :shakehands:
Quote:
Originally Posted by YoramFishke View Post
You are right the clinical scenario is suggestive of fibrocystic changes. But it's there in the options. Fibroadenosis is one of the histopathologic features of fibrocystic disease of the breast.
Reply With Quote Quick reply to this message
  #10  
Old 02-20-2011
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 65
Threads: 19
Thanked 51 Times in 24 Posts
Reputation: 61
Default

m sure its C

fibroadenosis is also known as cyclical mastalgia with nodularity.
Reply With Quote Quick reply to this message
  #11  
Old 02-20-2011
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 244
Threads: 16
Thanked 198 Times in 86 Posts
Reputation: 208
Thumbs Up

definitely fibrocystic disease of the breast. Not fibroadenoma - the point of the question may be to check if we think about the disease first or the demographics. cyclical mastalgia is a CLASSIC sign of fibrocystic disease.
Reply With Quote Quick reply to this message



Reply

Tags
ObGyn-, Pathology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Female with breast lump Ahmed-USMLE USMLE Step 1 Classic Clues 3 05-13-2015 09:06 PM
Exclusively Breast Fed accuroba USMLE Step 1 Classic Clues 2 06-15-2010 05:23 PM
Chronic Breast Abscess mosallam USMLE Step 2 CK Forum 8 03-19-2010 10:15 PM
Moving a painful limb Adamu2010 USMLE Step 2 CS Forum 2 03-13-2010 11:40 AM
Male Breast Cancer rasheed USMLE Step 2 CK Buzzwords 0 02-13-2010 01:57 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)