A 23-year-old female presents with episodic bilateral breast ...

[evelyn o bentley]

A 23-year-old female presents with episodic bilateral breast tenderness. Upon palpation, there are multiple areas of nodularity with no dominant breast mass and no tenderness, nipple, or skin changes. It is best to recommend:
 
  A. Ultrasound of the breasts
  B. Mammogram of the breasts
  C. Fine needle aspiration of one nodule within a breast
  D. Diary of menstrual cycle and breast symptoms

Question 2

A 34-year-old female who gave birth 2 weeks ago developed fever and pain in the right breast while nursing her baby. The patient has tenderness, eythema, and swelling of the nipple on the right breast.
 
  Which of the following diagnostic studies is indicated?
  A. White blood cell (WBC) count
  B. Breast milk culture
  C. Ultrasound
  D. Fine needle biopsy

[millet]

Answer to Question 1

ANS: D
Women who experience cyclic mastalgia usually have onset as a teen or young adult. It is important to determine menstrual and reproductive history and to identify all pharmacologic agents taken. A complete breast examination should be performed. The pain associated with hormonal fluctuation most commonly occurs during the second half of the woman's cycle. The variability of the signs and symptoms is identified with a symptom diary and record of the menstrual cycle. The pain is typically poorly localized, bilateral, and nonspecific. It may be accompanied by a sense of breast fullness. The examination may identify the multiple, bilateral nodularities associated with fibroadenomas or fibrocystic changes.

Answer to Question 2

ANS: A
For mastitis, white blood count should be obtained and is usually elevated. Even though the breast milk can be cultured, this is not generally recommended. If the presentation is atypicalthat is, the patient is not lactatingand there are no associated systemic signs or symptoms, a consultation should be obtained and mammography ordered to determine the definitive diagnosis and rule out malignancy.