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NBME 22 Answers

nbme22/Block 2/Question#15 (41.6 difficulty score)
A 62-year-old woman comes to the physician 3 ...
Carcinoma of the breast🔍
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 +4 
submitted by usmleuser007(377),
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reP aoma:htP

oMst onmocm in aspulspaetoonm eom:wn

1) cfiyroiscbt ghensc,a tutialrancd ppalaoil,m eaFoanrombdi

rMoe ylklie in leoomaspsautnp nmo e:)1w dslyopelh rtumo l-airnkoadmebfeo(i 2 )rmtu)o aserBt anrscec iareecdns riks / td )1 arsdecnie ge,a nidarotu of tergenso rtothouhgu file r(yael crheem,na aelt e,usnpaemo i toesby) 2) liAtapcy ay plapshrie 3) riFts gereed aesietvrl

esnoQitu esttsa ssetrpen it s a:a) 2mc f,irm ennretond )mssba on lilayrax amynhppoyeatdlh ro pnelpi srcd)hi eacg exlmrtey dasrenodie smsa hiwt uarrelgir sng eedstrcualmri rliuearrg imiiaccosanccrtlofi

so twha acn it :b)1 e SCDI = dose ont yaulusl dpcroue assm

)2 omdeCo pyet = h-ihg edrga elslc wthi scoinesr pam&; ydtcropshi stnaoicilcciaf at encert of cutd

)3 egtPa eaissDe = nsivvoel eht iskn fo het neppli rd(iygneuln cciamo)rna

4) DCI = )a frmso dutel-kci utturrcses %>08;( fo c sa)se b) ssam teecdetd by pyasclih nntoamixiae ecc)(h k c) lsulayu 1cm or regrate (h) ecck )d elDsacsmiopt storma = nceniceovt utisse growngi thiw muotr sruspot(p out)mr ~~~ check( -- reuglrari an)smri g )e lyraueldM monircCae )D(IC = smicmi nmoaoirdebfa

)5 SILC mp;a& ILC = OD OTN podruec iacnclsitocfai ro ssma a) LIC - secll vhea l-in"geseifl ptaert"n thkni fo a eddeba knecclae and uoy cut ti ni milded ak(lc ndcr-heai)E

usmleuser007  correction Most common in premenopausal women: 1) fibrocystic changes, intraductal papilloma, Fibroadenoma +2  



 +4 
submitted by joker4eva76(25),
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uCdol olsa eus eht a'ttnspie aeg ot kmea teh fanitirflee.d eAg si a kirs cforat dterlea to seartb aneccr nco(mmo in eanpopulst-mosa enom,w susenl rseeth' a rhtiyso of retbas acrnec in eth lif)aym.

Fytiiosccbr aghcsen adn frboameaniods rae llyusau ncmomo in lumpoapansere neomw.

oN arhgidcse ot,dne os is't ton an datrclnuita paapilol.m

yotsubato  Intraductal papillomas are also under the areola +5  



 +3 
submitted by paperbackwriter(104),

In addition to what everyone else said, they went out of their way to use the word "irregular" TWICE. Maybe simple-minded of me, but as far as I understand benign shtuff is rarely irregular.




 +1 
submitted by airhead5(2),
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Teh naswre is amnaiocrc fo the rabste. I tge ,tath btu mI’ nhvgia oruetbl rgnugifi uto ihchw cnmraoiCa fo eBrtas it i.s mI’ tkusc beneetw I,SDC dna nvaiIevs Dlatcu oaaincC.rm I’m nnleiag astdrow eIasvvin cDtual Coai,ancrm tusj aceuebs is’t 1() omts monmco adn 2)( eht msas wtih grrleauir sminarg in cserulst oussdn kiel it locdu be etls‘eatl tifiltaniro,n’ seen in anevsIiv cDatul oCrn.iaamc Btu ’Im tno rsue. nCa noaney pelh?

liverdietrying  There is not enough information in the question stem to determine what kind of cancer it is. You would need a biopsy and histology information to determine that. However, this is definitely not DCIS since there *is* a mass. DCIS usually just shows up as small microcalcifications on XR (I’d google an image so you can see it). All the words they use here describe an invasive cancerous scary mass -- what kind of cancer can’t be known until they biopsy it! +2  



 +0 
submitted by oznefu(21),
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tWah are teh wdrso ahtt niotp ot caamirnoC ehrrta nath istrcFbcioy or Fiabodanoemr or atF siorescN ont( an e?)srwna

hoesT nac hvea ssmsea nda afcisiclnacito itrg?h sI it olny eht urgrlriea mgrsi?an

mnemonia  Fibrocystic changes doesn’t technically encompass sclerosing adenosis, which is the one where you would get calcifications. Cysts and fibrosis don’t usually present with calcifications. Fat necrosis I’m sure they would give history of trauma in the stem. +  
mnemonia  Calcifications = fat necrosis, sclerosing adenosis, and DCIS/IDC. Microcalcifications specifically I would venture to say is a buzzword ductal carcinoma specifically. Either way, of these 3, only cancer is an answer choice. +1  



 +0 
submitted by seagull(1443),
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The amss si ni the retou upper taan,urdq tshi is ywh it tanw D.ICS eciN adn esilpm

seagull  *wasn't +  



 +0 
submitted by j000(5),

this is not mentioned in FA or pathoma, but according to Amboss:

In invasive ductal carcinoma, the mammography finding shows "star-shaped lesion occurs due to clustered microcalcifications of the surrounding tissue."

It is not DCIS because DCIS doesn't produce a mass It is not fibroadenoma (it is most common in women <35) It is not fibrocystic changes (premenopausal women 20-50, often bilateral, tender)




 -1 
submitted by mdmikek89(1),

Y'all need some Amboss in your lives.

This is a benign or malignant question.

focal mass or density

irregular margins

calcifications

= malignant = carcinoma

CLICK AND GTFO