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mammography

Practice targeted AMC-style multiple-choice questions on mammography.

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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old asymptomatic woman undergoes a screening mammogram. The image is shown. Which of the following is the MOST appropriate next step in the management of this patient?

A. MRI of the breast
B. Reassurance and routine screening in 1 year
C. Ultrasound of the breast
D. Excisional biopsy
E. Stereotactic core biopsy
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 72-year-old woman, status post mastectomy, presents with a lesion. What is the MOST appropriate initial diagnostic test?

A. Patch testing
B. Skin biopsy
C. Wood's lamp examination
D. KOH examination
E. Fungal culture
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A 58-year-old woman, otherwise healthy with no significant medical history, undergoes a routine screening mammogram. The report notes a new cluster of pleomorphic microcalcifications in the upper outer quadrant of her left breast, measuring approximately 1.5 cm, classified as BI-RADS 4. Clinical examination reveals no palpable mass or skin changes. She has no family history of breast cancer. What is the most appropriate next step in the management of this finding?

A. Fine needle aspiration cytology
B. Excisional biopsy
C. Repeat mammogram in 6 months
D. Stereotactic core needle biopsy
E. Ultrasound-guided core needle biopsy
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for routine mammography. She has no palpable lumps or skin changes. Her previous mammogram two years ago was normal. The current mammogram is shown. What is the MOST appropriate next step in management?

A. Excisional biopsy
B. Ultrasound of the breast
C. Reassurance and routine screening in 2 years
D. Stereotactic core biopsy
E. MRI of the breast
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman attends a routine mammography screening. She reports no palpable lumps, pain, or nipple discharge. Her family history is unremarkable. The image shows the findings of the current mammogram. What is the MOST appropriate next step in the management of this patient?

A. Reassurance and routine screening in 1 year
B. Excisional biopsy
C. MRI of the breast
D. Ultrasound of the breast
E. Stereotactic core biopsy
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A 45-year-old woman with a suspicious breast mass on mammography undergoes a biopsy, which confirms invasive ductal carcinoma. She is referred to an oncologist for further management. What is the next step in her management?

A. Order a PET scan.
B. Refer for radiation therapy.
C. Perform a sentinel lymph node biopsy.
D. Start chemotherapy.
E. Start hormonal therapy.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman presents for her routine biennial screening mammogram. She denies any breast lumps, pain, or nipple discharge. Her past medical history is notable only for well-controlled hypothyroidism. There is no family history of breast or ovarian cancer. Physical examination reveals no palpable abnormalities. The provided image is a magnified view from the craniocaudal projection of the left breast. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A. Stereotactic core needle biopsy of the area
B. Perform a diagnostic ultrasound of the breast
C. Repeat screening mammography in 12 months
D. Refer for immediate surgical excision
E. Order genetic testing for BRCA1/BRCA2 mutations
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for routine screening mammography. She has no palpable lumps or skin changes. Her mother was diagnosed with breast cancer at age 68. The provided image is from her mammogram. What is the MOST appropriate next step in management?

A. MRI of the breast
B. Ultrasound of the breast
C. Reassurance and routine screening in one year
D. Stereotactic core biopsy
E. Excisional biopsy
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for her routine mammogram. She has no personal or family history of breast cancer. She denies any breast pain, nipple discharge, or palpable lumps. Clinical breast exam is unremarkable. Review of her prior mammograms shows stable, scattered fibroglandular densities. The current mammogram is shown. What is the MOST appropriate next step in management?

A. MRI of the breast
B. Stereotactic core biopsy
C. Reassurance and routine screening in 1 year
D. Ultrasound of the breast
E. Excisional biopsy
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A 42-year-old woman, nulliparous, presents to her general practitioner with a palpable lump in her left breast, noticed two weeks ago. She reports some mild, intermittent tenderness associated with the lump, which she initially attributed to her menstrual cycle, but it has persisted. She has no significant family history of breast cancer. On examination, there is a 1.5 cm, firm, mobile lump in the upper outer quadrant. No skin changes or nipple discharge are noted. Axillary nodes are not palpable. She is otherwise well. Which of the following represents the most appropriate initial management step?

A. Reassurance and review in 3 months.
B. MRI of the breast.
C. Fine needle aspiration cytology of the lump.
D. Urgent mammography and ultrasound.
E. Referral to a specialist breast clinic for triple assessment.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman presents for her scheduled screening mammogram. She reports no breast lumps, pain, or nipple discharge. Her past medical history includes well-controlled hypertension and osteoarthritis. She has no known family history of breast or ovarian cancer. Physical examination reveals no palpable abnormalities in either breast or axillae. The mammogram is performed, and the image provided is a detail from the craniocaudal view of the left breast. Considering the clinical presentation and the findings demonstrated in the provided image, what is the most appropriate immediate next step in the management of this patient?

A. Repeat mammography in 6 months
B. Ultrasound of the breast
C. Excisional biopsy
D. Referral for genetic counselling and testing
E. Stereotactic core biopsy of the suspicious area
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman presents for her scheduled screening mammogram. She denies any breast lumps, pain, or nipple discharge. She has no family history of breast cancer. Her physical examination is unremarkable. The image provided is a detail from her left craniocaudal view. Considering this finding, what is the most appropriate immediate next step in her clinical management?

A. Referral for breast ultrasound.
B. Discussion regarding prophylactic mastectomy.
C. Annual routine screening mammography.
D. Stereotactic core needle biopsy of the area of concern.
E. Repeat mammography with magnification views in 3 months.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman attends her routine mammogram. She has no palpable lumps or skin changes. Her previous mammograms have been normal. The provided image is from the current study. Which of the following is the MOST appropriate next step in management?

A. Stereotactic core biopsy
B. Excisional biopsy
C. Reassurance and routine screening in 2 years
D. Ultrasound of the breast
E. MRI of the breast
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for her routine screening mammogram. She reports no breast symptoms, and physical examination is unremarkable. Her medical history includes well-controlled type 2 diabetes and hyperlipidaemia. She has no family history of breast cancer. The provided image is a magnified view from the craniocaudal projection of the right breast. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A. Breast ultrasound of the area
B. Referral to a medical oncologist for systemic therapy planning
C. Repeat screening mammogram in 6 months
D. Stereotactic core needle biopsy of the area
E. Excisional biopsy under wire localisation
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 65-year-old asymptomatic woman undergoes a screening mammogram. The image shows the findings. Her previous mammograms have been unremarkable. What is the MOST appropriate next step in the management of this patient?

A. Stereotactic core biopsy
B. MRI of the breast
C. Excisional biopsy
D. Ultrasound of the breast
E. Reassurance and routine screening in 1 year
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman with no palpable breast lumps presents for a routine screening mammogram. The image is shown. What is the MOST appropriate next step?

A. Stereotactic core biopsy
B. Ultrasound of the breast
C. Reassurance and routine follow-up in 1 year
D. Excisional biopsy
E. MRI of the breast
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 72-year-old woman presents to her oncologist for follow-up. She underwent a left simple mastectomy for invasive ductal carcinoma 10 years ago. She reports a new, persistent skin change on her left chest wall over the past few months. Physical examination reveals the findings depicted. A recent biopsy of the affected area confirmed the presence of malignant cells consistent with Paget's disease. Considering the patient's history and the biopsy findings, which of the following investigations is the most appropriate next step in her management?

A. Genetic testing for BRCA mutations
B. Topical imiquimod application
C. Repeat biopsy of the lesion
D. PET-CT scan for systemic staging
E. Wide local excision of the lesion
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A 42-year-old woman presents with a new, firm, mobile lump in her left breast, noticed two weeks ago. She is otherwise well. What is the most appropriate initial investigation?

A. Fine needle aspiration cytology (FNAC) of the lump
B. Reassurance and review in 3 months
C. Ultrasound of the breast only
D. Core biopsy of the lump
E. Mammogram and ultrasound of the breast
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A 52-year-old woman presents to her GP with a palpable lump in her right breast. She reports no pain, nipple discharge, or skin changes. She has no family history of breast cancer. On examination, the lump is firm, non-tender, and mobile. There is no axillary lymphadenopathy. What is the most appropriate initial investigation?

A. Breast ultrasound
B. Mammography
C. Fine-needle aspiration (FNA)
D. MRI of the breast
E. Core biopsy
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman undergoes routine screening mammography. She is asymptomatic with no personal or family history of breast cancer. Physical examination is unremarkable. The provided image is a magnified view from the craniocaudal projection of the right breast. Based on the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A. Stereotactic core needle biopsy of the area.
B. Order genetic testing for BRCA1/BRCA2 mutations.
C. Proceed directly to surgical excision.
D. Repeat screening mammography in 12 months.
E. Perform a diagnostic ultrasound of the breast.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for her routine mammogram. She has no personal or family history of breast cancer. She denies any breast pain, nipple discharge, or palpable lumps. Clinical breast exam is unremarkable. Her previous mammograms have been negative. The current mammogram reveals findings as shown in the image. What is the MOST appropriate next step in management?

A. Ultrasound-guided core biopsy
B. MRI of the breast
C. Stereotactic core biopsy
D. Excisional biopsy
E. Reassurance and routine screening mammography in 1 year
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A 45-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. She has no family history of breast cancer. On examination, the lump is firm, mobile, and approximately 2 cm. What is the most appropriate initial investigation?

A. Reassurance and review in 3 months
B. Mammogram and ultrasound of the breast
C. Core biopsy
D. MRI of the breast
E. Fine needle aspiration cytology
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A 50-year-old woman with a breast lump undergoes a mammogram, which shows microcalcifications. A core biopsy confirms ductal carcinoma in situ (DCIS). What is the most appropriate next step?

A. Start chemotherapy.
B. Perform a mastectomy.
C. Observe with repeat imaging in 6 months.
D. Perform a lumpectomy with radiation.
E. Start tamoxifen.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman attends for her routine screening mammogram. She has no breast symptoms and no family history of breast cancer. Her physical examination is unremarkable. The mammogram is performed, and a finding is noted in the upper outer quadrant of the left breast, as shown in the image. Based on the appearance of the finding demonstrated in the image, what is the most appropriate next step in her management?

A. Repeat mammography in 6 months.
B. Stereotactic core biopsy of the calcifications.
C. Breast ultrasound of the area.
D. Immediate surgical excision of the area.
E. Referral for breast MRI.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman undergoes routine screening mammography. She is asymptomatic with no relevant family history of breast cancer. Physical examination is unremarkable. The provided image is a detail from her mammogram. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?

A. Refer directly to a breast surgeon for consultation.
B. Refer for breast MRI for further characterisation.
C. Proceed directly to core needle biopsy of the suspicious area.
D. Perform additional diagnostic mammographic views and potentially targeted ultrasound.
E. Schedule for routine annual screening mammography in 12 months.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman attends a routine mammography screening. She reports no palpable lumps, pain, or nipple discharge. Her family history is unremarkable. The current mammogram reveals new findings compared to her prior images from the last 5 years. The image is shown. What is the MOST appropriate next step?

A. Reassurance and repeat mammogram in 1 year
B. MRI of the breast
C. Excisional biopsy
D. Stereotactic core biopsy
E. Ultrasound of the breast
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Based on the appearance of the abnormality demonstrated in the provided image, which is the most appropriate method for obtaining a tissue diagnosis?

A. Surgical excisional biopsy with wire localisation as the initial diagnostic step
B. Ultrasound-guided core biopsy of the area corresponding to the mammographic finding
C. Follow-up mammography in 6 months to assess stability of the finding
D. Stereotactic core biopsy targeting the clustered microcalcifications
E. Fine needle aspiration cytology of the suspicious area
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A 50-year-old woman presents with a newly discovered, firm, mobile lump in her left breast, approximately 2 cm in size. She has no family history of breast cancer. She is post-menopausal. On examination, the lump is palpable in the upper outer quadrant, appears well-defined, and is non-tender. There are no skin changes or nipple discharge. Axillary nodes are not palpable. Considering the Australian guidelines for breast lump assessment, which of the following is the most appropriate initial investigation?

A. Mammography and ultrasound
B. Clinical breast examination and review in 3 months
C. Ultrasound and core biopsy
D. Fine needle aspiration cytology
E. Mammography alone
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Based on the clinical presentation, the patient's history, and the specific finding demonstrated in the provided image from her screening mammogram, what is the most appropriate immediate next step in the management pathway for this patient?

A. Stereotactic vacuum-assisted core biopsy of the suspicious calcifications.
B. Proceed directly to surgical excision of the area under wire localisation.
C. Repeat the mammogram in 3-6 months with spot compression and magnification views.
D. Request a breast MRI with contrast to better delineate the extent of the abnormality.
E. Perform a targeted ultrasound of the area of concern.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for routine mammography. The image is shown. What is the MOST appropriate next step?

A. Reassurance and routine screening
B. Stereotactic core biopsy
C. Ultrasound of the breast
D. MRI of the breast
E. Excisional biopsy
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Assuming that subsequent investigation of the area highlighted in the image confirms a diagnosis of ductal carcinoma in situ (DCIS) and the patient undergoes breast-conserving surgery, which of the following factors is most important in determining the need for adjuvant radiotherapy?

A. Patient's body mass index (BMI)
B. Margin status of the surgical excision specimen
C. Oestrogen receptor status of the DCIS cells
D. Ki-67 proliferation index of the DCIS cells
E. Presence of metastatic disease on staging scans
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