NM 701 Exam 4 Questions and Answers Latest Update 2025-2026
Components of breast tissue - Answers -nipple and areola
-lobes of glandular tissue
-ducts
-fibrous tissue
-fatty tissue (amount determines size)
Describe glandular lobes of the breast - Answers -12 to 20 lobes per breast
-10 to 100 lobules per lobe
-lobules are subdivided into secretory alveoli
---produce milk during lactation
each lobe empties into a single lactiferous duct that travels out through the nipple
How to evaluate mastalgia - Answers -cyclic vs non-cyclic (prospective diary may help)
-diffuse vs focal
-non-breast pain (chest wall pain)
-thorough OLDCARTS
-other symptoms like discharge or mass
-h/o breast disease or surgery
-hx including menstruation, pregnancy, lactation, medications
-complete breast exam
Dx testing for mastalgia - Answers Imaging *if* mass or other abnormality
-mammo
-u/s
-MRI
-tomosynthesis
,Likely causes of mastalgia - Answers *cyclic*: common in luteal phase, ages 30-50
*non-cyclic*: pregnancy, mastitis, cysts, abscesses, cancer (rare, more of concern if
postmenopausal)
*chest wall*: costochondritis, Tietze syndrome
other: medications, arthritis, pleuritis, cervical spondylitis, herpes zoster, cholecystitis, MI
What is 1st line treatment for mastalgia - Answers *reassurance* is effective for 85% of women
-adjust hormones for postmenopausal
-change type of hormonal contraceptive
-various medications
Mammary duct ectasia: define and clinical presentation - Answers *Ducts dilate/expand and
become inflamed*
*e*ctasia = *e*xpansion = icktasia
-bilateral, multiductal, sticky, green, brown, or black discharge
-those >50 yrs; inflammation and fibrosis around ducts
-may have palpable mass
Management of mammary duct ectasia - Answers expectant r/t usually benign
surgical removal of subareolar ducts if focal thickening of duct wall or severe symptoms
Intraductal papilloma: define and clinical presentation - Answers Benign lesion in ducts that may
or may not be palpable
-spontaneous bloody, unilateral, uniductal discharge
-age 40 to 50
, -small benign growth in duct
-may have palpable mass
Intraductal papilloma management - Answers duct excision if multiple OR single and >1 cm
no treatment if single and <1 cm
More worrisome nipple discharge - Answers -spontaneous
-unilateral
-from single duct
-clear, bloody, serosanguinous
-assoc with mass
-in older women
Less worrisome nipple discharge - Answers -occurs with manipulation or stimulation
-bilateral
-multiductal
-milky (galactorrhea)
-yellow, green, brown, black (ectasia)
Benign causes of nipple discharge - Answers -pregnancy
-meds
-pituitary or thyroid abn
-duct ectasia
-intraductal papilloma
What to do about nipple discharge - Answers -Hx
-clinical breast exam (CBE)
-labs as needed
-mammo if assoc mass
Components of breast tissue - Answers -nipple and areola
-lobes of glandular tissue
-ducts
-fibrous tissue
-fatty tissue (amount determines size)
Describe glandular lobes of the breast - Answers -12 to 20 lobes per breast
-10 to 100 lobules per lobe
-lobules are subdivided into secretory alveoli
---produce milk during lactation
each lobe empties into a single lactiferous duct that travels out through the nipple
How to evaluate mastalgia - Answers -cyclic vs non-cyclic (prospective diary may help)
-diffuse vs focal
-non-breast pain (chest wall pain)
-thorough OLDCARTS
-other symptoms like discharge or mass
-h/o breast disease or surgery
-hx including menstruation, pregnancy, lactation, medications
-complete breast exam
Dx testing for mastalgia - Answers Imaging *if* mass or other abnormality
-mammo
-u/s
-MRI
-tomosynthesis
,Likely causes of mastalgia - Answers *cyclic*: common in luteal phase, ages 30-50
*non-cyclic*: pregnancy, mastitis, cysts, abscesses, cancer (rare, more of concern if
postmenopausal)
*chest wall*: costochondritis, Tietze syndrome
other: medications, arthritis, pleuritis, cervical spondylitis, herpes zoster, cholecystitis, MI
What is 1st line treatment for mastalgia - Answers *reassurance* is effective for 85% of women
-adjust hormones for postmenopausal
-change type of hormonal contraceptive
-various medications
Mammary duct ectasia: define and clinical presentation - Answers *Ducts dilate/expand and
become inflamed*
*e*ctasia = *e*xpansion = icktasia
-bilateral, multiductal, sticky, green, brown, or black discharge
-those >50 yrs; inflammation and fibrosis around ducts
-may have palpable mass
Management of mammary duct ectasia - Answers expectant r/t usually benign
surgical removal of subareolar ducts if focal thickening of duct wall or severe symptoms
Intraductal papilloma: define and clinical presentation - Answers Benign lesion in ducts that may
or may not be palpable
-spontaneous bloody, unilateral, uniductal discharge
-age 40 to 50
, -small benign growth in duct
-may have palpable mass
Intraductal papilloma management - Answers duct excision if multiple OR single and >1 cm
no treatment if single and <1 cm
More worrisome nipple discharge - Answers -spontaneous
-unilateral
-from single duct
-clear, bloody, serosanguinous
-assoc with mass
-in older women
Less worrisome nipple discharge - Answers -occurs with manipulation or stimulation
-bilateral
-multiductal
-milky (galactorrhea)
-yellow, green, brown, black (ectasia)
Benign causes of nipple discharge - Answers -pregnancy
-meds
-pituitary or thyroid abn
-duct ectasia
-intraductal papilloma
What to do about nipple discharge - Answers -Hx
-clinical breast exam (CBE)
-labs as needed
-mammo if assoc mass
