Surgery MCQs Q23

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SURGERY • BREAST

A 22-year-old woman presents with a painless breast lump noticed incidentally. On examination, the lump is firm, well-defined, highly mobile (“breast mouse”), and non-tender. There are no skin changes or lymphadenopathy.

Which of the following statements regarding this lesion is true?

A Is a common malignant lump in young females

B Is encapsulated

C Is always present in upper outer quadrant

D Is usually painless and fixed to underlying fascia

E Non-lactational abscess

Encapsulated. The description of a firm, highly mobile, and well-defined lump in a young woman is diagnostic of a fibroadenoma, which is characterized pathologically by being encapsulated.

Decoding the Stem

1

CLUE "Young female + painless + mobile, well-defined lump"

TRANS Classic description of Fibroadenoma.

Explanation

B. Is encapsulated: Correct. Fibroadenomas are benign proliferations of stromal and epithelial tissue that are typically well-circumscribed and encapsulated.

A. Common malignant lump: Incorrect. Fibroadenoma is the most common benign tumor in young women; malignancy is rare in this age group.

C. Always present in UOQ: Incorrect. While the Upper Outer Quadrant is the most frequent site for any breast pathology, fibroadenomas can occur in any quadrant.

D. Fixed to underlying fascia: Incorrect. Fixity to skin or fascia is a hallmark of malignancy (Invasive Carcinoma). Fibroadenomas are "highly mobile."

E. Non-lactational abscess: Incorrect. An abscess is an acute inflammatory lesion presenting with pain, redness, and heat.

🧠 High-Yield Pearls

Feature	Fibroadenoma Characteristic
Eponym	"Breast Mouse" (slippery/highly mobile)
Consistency	Firm and Rubbery
Hormonal Response	May enlarge during pregnancy / end of cycle
Pathology	Benign fibroepithelial tumor

Integrated Clinical Questions

1. Most common malignant breast tumor overall?

Answer: Invasive ductal carcinoma (IDC).

2. Typical age group for fibroadenoma presentation?

Answer: Young women, typically less than 30 years old.

3. Initial investigation of choice for a lump in a woman < 30?

Answer: Ultrasound of the breast (dense breast tissue makes mammography less effective).

4. When is surgical excision considered for fibroadenoma?

Answer: When it is large (>3 cm), growing rapidly, or causing significant patient anxiety.

5. Main differential for a rapidly growing, firm, mobile lump in an older woman?

Answer: Phyllodes tumor (can be benign or malignant).

⚡ Exam Pearls

• Young + mobile lump = fibroadenoma: It is the classic "triple assessment" candidate in medical students.
• Hard, fixed, irregular = malignancy: These signs should always trigger urgent investigation for cancer.
• Encapsulation: This is a hallmark of many benign tumors (like lipomas and fibroadenomas) and explains their mobility.

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