{"id":5449,"date":"2025-02-26T16:30:53","date_gmt":"2025-02-26T21:30:53","guid":{"rendered":"https:\/\/usmle-rx.com\/?p=5449"},"modified":"2025-02-26T16:52:07","modified_gmt":"2025-02-26T21:52:07","slug":"step-1-question-of-the-month-february","status":"publish","type":"post","link":"https:\/\/usmle-rx.com\/step-1-question-of-the-month-february\/","title":{"rendered":"STEP 1 Question of the Month (February)"},"content":{"rendered":"<h3>Conquer STEP 1, One Question at a Time! The answer is explained below.<\/h3>\n<p>&nbsp;<\/p>\n<p>A 36-year-old nulliparous woman comes to her primary care physician because of breast pain for several days. She says she has felt lumps in her breasts previously. These lumps worsen the week before and around the time of her period but subside afterward. Breast examination shows several small, mobile lumps on both breasts. There is no axillary lymphadenopathy.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Which of the following would a biopsy specimen of the breast lumps most likely reveal?<\/strong><\/p>\n<p>A) Central necrosis<\/p>\n<p>B) Increase in number of acini and intralobular fibrosis<\/p>\n<p>C) Large cells with clear &#8220;halos&#8221;<\/p>\n<p>D) Lymphatic involvement<\/p>\n<p>E) Sheets of pleomorphic cells infiltrating adjacent stroma<\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p>Check the answer below \ud83d\udc47<\/p>\n<p>.<\/p>\n<p>.<\/p>\n<p>.<\/p>\n<p>.<\/p>\n<p>.<\/p>\n<p>.<\/p>\n<p>.<\/p>\n<p>.<\/p>\n<p>&nbsp;<\/p>\n<p>The correct answer is: <span style=\"color: #008000;\"><strong>B) Increase in number of acini and intralobular fibrosis.<\/strong><\/span><\/p>\n<p>&nbsp;<\/p>\n<h3 class=\"ng-tns-c4250228263-52\">High-Yield Summary<\/h3>\n<div class=\"rich-text high-yield-explanation ng-tns-c4250228263-52\" data-rxannotationdata=\"bottomLine\">\n<ul>\n<li>Bilateral breast pain and cystic lumps without skin changes, nipple discharge, or axillary\u00a0lymphadenopathy\u00a0that worsen before menses and with\u00a0caffeine\u00a0intake is a typical presentation of fibrocystic breast changes.<\/li>\n<li>Histologically, fibrocystic breast changes appear as fibrous tissue,\u00a0cysts, and possible proliferation of acini.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<\/div>\n<div class=\"answer-wrapper ng-tns-c4250228263-52 --correct --selected ng-star-inserted --expanded\">\n<div id=\"cdk-accordion-child-1\" class=\"mat-expansion-panel-content ng-tns-c857250080-56 ng-trigger ng-trigger-bodyExpansion\" role=\"region\" aria-labelledby=\"mat-expansion-panel-header-1\">\n<div class=\"mat-expansion-panel-body ng-tns-c857250080-56\">\n<h3><strong>Step 1: Disease Diagnosis<\/strong><\/h3>\n<p>This patient presents with cyclic, premenstrual breast pain with no additional symptoms and multiple bilateral, small, mobile lumps; no skin changes; and no axillary lymphadenopathy. This is a classic presentation of <strong>fibrocystic changes of the breast<\/strong>, which typically fluctuate in relation to the hormonal effects of\u00a0estrogen\u00a0and may be aggravated by\u00a0caffeine\u00a0intake.<\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Step 2: Normal Structure\/Function<\/strong><\/h3>\n<p>Fibrocystic disease is a benign condition that appears as <strong>fibrous tissue,\u00a0cysts, and possible proliferation of acini<\/strong>\u00a0on histologic examination. It manifests as diffuse breast pain and multiple bilateral cystic masses, typically in the outer quadrants. It is one of the most common causes of breast lumps in women, from the onset of menses to the onset of\u00a0menopause. Fibrocystic breast tissue histologically appears as fibrous stroma (red arrow) and cysts (black arrow). There may be focal proliferative changes in some cases with an increase in the number of acini (terminal breast unit) per lobe.<\/p>\n<p>The other choices are incorrect:<\/p>\n<ul>\n<li><strong>Central\u00a0necrosis\u00a0<\/strong>is characteristic of comedocarcinoma, a subtype of\u00a0ductal carcinoma in situ\u00a0that presents as a unilateral, palpable mass with nipple discharge.<\/li>\n<li><strong>Large cells with clear \u201chalos\u201d\u00a0<\/strong>are seen in\u00a0Paget disease, which occurs unilaterally with eczematous skin findings and is associated with underlying ductal carcinomas.<\/li>\n<li><strong>Lymphatic involvement<\/strong>\u00a0of breast tissue is indicative of inflammatory carcinoma, which presents with peau d\u2019orange appearance of the skin and\u00a0erythema\u00a0and swelling.<\/li>\n<li><strong>Sheets of pleomorphic cells infiltrating adjacent stroma\u00a0<\/strong>are seen in invasive ductal carcinoma, which presents in older women as fixed, irregular masses with skin changes such as retraction, dimpling, and\/or unilateral bloody nipple discharge.<\/li>\n<\/ul>\n<div class=\"distractor-media-wrapper ng-tns-c4250228263-52 ng-star-inserted\">\n<p><img decoding=\"async\" class=\"test-image ng-tns-c4250228263-52 ng-star-inserted aligncenter\" src=\"https:\/\/cdn.scholarrx.com\/dam\/Image\/31397.png\" alt=\"\" width=\"400\" \/><\/p>\n<div class=\"image-caption image-caption-inherit ng-tns-c4250228263-52 ng-star-inserted\" style=\"text-align: center;\"><span style=\"font-size: 10pt;\">Image courtesy of Wikimedia Commons<\/span><\/div>\n<div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<hr \/>\n<h3><\/h3>\n<h3>Don\u2019t Wait \u2013 Sign Up Now!<\/h3>\n<div class=\"fl-module fl-module-rich-text fl-node-tups6r2nwj0v\" data-node=\"tups6r2nwj0v\">\n<div class=\"fl-module-content fl-node-content\">\n<div class=\"fl-rich-text\">\n<p>When you sign up for a free account, you\u2019ll have access to\u00a0<strong><a href=\"https:\/\/usmle-rx.com\/products\/step-1-rx360\/\" target=\"_blank\" rel=\"noopener\">Rx360+<\/a><\/strong> for the first five days after sign-up. Take advantage of that time to test-drive the most comprehensive study system on the market and see the difference we can make in your studying.<\/p>\n<p><a class=\"pp-button\" role=\"button\" href=\"https:\/\/account.scholarrx.com\/Account\/Login?ReturnUrl=%2Fconnect%2Fauthorize%2Fcallback%3Fclient_id%3DeCommerce%26response_type%3Dcode%26scope%3Dopenid%2520email%2520profile%26redirect_uri%3Dhttps%253A%252F%252Fwww2.usmle-rx.com%252Fopenid-connect%252Fgeneric%26state%3DAtlMPky5WbQy4h56eZjA37PdVhIUbiSZhPLEWjjxghU%26op%3Dfreetrial%26product%3D360TRIAL%26utm_source%3Dwebsite%26utm_medium%3DStep1ProductPage360%26utm_campaign%3DPlatform2.0LaunchFreeTrial\" target=\"_blank\" rel=\"noopener\" aria-label=\"Create My Free Account\"><span class=\"pp-button-text\">Create Your Free Account<\/span><\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"Conquer STEP 1, One Question at a Time! The answer is explained below. &nbsp; A 36-year-old nulliparous woman comes to her primary care physician because of breast pain for several days. She says she has felt lumps in her breasts previously. These lumps worsen the week before and around the time of her period but&hellip;","protected":false},"author":43,"featured_media":5450,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"sync_status":"none","episode_type":"audio","audio_file":"","podmotor_file_id":"","podmotor_episode_id":"","castos_file_data":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","filesize_raw":"","date_recorded":"","explicit":"","block":"","itunes_episode_number":"","itunes_title":"","itunes_season_number":"","itunes_episode_type":"","footnotes":""},"categories":[147,190],"tags":[],"series":[],"class_list":["post-5449","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-step-1","category-exams"],"acf":[],"episode_featured_image":"https:\/\/usmle-rx.com\/wp-content\/uploads\/2025\/02\/USMLE-Rx-banner-1.png","episode_player_image":"https:\/\/usmle-rx.com\/wp-content\/uploads\/2020\/09\/AudioBricks_CoverArt-1.png","download_link":"","player_link":"","audio_player":false,"episode_data":{"playerMode":"dark","subscribeUrls":{"apple_podcasts":{"key":"apple_podcasts","url":"https:\/\/podcasts.apple.com\/us\/podcast\/the-rx-bricks-podcast\/id1530646481","label":"Apple Podcasts","class":"apple_podcasts","icon":"apple-podcasts.png"},"google_play":{"key":"google_play","url":"https:\/\/www.google.com\/podcasts?feed=aHR0cHM6Ly93d3cudXNtbGUtcnguY29tL2ZlZWQvcG9kY2FzdA%3D%3D","label":"Google Play","class":"google_play","icon":"google-play.png"},"overcast":{"key":"overcast","url":"https:\/\/overcast.fm\/itunes1530646481\/the-rx-bricks-podcast","label":"Overcast","class":"overcast","icon":"overcast.png"},"spotify":{"key":"spotify","url":"https:\/\/open.spotify.com\/show\/6difsNR0giFPpNfJM2e5l2","label":"Spotify","class":"spotify","icon":"spotify.png"},"stitcher":{"key":"stitcher","url":"https:\/\/www.stitcher.com\/show\/the-rx-bricks-podcast","label":"Stitcher","class":"stitcher","icon":"stitcher.png"}},"rssFeedUrl":"https:\/\/usmle-rx.com\/feed\/podcast\/the-rx-bricks-podcast","embedCode":"<blockquote class=\"wp-embedded-content\" data-secret=\"OUsb2IB5sJ\"><a href=\"https:\/\/usmle-rx.com\/step-1-question-of-the-month-february\/\">STEP 1 Question of the Month (February)<\/a><\/blockquote><iframe sandbox=\"allow-scripts\" security=\"restricted\" src=\"https:\/\/usmle-rx.com\/step-1-question-of-the-month-february\/embed\/#?secret=OUsb2IB5sJ\" width=\"500\" height=\"350\" title=\"&#8220;STEP 1 Question of the Month (February)&#8221; &#8212; USMLE-Rx\" data-secret=\"OUsb2IB5sJ\" frameborder=\"0\" marginwidth=\"0\" marginheight=\"0\" scrolling=\"no\" class=\"wp-embedded-content\"><\/iframe><script>\n\/*! 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