Yet another NBME 7 question

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DAdams

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Woman finds lump on breast, comes into clinic. Physical exam shows dimpling over mass. Mammography shows 4 cm mass over low lateral quadrant. Dimpling of skin is most likely due to traction of the tumor on which of the following structures?

a) branches of cutaneous pectoral nerves
b) lactiferous ducts
c) mammary arteries and veins
d) mammary lymphatics
e) suspensory (cooper) ligaments


I put mammary lymphatics because I thought breast dimpling meant peau d'orange which is caused by obstruction of lymphatic drainage, but this was not the answer. What exactly is this question talking about here?
 
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DAdams said:
Woman finds lump on breast, comes into clinic. Physical exam shows dimpling over mass. Mammography shows 4 cm mass over low lateral quadrant. Dimpling of skin is most likely due to traction of the tumor on which of the following structures?

a) branches of cutaneous pectoral nerves
b) lactiferous ducts
c) mammary arteries and veins
d) mammary lymphatics
e) suspensory (cooper) ligaments


I put mammary lymphatics because I thought breast dimpling meant peau d'orange which is caused by obstruction of lymphatic drainage, but this was not the answer. What exactly is this question talking about here?
Click to expand...

Its E-suspensory ligaments. There was actually a world question similar to this and I did the same as you-mammary lymphatics. But notice the word TRACTION. Dimpling of the skin would result from BLOCKAGE of the lymphatics. I know it seems like a small word but it actually does make a difference.
 
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There are two questions like this in UWorld (as far as I remember). One was peau with lymphatics, the other was Cooper's ligaments.

I guessed lymphatics as well, so if that's wrong, I'm going with Cooper's, based solely on my belief in UWorld.
 
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It's the cooper's ligaments one. Our anatomy professor (thankfully) drove this point home to us first year. As Eddie said, it deals with the word "traction"...blockage would suggest lymphatics for inflammatory carcinoma of the breast. Honestly, I think this sort of question should not appear on the boards, it's too subtle of a difference for us to discern with such a brief history.
 
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Vikingwizardguy said:
It's the cooper's ligaments one. Our anatomy professor (thankfully) drove this point home to us first year. As Eddie said, it deals with the word "traction"...blockage would suggest lymphatics for inflammatory carcinoma of the breast. Honestly, I think this sort of question should not appear on the boards, it's too subtle of a difference for us to discern with such a brief history.
Click to expand...

Yup, no question about it. Ligaments.
 
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eddie13231 said:
Acoustic neuroma: basically always at cerebellar-pontine angle

I thought that was a tricky one though.

Think NF-2 with these and hearing loss
Click to expand...
it was definitely tricky. I recognized the cerebellopontine angle tumor and thought back to a huge note I have written in my first aid "CEREBELLOPONTINE = CN VII or CN VIII".
 
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