{"id":9945,"date":"2026-05-11T00:04:53","date_gmt":"2026-05-11T08:04:53","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9945"},"modified":"2026-04-10T16:45:33","modified_gmt":"2026-04-11T00:45:33","slug":"usmle-step-1-question-of-the-day-breast-cancer-exam","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-breast-cancer-exam","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Breast cancer exam"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-breast-cancer-exam\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-breast-cancer-exam\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-breast-cancer-exam\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-breast-cancer-exam\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-breast-cancer-exam\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-breast-cancer-exam\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Today\u2019s USMLE\u00ae Step 1 question of the day features a patient with a persistent rash on their breast. What&#8217;s the most likely cause? Let&#8217;s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A 50-year-old woman<\/strong> comes to the office for evaluation of a <strong>red rash over her right breast for the past three months.<\/strong> The rash is <strong>itchy and feels rough to the touch.<\/strong> The patient has tried applying <strong>emollients without relief.<\/strong> Her last menstrual period was three years ago. Past medical history includes <strong>type II diabetes mellitus.<\/strong> Family history is significant for <strong>ovarian cancer in the patient\u2019s grandmother at age 40.<\/strong> Vital signs are within normal limits. Physical examination shows <strong>redness and swelling of the right breast without palpable masses.<\/strong> The overlying skin appears <strong>indurated and retracted.<\/strong> The <strong>right nipple appears normal<\/strong>, and the left breast examination is unremarkable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>This patient\u2019s physical examination findings are most likely due to the involvement of which of the following breast structures?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Retromammary space<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Nipple<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Axillary lymph nodes<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Suspensory ligament<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Lactiferous duct<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Axillary lymph nodes<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Retromammary space<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Breast cancer cells can spread contiguously, including the retro mammary space or the pectoral fascia. Peau d\u2019orange appearance in this patient suggests axillary lymph node invasion. When breast cancer metastasizes to the interpectoral nodes, the breast elevates when the pectoral muscle contracts.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Nipple<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Involvement of the nipple occurs in patients with Paget disease of the breast, characterized by eczematous exudate over the nipple and areola.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Suspensory ligament<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Dimpling of the skin can result from the invasion of glandular tissue and fibrosis, which may place tension on the suspensory ligaments of the breast. This most commonly presents with retraction of the nipple and distortion of the breast contour.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Lactiferous duct<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The lactiferous ducts connect the nipple to the mammary lobules for lactation. Spread of ductal carcinoma through the ductal system may present with nipple discharge.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"936\" height=\"702\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_cd4ebe.png\" alt=\"Illustration of a breast showing signs of inflammation, including bruised skin, swelling, and a dimpled \u201corange peel\u201d (peau d\u2019orange) appearance around the nipple.\" class=\"wp-image-9948\" style=\"aspect-ratio:1.3333176337603616;width:517px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_cd4ebe.png 936w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_cd4ebe.png?resize=300,225 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_cd4ebe.png?resize=768,576 768w\" sizes=\"auto, (max-width: 936px) 100vw, 936px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with findings consistent with a <strong>peau d\u2019orange rash due to the involvement of axillary lymph nodes.<\/strong> This finding is <strong>highly associated with inflammatory breast cancer.<\/strong> <strong>Axillary lymph nodes serve as the most common site of breast cancer metastasis<\/strong>, and <strong>peau d&#8217;orange manifests secondary to cutaneous lymphatic edema and obstruction.<\/strong> Clinically, this rash is characterized by a <strong>thickened, leather-like appearance of the skin.<\/strong> Prominent \u201cpuffy\u201d skin between dimpled pores gives the overlying skin the appearance of an orange peel (<strong>peau d\u2019orange sign<\/strong>), illustrated below.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Breast cancer often presents as a palpable breast mass that is hard, immobile, and with irregular borders.<\/strong> It is most commonly found in the <strong>upper outer quadrants<\/strong> with associated <strong>skin dimpling.<\/strong> <strong>Cancerous invasion of the glandular tissue and fibrosis may pull on the breast&#8217;s suspensory ligaments, resulting in retraction of the nipple.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When breast cancer invades the <strong>retro mammary space or the pectoral fascia<\/strong>, or when it metastasizes to the <strong>interpectoral nodes<\/strong>, the breast elevates when the muscle contracts. <strong>This finding usually signals advanced cancer.<\/strong> Furthermore, local cancerous invasion of the <strong>pectoral fascia and pectoralis major<\/strong> may result in <strong>deep fixation of the breast tissue.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Breast cancer can change the appearance of the breast. Signs include a palpable, irregular mass, peau d\u2019orange, retraction of the nipple, lymphedema, and a leather-like appearance.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Breast_cancer:_Pathology_review\">Breast cancer: Pathology review<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Jesinger, R. A. (2014). <strong>Breast anatomy for the interventionalist.<\/strong> Techniques in vascular and interventional radiology, 17(1), 3-9.\u00a0<\/li>\n\n\n\n<li>Van Uden, D. J. P., van\u00a0Laarhoven, H. W. M., Westenberg, A. H., de Wilt, J. H. W., &amp; Blanken-Peeters, C. F. J. M. (2015). <strong>Inflammatory breast cancer: an overview.<\/strong> Critical reviews in oncology\/hematology, 93(2), 116-126.\u00a0<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"http:\/\/osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 1<\/strong> <strong>practice questions<\/strong>? Try <strong>Osmosis from Elsevier<\/strong> today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>&nbsp;and discover why millions of current and future <strong>clinicians <\/strong>and <strong>caregivers <\/strong>love <strong>learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 50-year-old woman presents with a persistent itchy breast rash and skin changes, including peau d&#8217;orange, dimpling, nipple retraction, and fixation of the breast. What&#8217;s the diagnosis?<\/p>\n","protected":false},"author":208,"featured_media":9949,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[3002,2993,2529,2997,2531,2999,3001,2996,2998,74,3003,3000,2994,2995,664],"class_list":["post-9945","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-axillary-lymph-nodes","tag-breast-anatomy","tag-breast-cancer","tag-breast-exam","tag-breast-tumor","tag-edema","tag-inflammatory-breast-cancer","tag-interpectoral-nodes","tag-lymphatic-spread","tag-medical-imaging","tag-nipple-involvement","tag-peau-dorange","tag-pectoral-fascia","tag-retromammary-space","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day:\u00a0Breast cancer exam - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-breast-cancer-exam\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day:\u00a0Breast cancer exam - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 50-year-old woman presents with a persistent itchy breast rash and skin changes, including peau d&#039;orange, dimpling, nipple retraction, and fixation of the breast. 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What is the best initial medication to manage his condition effectively?","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE Step 2 CK Question of the Day:\u00a0Painful rash","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg 2x"},"classes":[]},{"id":3336,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema","url_meta":{"origin":9945,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: Bilateral Pitting Ankle Edema","author":"Marina Horiates Kerekes, MD &amp; Team","date":"March 31, 2021","format":false,"excerpt":"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. 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Physical examination shows conjunctival pallor and bilateral pitting ankle\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 1 Question of the Day: Bilateral Pitting Ankle Edema","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/9945","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/users\/208"}],"replies":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/comments?post=9945"}],"version-history":[{"count":3,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/9945\/revisions"}],"predecessor-version":[{"id":9952,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/9945\/revisions\/9952"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/9949"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=9945"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=9945"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=9945"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}