Nokea
A 63-year-old nurse comes to your office, upset because she has found an enlarged lymph node under her right arm. She states she found it last week while taking a shower. She isn't sure if she has any breast lumps because she doesn't know how to do self-exams. She states her last mammogram was 5 years ago and it was normal. Her past medical history is significant for high blood pressure and chronic obstructive pulmonary disease. She quit smoking 2 years ago after a 55-packs/year history. She denies using any illegal drugs and drinks alcohol rarely. Her mother died of a heart attack and her father died of a stroke. She has no children. On examination you see an older female appearing her stated age. On visual inspection of her right axilla you see nothing unusual. Palpating this area, you feel a 2-cm hard, fixed lymph node. She denies any tenderness. Visualization of both breasts is normal. Palpation of her left axilla and breast is unremarkable. On palpation of her right breast you feel a nontender 1-cm lump in the tail of Spence. What disorder of the axilla is most likely responsible for her symptoms?
Correct Answer: A
Rationale: The correct answer is A: Breast cancer. The presence of an enlarged, hard, fixed lymph node in the right axilla, along with a nontender lump in the tail of Spence (an area of the breast where breast cancer commonly occurs), strongly suggests breast cancer as the most likely cause. The patient's age, gender, history of smoking, and lack of breast self-exams increase her risk for breast cancer. The absence of tenderness in the lymph node also raises suspicion. Other choices are less likely: B (lymphadenopathy of infectious origin) would typically present with other symptoms like fever or localized infection; C (hidradenitis suppurativa) is a chronic skin condition affecting the sweat glands, not typically presenting with an enlarged lymph node. The patient's history and examination findings align more with breast cancer.