Breast Surgery Quiz

Question 1

A 65-year-old woman with a family history of breast cancer is worried about her odds of developing breast cancer. Which of the following would also increase her risk?

Answer 1

Early onset of menarche

Question 2

A 55-year-old woman presents with a 0.5-cm invasive carcinoma of the breast, detected on mammography. What would be the appropriate local therapy for the tumor?

Answer 2

Local excision and axillary dissection followed by radiation therapy

Question 3

A 15-year-old black girl has her left breast removed because of a large mass. The tumor weighs 1350 g and has a bulging, very firm, lobulated surface with a whorl-like pattern. Which of the following is the most likely diagnosis

Answer 3

Fibroadenoma

Question 4

A 60-year-old woman who has a history of severe depression and a radical mastectomy for carcinoma of the breast one year previously develops polyuria, nocturia, and excessive thirst. Laboratory values are as follows:

Serum electrolytes: Na: 1 149 meq/L; K: 3.6 meq/L
Serum calcium: 9.5 mg/dL
Blood glucose: 110 mg/dL
Blood urea nitrogen: 30 mg/dL
Urine osmolality: 150 mOsm/kg

Answer 4

Diabetes insipidus

Question 5

A 54-year-old woman with a history of left mastectomy and subsequent radiation therapy for breast cancer two years ago presents with a 3-cm mass along the edge of the surgical suture line. She denies fever, chills, weight loss, and night sweats. Physical examination reveals some generalized induration and a tanned appearance of the skin overlying the mastectomy secondary to radiation therapy. There is a nonmobile nontender mass along the suture line that is not warm or fluctuant. She has no axillary lymphadenopathy. A biopsy specimen of the breast mass is most likely to show which of the following?

Answer 5

Malignancy

Question 6

Which of the following side effects is relatively common immediately after isosulfan blue dye injection for mapping and sentinel node identification?

Answer 6

Spurious pulse oximeter reading

Question 7

Which of the following statements best describes the long thoracic nerve?

Answer 7

If damaged, Causes winged scapula

Question 8

Axillary lymph nodes are classified according to their relationship with which muscle?

Answer 8

Pectoralis minor

Question 9

Which of the following best describes the Breast Cancer Type 2 gene (BRCA2)?

Answer 9

It is associated with a 40% lifetime risk of ovarian cancer

Question 10

A 40-year old female presents to the clinic with a palpable mass. On physical examination, the mass is a 1 cm, mobile, firm nodule at 2:00 position. What is the next best step in management for this new mass?

Answer 10

Mammogram

Question 11

Which of the following statements best describes breast MRIs?

Answer 11

They allow for easy acquisition of tissue for pathologic diagnosis

Question 12

What is the most common cause of a bloody nipple discharge?

Answer 12

Intraductal papilloma

Question 13

Which of the following statements is most characteristic of phylloides tumors?

Answer 13

They tend to recur

Question 14

A 34-year old woman is referred for evaluation of breast pain. It is described as burning, occasionally sharp and located in the subareolar area. It is always present and unilateral. On physical exam, she has dense tissue in both breasts, but no discrete nodules. What is the best working diagnosis?

Answer 14

Noncyclic breast pain (If they ask treatment for this, it is just reassurance)

Question 15

Following a needle localized excisional biopsy for microcalcifications, pathology is found to be fibrocystic changes associated with sclerosing adenosis and ductal hyperplasia. There was no atypia, but lobular carcinoma in situ (LCIS) was present. What is the next best step in management?

Answer 15

Tell the patient that she has future cancer risk of 1% per year.

Question 16

A woman had a mastectomy and sentinel node biopsy for a diagnosed invasive breast cancer. Her sentinel node was positive and she had an axillary dissection. The final pathology showed a 4cm invasive lobular carcinoma. Five of thirteen lymph nodes were positive. Additional therapy would include which of the following?

Answer 16

Radiation

Question 17

A young patient had a mass removed from her breast that was thought to be a fibroadenoma. On the final pathology, it was found to be a malignant phylloides tumor with margins less than 1 mm. Which of the following should be included in additional therapy?

Answer 17

Margin re-excision

Question 18

Appropriate management of a patient with a positive sentinel lymph node might include which of the following actions?

Answer 18

Systemic chemotherapy and axillary lymph node dissection

Question 19

A 45-year-old man presents with a 2-cm painless subareolar mass of his left breast with nipple retraction. Physical examination shows no lymph node involvement. A biopsy revealed infiltrating ductal carcinoma with positive hormone receptors. There is no evidence of metastatic disease. What is the most appropriate treatment plan?

Answer 19

Modified radical mastectomy

Question 20

A 22-year-old woman in her 9th week of pregnancy presents with a painless lump of her left breast. On physical examination, there is a 3 cm mass in the left breast with no palpable lymph nodes. What imaging study should be performed first?

Answer 20

Ultrasound

Question 21

A 22-year-old woman in her 9th week of pregnancy presents with a painless lump of her left breast. On physical exam there is a 3 cm mass in the left breast with no palpable lymph nodes. The mass is found to be solid and a biopsy is performed. It returns as infiltrating ductal carcinoma. Around what topic should the treatment discussion center?

Answer 21

Mastectomy with axillary sampling

Question 22

What is an acceptable treatment for ductal carcinoma in situ (DCIS)?

Answer 22

Mastectomy

Question 23

Lobular carcinoma in situ (LCIS) may be treated by which of the following methods?

Answer 23

Bilateral mastectomies

Question 24

A 45-year-old woman is referred for an abnormal mammogram. It shows a cluster of calcifications in the central left breast for a span of 1.5 cm read by the radiologist as a BIRADS 4. There is no associated mass and nothing is palpable on physical examination. What is the next best step in management?

Answer 24

Stereotactic biopsy

Question 25

A woman has a core needle stereotactic biopsy that shows fibrocystic condition and adenosis. There was evidence of atypical ductal hyperplasia. What is the next best step in management?

Answer 25

Wire localized excisional biopsy

Question 26

BRCA 2 gene mutation is associated with a higher risk of developing which cancer?

Answer 26

Male breast

Question 27

A 65-year-old woman presents with a large mass encompassing her whole right breast with peu d’orange, redness and thickened skin. There are palpable lymph nodes in the right axilla. She has no fever and the breast itself is not painful. What is the working diagnosis?

Answer 27

Inflammatory breast cancer

Question 28

A 65-year-old woman presents with a large mass encompassing her whole right breast with peu d’orange, redness and thickened skin. There are palpable lymph nodes in the right axilla. She has no fever and the breast itself is not painful. What is the next step in the evaluation of this patient?

Answer 28

Core biopsy

Question 29

A 40-year-old woman presents with a 2 cm mass in her right breast detected by mammogram. Core biopsy shows infiltrating ductal carcinoma. She has no palpable axillary lymph nodes. Appropriate therapy for the patient would include which of the following?

Answer 29

Sentinel lymph node biopsy, radiation therapy, and lumpectomy

Question 30

A 40-year-old woman presents with a 2 cm mass in her right breast detected by mammogram. Core biopsy shows infiltrating ductal carcinoma. She has no palpable axillary lymph nodes. The patient has a negative sentinel node biopsy and no evidence of metastatic disease. In what stage is the patient?

Answer 30

Stage I

Question 31

A 40-year-old woman presents with a 2 cm mass in her right breast detected by mammogram. Core biopsy shows infiltrating ductal carcinoma. She has no palpable axillary lymph nodes. If the patient had a positive sentinel node biopsy and no evidence of metastatic disease, what would her stage be?

Answer 31

Stage II

Question 32

25 yo with 2.5 cm mass anechoic and no internal echos.

Answer 32

A fibroadenoma and do an aspiration.

Question 33

Young person with mass and mother who died of breast CA at 40.

Answer 33

Work it up.

BRCA, metastatic workup and MRI

Question 34

Loss of posterior sensation of arm after partial mastectomy from damage to which nerve?

Answer 34

Intercostobrachial N.

Question 35

Pregnant female needs workup.

Answer 35

Ultrasound and excision

Question 36

Dense breast with subareolar constant sharp burning pain. Non-Cyclic breast pain. Management?

Answer 36

Reassurance?

Question 37

Abscess with smoking history. Management?

Answer 37

ABX and drainage/cut nipple