breast

Question 1

What is the location of the greatest volume of the breast

Answer 1

upper outer quadrant

Question 2

Blood supply of breast

Answer 2

1. internal mammary artery 2. posterior intercostal artery 3. branches of axillary artery

Question 3

Venous drainage of breast

Answer 3

1. Lateral thoracic and thoracoacromial to axillary 2. Internal thoracic

Question 4

Possible route for breast cancer metastases to the vertebrae, skull, pelvic bones and CNS

Answer 4

Batson’s vertebral plexus

Question 5

Most common site of axillary LN metastasis

Answer 5

Lateral/ axillary vein group - I

Question 6

This hormone promotes ductal development of breast

Answer 6

estrogen

Question 7

This hormone promotes lobular development of breast

Answer 7

progesterone

Question 8

Treatment of breast abscess

Answer 8

1. pre operative ultrasound 2. incision and drainage - with suppuration 3. local wound care - antibiotics and warm compress

Question 9

This is a recurrent retroareolar infection and abscess of the breast

Answer 9

Zuska’s disease (recurrent periductal mastitis)

Question 10

A benign self limited condition which is a variant of thrombophlebitis that involves the superficial veins of the anterior chest wall and breast

Answer 10

mondor disease

Question 11

Treatment of mondor disease

Answer 11

1. anti inflammatory medications 2. warm compress 3. restriction of motion 4. brassiere support

Question 12

What is a size of a giant fibroadenoma

Answer 12

> 3 cm

Question 13

Treatment of fibroadenoma

Answer 13

1. cryoablation 2. surgical removal 3. observe

Question 14

This occurs when the stroma of the breast involutes too quickly and the alveoli remains.

Answer 14

Breast Cyst

Question 15

Management of breast cyst

Answer 15

Core needle biopsy

Question 16

Definition of microcalcification

Answer 16

1. < 0.5 mm 2. fine 3. linear 4. branching

Question 17

It occurs in premenopausal women with serous or bloody nipple discharge

Answer 17

intraductal papilloma - Most common cause of bloody nipple discharge

Question 18

What age to perform baseline mammography

Answer 18

35 y.o

Question 19

What age to do annual mammogram

Answer 19

40 y.o

Question 20

What is the treatment if there is mutation in HER 2 gene

Answer 20

herceptin/trastuzumab

Question 21

Most common sign of breast CA

Answer 21

Mass

Question 22

Where is BRCA 1 located

Answer 22

chromosome 17q -develops invasive ductal carcinoma -poorly differentiated -hormone receptor negative

Question 23

Where is BRCA 2 located

Answer 23

Chromosome 13q -develops invasive ductal carcinoma -well differentiated -hormone receptor positive

Question 24

Most important prognostic correlate of disease free and overall survival of breast CA

Answer 24

axillary lymph node status

Question 25

Most common sites of metastases in breast CA

Answer 25

1. bone 2. lung 3. pleura 4. soft tissue 5. liver

Question 26

Treatment of LCIS

Answer 26

1. observation 2. chemoprevention with tamoxifen and bilateral total mastectomy 3. close follow up with PE and bilateral mammograms

Question 27

Treatment of DCIS

Answer 27

1. \>4 cm or \>1 quadrant - mastectomy 2. low grade DCIS (cribriform or papillary subtype) and \< 0.5 cm - lumpectomy

Question 28

What is the pathognomonic finding of Paget's disease of nipple

Answer 28

PAGET CELLS - large, pale, vacuolated cells in the rete pegs of the epithelium

Question 29

Paget disease is positive for what marker? How can you differentiate it from Melanoma?

Answer 29

o (+) CEA – Paget disease o (+) S-100 – Melanoma

Question 30

It is a multifocal, multicentric and bilateral breast cancer with signet ring cells

Answer 30

INVASIVE LOBULAR CARCINOMA - Absence of e-cadherin as diagnostic biomarker - Small cells arranged in single file orientation (Indian file configuration) - Intracytoplasmic mucin that may displace the nucleus (Signet ring cell carcinoma)

Question 31

What test is used in nipple discharge

Answer 31

ductography

Question 32

Treatment of early invasive breast cancer (stage I, IIA, IIB)

Answer 32

Breast conservation surgery 1. lumpectomy 2. radiation therapy

Question 33

Contraindication to breast conservation surgery

Answer 33

1. prior RT 2. unknown margin status 3. multicentric disease 4. scleroderma or SLE

Question 34

Treatent of advanced local regional breast cancer (IIIA, IIIB)

Answer 34

1. surgery - MRM 2. adjuvant RT 3. chemotherapy - neoadjuvant

Question 35

5 year survival rate of breast cancer

Answer 35

I - 94% IIA - 85% IIB - 70% IIIA - 52% IIIB - 48% IV - 18%

Question 36

Differentiate the types of mastectomy

Answer 36

Question 37

What comprises a MRM

Answer 37

1. removal of all breast tissue 2. nipple areola complex 3. level I and II LN 4. skin

Question 38

This surgery removes all breast tissue and skin, nipple areola complex, pectoralis major and minor, and level I, II, III LN

Answer 38

halstead radical mastectomy

Question 39

Most frequent complication of MRM

Answer 39

seroma

Question 40

treatment of pregnant breast CA

Answer 40

1st and 2nd trimester - MRM 3rd trimester - lumpeectomy with Axillary ND and RT after delivery

Question 41

Treatment of Phylloides tumor/cystosarcoma

Answer 41

Benign - total excision with 2 - 3 cm margin Malignant - total mastectomy WITHOUT` LN dissection

Question 42

It is a variant of infiltrating ductal carcinoma characterized by skin changes of brawny induration, erythema with a raised edge, and edema/ peau d orange

Answer 42

inflammatory breast cancer

Question 43

what causes the appearane of inflammatory breast cancer

Answer 43

dermal lymphatic invasion

Question 44

This surgery is the removal of all breast tissue, nipple areola complex, skin

Answer 44

total (simple) mastectomy

Question 45

This presents as a chronic, erythematous, eczematoid rash or ulcer and is associated with DCIS and invasive cancer of the breast

Answer 45

Paget's disease

Question 46

Treatment of Paget's disease

Answer 46

1. lumpectomy 2. mastectomy 3. MRM depends on the extent of involvement and presence of invasive cancer

Question 47

This drug is quoted as medical adrenalectomy

Answer 47

anastrazole - inhibit production of adrenal steroid and conversion of androgen to estrogen in the adrenal gland and peripherally