Breast

Question 1

Women’s lifetime risk of developing caner?

Answer 1

12%

1 in 8 women

Question 2

Recommend imaging for a breast mass in woman < 30?

Answer 2

Ultrasound

Question 3

Imaging for breast mass in woman > 30?

Answer 3

Mammogram

Question 4

BI RADS 0

Answer 4

No enough info

Get additional info

Question 5

BI RADS 1

Answer 5

Negative

Question 6

BI RADS 2

Answer 6

Benign (simple cyst)

Continue routine screening

Question 7

BI RADS 3

Answer 7

Probably benign

CBE and US +/- mammogram for stability (if low suspicion) OR tissue biopsy (if high suspicion)

Question 8

BI RADS 4

Answer 8

Suspicious

GET BIOPSY

Question 9

BI RADS 5

Answer 9

Highly suggestive of malignancy

GET BIOPSY

Question 10

When should women get screening mammograms?

Answer 10

Annually starting at age 40

Question 11

Blood, serous or clear discharge is concerning for what?

Answer 11

Intraductal papillomas

If atypia present on core biopsy, need surgical excision since invasive or in situ carcinoma found in 15-20%

Question 12

Most common cause of bloody nipple discharge?

Answer 12

Intraductal papillomas

If atypia present on core biopsy, need surgical excision since invasive or in situ carcinoma found in 15-20%

Question 13

Most common benign tumor in the breast that accounts for half of all breast biopsies?

Answer 13

Fibroadenoma

Question 14

Well defined, 1-2 cm, mobile mass on exam is likely what?

Answer 14

Fibroadenoma

Question 15

Two most common pathogens in mastitis

Answer 15

Staph aureus

Strep Viridans

Question 16

Treatment of breast abscess

Answer 16

I&D

If tissue is fluctuant OR if patient’s symptoms do not improve after 2-3 days of treatment

Send fluid for culture

Give IV antibiotics w/ Vanc until surgical I&D, then Bactrim DS BID for 10-14 days

Question 17

What hormone stimulates glandular growth in the breast?

Answer 17

Progesterone secreted by the theca EXTERNA

*overstimulation of these glands can lead to cyst formation, which in turns lead to fibrocystic change of the breast

Question 18

What is the risk of an underlying carcinoma in the surrounding areas of atypical ductal hyperplasia?

Answer 18

30%

Relative risk = 5.0

Question 19

Lifetime risk of ovarian cancer w/ BRCA1?

Answer 19

40%

Question 20

BRCA1 is found on what chromosome?

Answer 20

17

Question 21

BRAC2 is found on what chromsome?

Answer 21

13

Question 22

Performing elective oophorectomy at time of hysterectomy in premenopausal pt w/ no family or personal hx of cancer will increase her risk for???

Answer 22

All cause mortality

Question 23

Most likely clinical symptom of Paget’s disease of the breast?

Answer 23

Scaly rash arising from the nipple

Question 24

When is a breast MRI indicated for screening?

Answer 24

A high lifetime risk of breast cancer (>20-25%) = BRCA mutation carriers, strong family hx, or hx of chest radiation

Question 25

Treatment of DCIS?

Answer 25

Lumpectomy/WLE w/ or w/out radiation therapy

Question 26

When would you do a total mastectomy for treatment of DCIS?

Answer 26

- Persistent positive margins - Multicentric disease involving more than one quadrant - Cosmetically unacceptable breast conservation surgery due to a large DCIS process Li Fraumeni Syndrome Cowden Syndrome Peutz-Jeghers Syndrome

Question 27

What treatment is appropriate for a patient with a history of breast cancer and vasomotor symptoms of menopause?

Answer 27

Paroxetine FDA APPROVED!

Question 28

Describe benign nipple discharge

Answer 28

Multiductal Bilateral Expressed Green/Milky/Clear

Question 29

Descrbie malignant nipple discharge

Answer 29

Uniductal Unilateral Sponatneous Serous/Clear/Bloody

Question 30

Nipple discharge w/ age > 40?

Answer 30

Requires US AND MAMMO regardless if benign or malignant features

Question 31

Endocrine therapy for pre menopausal breast ca?

Answer 31

Tamoxifen for 5 years

Question 32

Tamoxifen will decrease annual risk of breast cancer recurrence by how much?

Answer 32

40%!! And reduces annual mortality by 35%!

Question 33

Endocrine therapy for post menopausal breast ca?

Answer 33

Tamoxifen OR Aromatse Inhibitor *Aromatse inhibitors are more effective, and have a better SE profile

Question 34

Benefits of Aromatse inhibitors over tamoxifen?

Answer 34

- reduced risk of thrombus - reduced em ca - reduced vaginal bleeding