Breast

Question 1

48 yo with Large painless breast lump, no lymphadenopathy, rapidly growing, leaf-like appearance tumor under microscope

Answer 1

Phyllodes tumor- benign tumor that looks like fibroadenoma in imaging

Question 2

Mastalgia, cyclic pain with menses, clear/white discharge

Answer 2

Fibrocystic Breast disease

Question 3

A rapid introduction proliferation of cells that leads to necrosis and cellular debris within the ducts. On microscope: solid growth of large, paleo Orphic, high-grade cell’s with central expansile necrosis, mitotic figures, periductal inflammation and fibrosis and coarse microcalcifications

Answer 3

Comedocarcinoma- a type of ductal carcinoma in situ with rapid introduction proliferation of cells

Question 4

Painless breast mass, skin changes (retraction, dimpling, edema), nipple retraction, bloody discharge, microcalcifications and stromal invasion on biopsy

Answer 4

Invasive ductal carcinoma

Question 5

<35yo F, presents as a solitary, nontenders, mobile mass, “popcorn” calcification on mammography, biopsy show benign hyperplastic stroma encapsulating ductal tissue

Answer 5

Fibroadenoma

Question 6

Sometimes palpable, single or multiple lesions with serous or bloody nipple discharge, biopsy. Show a central, branching, fibrovascular core with surrounding myoepithelial and epithelial cells

Answer 6

Intraductal papilloma

Question 7

Painless breast nodule with microcalcification and speculations on mammogram and malignant cels in lobules and monomorphic cells in single rows referred to as “Indian file” pattern on biopsy

Answer 7

Invasive lobular carcinoma

Question 8

Drug with Increased risk of endometrial hyperplasia? Why?

Answer 8

Tamoxifen; unopposed estrogen on uterus (estrogen agonist)

Question 9

Drug with decreases the risk of endometrial hyperplasia? Why? What is its SE?

Answer 9

Raloxifene; estrogen antagonist in breast and the uterus ; but risk of thromboembolic events

Question 10

Medication for Mastitis?

Answer 10

Dicloxacillin or cephalexin (strong activity against Stap aureus)
Continue to Breastfeed to avoid abcess development
If MRSA- use TMP-SMX (Bactrum) but risk of kernicterus in newborn

Question 11

Galctorrhea, headaches, MRI mass in the sella turcica suggests ? What will be the hormonal levels for Dopamine? LH? & FSH?

Answer 11

Pituitary lactotroph adenoma; dopamine is high because prolactin stimulates it, LH & FSH will be low due to negative feed back by inhibition of GnRH secretion

Question 12

28YO F, with multiple right inframammary lumps, foul-smelling odor, painful welling sin her axillae, erythematous nodules and fistula discharging pus is? Risk factors?

Answer 12

Hidradenitis Suppurativa (HS) or acne inversa- risk: smoking, obesity, hyperandrogenism, impaired glucose tolerance, IBD

Question 13

6YO F, AA, with 95% height, 99% weight and BMI, coarse hair under both axilla and sparse dark hair on the mons pubis and along the labia majora, no palpable glandular breast tissue? Cause? Risk?

Answer 13

Isolated premature adrenarche or peripheral precocious puberty (PPP). Due to High levels of insulin: Risk: obese pt, AA

Question 14

42yof with Irregular menstrual periods, nipole discharge, on atypical antipsychotics. Cause of symptoms?

Answer 14

Medication Risperidone, D2 antagonist, no inhibition of prolactin, then prolactin inhibiting GnRH

Question 15

34F, increased breast tenderness, N, wt gain, urinary frequency for 2 month. Trying to get pregnant for 6 month, B-hCG is neg. Vaginal ultrasonography no abnormalities.

Answer 15

pseudocyesis

Question 16

First line treatment for prolactinomas & macroadenomas?

Answer 16

Dopamin receptor agonist (Cabergoline or bromocriptine); transsphenoidal hypophysectomy for macro-adenomas

Question 17

Drug used for HER2 cancer ? Also used for ?

Answer 17

Transtuzumab(Blocks HER2 receptor) also used in Gastric cancer

Question 18

Drug used for MS, CLL

Answer 18

Alemtuzumab

Question 19

Drug used for Colorectal cancer, Renal cell carcinoma, Non-small cell lung cancer, and neovascular age-related muscular degeneration

Answer 19

Bevacizumab

Question 20

Drug used to treat Rheumatoid arthritis, ITP, CLL, B-cell non-hodgkin lymphoma and symptomatic waldernstrom macroglobulinemia

Answer 20

Rituximab

Question 21

Loss of heterozygosity in tumor suppressor gene p53, cause multiple cancers

Answer 21

Li-Fraumeni syndrome

Question 22

45Yo, F, with itchy rash on L nipple, jello watery discharge, blood-tinged, weeping, ulcerated lesion involving the entire left nipple-areolar complex

Answer 22

Paget’s disease of the breast- ductal carcinoma that infiltrates the nipple-areola complex

Question 23

29YO, F with blood-tinged discharge from L nipple, NSIM?

Answer 23

Subareolar ultrasound

Question 24

Atypical antipsychotic drug with no hyperprolactinemia SE?

Answer 24

Aripiprazole

Question 25

Why does Hypothyroidism cause hyperprolactinemia?

Answer 25

Low T3,T4 -> high TSH Low T3,T4->stimulates hypothalamus to release TRH which in turn increases TSH and also excessive TRH stimulates the lactotroph cells of the anterior pituitary to release prolactin

Question 26

Turner syndrome child is at risk for osteoporosis because?

Answer 26

Ovarian dysgenesis-> estrogen deficient, increased osteoclast activity, decreased osteoblast activity and bone reabsorption

Question 27

A sex cord-stomal tumor with elevated estrogen & progesterone is

Answer 27

A granulose cell tumor ( Cell-Exner bodies on histology)

Question 28

CA 125 is increased in what kind of ovarian tumors?

Answer 28

Epithelial eg: serous cystuadenocarcinoma (Shows psammoma bodies)

Question 29

What can be used as a tumor marker for ovarian tumors like dysgerminomas (Fried-egg appearance)

Answer 29

Lactate dehydrogenase (LDH): B-hCG levels are increased )

Question 30

Standard screening test for breast cancer Women 50-74 yo by USPTF

Answer 30

Every 2 years (average risk for breast cancer)

Question 31

Development of secondary sexual characteristics in 7yo girl indicates

Answer 31

Precocious puberty

Question 32

Lack of elevation of LH levels following GnRH agonist stimulation indicates

Answer 32

peripheral precocious puberty caused by estrogen-secreting ovarian tumors like granulosa cell tumors

Question 33

Precocious puberty with prostatic fibrous dysplasia and abnormal skin pigmentation (cafe-au-lait spots)

Answer 33

McCune-Albright syndrome

Question 34

Increased TSH indicates

Answer 34

hypothyroidism

Question 35

Galactorrhea and irregular menstrual cycles suggest

Answer 35

hyperprolactinemia

Question 36

Excess TRH (from Low T3, T4) causes increase TSH and stimulates what other cells

Answer 36

lactotroph cells to release prolactin

Question 37

Gynecomastia causing medications

Answer 37

- Ketoconazole - Spironolactone - Digoxin - Flutamide - Leuprolide - H2 antagonists (cimetidine)