Breast

Question 1

Hormone responsible for duct development

Answer 1

Estrogen

Question 2

Hormone responsible for lobular development

Answer 2

Progesterone

Question 3

Hormone responsible for breast swelling, growth of glandular tissue

Answer 3

Estrogen

Question 4

Hormone responsible for increased maturation of glandular tissue, withdrawal causes menses

Answer 4

Progesterone

Question 5

Hormones to cause ovum release

Answer 5

FSH, LH surge

Question 6

Winged scapula, innervates serratus anterior

Answer 6

Long thoracic nerve

Question 7

Weak adduction, innervates latissimus dorsi

Answer 7

Thoracodorsal nerve

Question 8

Innervates pectoralis major and pectoralis minor

Answer 8

medial pectoral nerve

Question 9

Innervates pectoralis major only

Answer 9

lateral pectoral nerve

Question 10

Most commonly injured nerve w/ ALND and modified radical mastectomy

Answer 10

Intercostobrachial nerve (numbness in medial arm/axilla)

Question 11

Blood supply to breast is from (4)

Answer 11

internal thoracic a
intercostal a
thoracoacromial a
lateral thoracic a

Question 12

Valveless vein plexus that allows direct hematogenous metastasis of breast cancer to spine

Answer 12

Batson’s plexus

Question 13

Primary axillary adenopathy

Answer 13

1 in lymphoma

Question 14

What node status is + supraclavicular nodes

Answer 14

N3 disease

Question 15

Most common bug in breast abscess

Answer 15

s. aureus

Question 16

Noncyclical mastodynia, erythema of breast, creamy discharge from nipple

Answer 16

Periductal mastitis

Question 17

Poland Syndrome

Answer 17

Hypoplasia of chest wall
Amastia
Hypoplastic sholder
No pectoralis muscle

Question 18

Treatment of mastodynia

Answer 18

Danazol
OCP
NSAIDs
Evening primrose oil
Bromocriptine

Question 19

Mondor’s disease

Answer 19

Superficial vein thrombophlebitis of breast
Feels cordlike
Tx w/ NSAIDs

Question 20

Which types of fibrocystic disease have to be resected due to cancer risk (2)

Answer 20

Atypical ductal
Lobular hyperplasia
**Does NOT need negative margins

Question 21

Most common cause of bloody nipple discharge

Answer 21

Intraductal papilloma

Question 22

Prominent fibrous tissue compressing epithelial cells

Answer 22

Fibroadenoma

Question 23

What 3 criteria must be met in patient <40 w/ suspected fibroadenoma to observe

Answer 23

1) mass needs to feel clinically benign
2) US/Mammo consistent w/ fibroadenoma
3) FNA/CNBx to confirm fibroadenoma
If not 3/3 then requires excisional biopsy
If >40 then –> excisional biopsy

Question 24

Most aggressive subtype of DCIS

Answer 24

Comedo pattern - high risk for recurrence

Question 25

Treatment for DCIS

Answer 25

Lumpectomy and XRT | Need 1cm margins

Question 26

Treatment for Comedo type DCIS

Answer 26

Simple mastectomy and SLNB

Question 27

DCIS on mammogram

Answer 27

Cluster of calcifications on mammogram, not palpable

Question 28

LCIS on mammogram

Answer 28

No calcifications, not palpable

Question 29

What type of cancer do patients w/ LCIS develop

Answer 29

Ductal CA

Question 30

Margins needed for LCIS

Answer 30

Do NOT need negative margins

Question 31

LN Levels Mastectomy

Answer 31

I: lateral to pec minor II: deep to pec minor III: medial to pec minor

Question 32

Nodes between pec major and pec minor

Answer 32

Rotter's nodes

Question 33

Most common site for distant metastasis

Answer 33

bone (lung, liver, brain)

Question 34

BRCA I lifetime risk Female Breast cancer Ovarian Cancer Male Breast Cancer

Answer 34

60 40 1

Question 35

BRCA II lifetime risk Female Breast cancer Ovarian Cancer Male Breast Cancer

Answer 35

60 10 10

Question 36

BRCA screening

Answer 36

yearly mammogram and breast MRI starting at age 25 | yearly pelvic exam + US, CA-125 starting at age 25

Question 37

Receptor blocker for Her2/neu + breast cancer

Answer 37

Trastuzumab (Herceptin)

Question 38

Worse prognosis subtype of ductal cancer

Answer 38

Scirrhotic

Question 39

More favorable prognosis subtype of ductal cancer

Answer 39

medullary (increased lymphocytes)

Question 40

Treatment of Ductal Cancer

Answer 40

MRM | Breast conserving + post op XRT

Question 41

Worse prognosis sybtype of lobulcar cancer

Answer 41

Signet ring cells

Question 42

Treatment of Lobular cancer

Answer 42

MRM | Breast conserving + post op XRT

Question 43

Treatment of inflammatory cancer

Answer 43

Neoadjuvant chemo + MRM + adjuvant chemo/XRT

Question 44

Indication for SLNB

Answer 44

Tumors >1cm w/o clinical nodes

Question 45

Indication for XRT after mastectomy

Answer 45

advance nodal disease (>4 nodes, N2-N3) skin/chest wall involvement + margins T3-T4

Question 46

Who gets chemotherapy

Answer 46

>1cm + negative nodes | + nodes

Question 47

Occult breast cancer

Answer 47

axillary metastases w/ unknown primary

Question 48

Paget's disease

Answer 48

scaly skin lesion on nipple, associated w/ DCIS or ductal CA

Question 49

Spread of phyllodes tumor

Answer 49

hematogenous

Question 50

Stewart-Treves syndrome

Answer 50

Lymphangiosacroma from chronic lymphedema following axillary dissection **presents w/ dark purple nodule or lesion on arm 5-10 years after surgery