BRST 2

Question 1

Dose delivered by conventional mammography

Answer 1

0.1cGy

Question 2

What mammographic view shows the greatest volume of breast tissue?

Answer 2

MLO view

mediolateral oblique

Question 3

What is the advantage of CC

(craniocaudal) view?

Answer 3

provides better visualization of the medial aspect of the breast and permits greater breast compression

Question 4

Specific mammographic features that suggest a diagnosis of breast cancer (3)

Answer 4

Solid mass with or without stellate features
Asymmetric thickening of breast tissues
Clustered microcalcifications

Question 5

NCCN guideline for breast exam for normal-risk women >=20 years

Answer 5

Breast exam at least every 3 years

Question 6

NCCN guidelines for breast exam/mammogram at age 40 years

Answer 6

yearly breast exam and mammogram

Question 7

Primary indication for ductography

Answer 7

nipple discharge

Question 8

Breast Ultrasound does not reliably detect breast lesions of this size

Answer 8

<= 1 cm in diameter

Question 9

Who among the following patients will benefit from Breast MRI in characterizing mammographic findings

a. 30 y.o female, no family history of breast cancer, 2cm palpable mass
b. 25 y.o. female, strong family history of breast cancer, nulliparous, early menarche, obese
c. 40 y.o. female, newly diagnosed Invasive carcinoma of the breast
d. A and B
e. B and C

Answer 9

E

Question 10

Clinical determination of axillary lymph node metastases has an accuracy of only

Answer 10

33%

Question 11

True of axillary lymph node disease EXCEPT

a. The number of axillary lymph nodes involved with metastatic disease is one of the most important predictors of 10- and 20 year survival
b. The internal mammary node or a low axillary node when positive alone carried the same prognostic weight
c. Drainage to the internal mammary nodes is more frequent with lateral quadran cancers
d. NOTA

Answer 11

C

Question 12

In postmenopausal women, hormone replacement therapy consisting of estrogen plus progesterone increases the risk of breast cancer by _____

Answer 12

26%

Question 13

Tumors positive for ER and PR have a response rate to estrogen therapy of

Answer 13

> 50%

Question 14

Tumors negative for both er/pr have a response rate to estrogen therapy of

Answer 14

10%

Question 15

Tumors positive for either estrogen or progesterone receptors have a response rate to estrogen therapy of

Answer 15

33%

Question 16

True about HER2/neu receptor positivity

a. associated with mutated p53, ki67 overexpression, ER negativity
b. An important prognostic and predictive factor in breast cancer
c. the receptor Promotes growth and proliferation and increases invasive and metastatic capabilites
d. correlated with a more aggressive type of cancer
e. NOTA
f. AOTA

Answer 16

F

Question 17

GIve 2 indices of proliferation of breast cancer

Answer 17

Ki67

PCNA

Question 18

Her2/neu receptor: Trastuzumab as VEGF receptor:______

Answer 18

Bevacizumab

Question 19

Patients not suitable or sentinel lymph node (SLN)
biopsy include all o the following EXCEPT
A. Inflammatory carcinoma o the breast.
B. Prior axillary surgery.
C. Biopsy-proven distant metastases.
D. Lower inner quadrant o breast primary carcinoma.
E. Pregnancy

Answer 19

D and E

Question 20

The following are prognostic and predictive tumor factors for invasive breast cancer EXCEPT

a. Nodal status
b. Tumor size
c. Vascular invasion
d. Hormone receptor status
e. AOTA
f. NOTA

Answer 20

F

nodal status
tumor size
histologic/nuclear grade
lymphatic/vascular invasion
pathologic stage
hormone receptor status
DNA content
Extent of intraductal component
Her-2/neu expression

Question 21

The following are prognostic and predictive Host factors for invasive breast cancer EXCEPT

a. Age
b. menopausal status
c. Previous benign breast mass
d. Nutrition
e. Immunosuppression
f. AOTA
g. NOTA

Answer 21

C

Age manopausal status
family history
previous breast cancer
immunosuppression
Nutrition
Prior chemotherapy
Prior radiation therapy

Question 22

diagnostic studies for breast cancer patients Stage 0

a. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status
b. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu
c. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test
d. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR

Answer 22

A

Question 23

In Stage 0 breast CA, workup involves Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status. What test is added to this list for Stage I?

Answer 23

Her 2/neu expression

Question 24

What diagnostic workup is required for Stage II Breast CA

Answer 24

Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR

Question 25

What diagnostic workup is required for Stage III and IV breast CA?

Answer 25

Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR, Bone scan, abdominal CT or UTS, or MRI (with or without pelvis)

Question 26

Treatment options for LCIS cancer

Answer 26

observation chemoprevention bilateral total mastectomy

Question 27

True about LCIS EXCEPT a. goal of treatment is to prevent or detect at an early stage the invasive cancer that subsequently develops in 25% to 35% of these women. b. Excising LCIS is prevents cancer formation c. Tamoxifen as risk reduction strategy should be conisdered d. ATOA e. NOTA

Answer 27

B; no benefit

Question 28

Indication for mastectomy in DCIS

Answer 28

extensive disease (>4cm of disease or disease in more than one quadrant)

Question 29

Treatment recommendations for women with limited DCIS

Answer 29

Lumpectomy and radiation therapy

Question 30

T/F adjuvant tamoxifen is considered for all DCIS patients

Answer 30

F; those with ER-positive disease

Question 31

Gold standard treatment for DCIS

Answer 31

mastectomy

Question 32

Duration of tamoxifen treatment in women with ER-positive DCIS, after surgery and radiation therapy

Answer 32

5 years

Question 33

What are the equivalent treatments for patients with stage I and II breast cancer?

Answer 33

Mastectomy with axillary staging or | Breast conserving surgery with axillary staging and radiation therapy

Question 34

What are relative contraindications to breast conservation therapy? (4)

Answer 34

PMS Prior radiation therapy to the breast or chest wall Persistently positive surgical margins after re-excision Multicentric disease Scleroderma or lupus erythematosus

Question 35

T/F patients who are planned for postmastectomy radiation therapy are not ideal candidates for nipple-sparing mastectomy

Answer 35

T

Question 36

What are the benefits of SLN dissection for those qualified?

Answer 36

``` Decreased morbidity (arm swelling and range of motion) Improved quality of life vs. patients who underwent ALND ```

Question 37

What is the most common immediate effect of SLN dissection?

Answer 37

Axillary seroma

Question 38

Indications for adjuvant chemotherapy for patients with early stage invasive breast cancer

Answer 38

node positive cancers patients with cancers >1cm patients with node negative cancers of >0.5cm when an adverse prognostic factor is present

Question 39

What are the adverse prognostic factors of early stage breast cancer?

Answer 39

``` NB(H3) Negative hormone receptor blood vessel or lymph vessel invasion high nuclear grade high histologic grade Her-2/neu overexpression or amplification ```

Question 40

What does "switch" regime for adjuvant hormonal therapy for breast cancer?

Answer 40

3 years aromatase inhibitor + 2 years tamoxifen; but 5 years AI regimen is preferred

Question 41

What is the treatment for Stage III breast cancer?

Answer 41

Neoadjuvant chemotherapy Surgery Radiation Adjuvant Chemotherapy