68 Questions
Which hormone is responsible for the maturation of glandular tissue in the breast?
Progesterone
Which nerve innervates the serratus anterior muscle and can result in winged scapula if injured?
Long thoracic nerve
After menopause, which hormones' lack results in atrophy of breast tissue?
Estrogen
Which artery supplies the latissimus dorsi muscle and can result in weak arm pull-ups if injured?
Thoracodorsal artery
Which hormone synergizes with estrogen and progesterone in breast development?
Prolactin
Which nerve provides sensation to the medial arm and axilla and is most commonly injured during axillary dissection?
Intercostobrachial nerve
Which condition typically presents with noncyclical mastodynia, erythema, and nipple retraction?
Periductal mastitis
What is the most common cause of bloody nipple discharge?
Intraductal papilloma
Which condition is characterized by superficial vein thrombophlebitis of the breast, often associated with trauma and strenuous exercise?
Mondor’s disease
What is the primary cause of neonatal breast enlargement?
Circulating maternal estrogens
Which condition is characterized by breast cysts filled with milk and may occur during breastfeeding?
Galactocele
What is a major neurovascular structure to be preserved in an axillary dissection to prevent direct hematogenous metastasis of breast cancer to the spine?
Batson’s plexus
Which condition can be associated with increased prolactin levels and amenorrhea?
Galactorrhea
In which condition are accessory nipples most commonly found?
Axilla
What is the most common lymphatic drainage pathway for breast tissue?
Axillary nodes
Which condition is characterized by sequala from infectious mastitis or periductal mastitis?
Breast abscess
What is the primary cause of lactational mastitis?
Blockage of lactiferous ducts
Which condition requires excisional biopsy including skin if it fails to resolve after 2 weeks or recurs?
Breast abscess
What is the main side effect of aromatase inhibitors in the context of breast cancer treatment?
Fractures
Which medication is recommended for HER2/neu receptor-positive tumors either > 1 cm or if nodes are positive?
Trastuzumab
What is the characteristic skin lesion associated with Paget's disease of the breast?
Scaly and ulcerated skin lesion on the nipple
What is the likely diagnosis when breast cancer presents as axillary metastases with unknown primary?
Occult breast cancer
What is the recommended treatment if cancer is present in Paget's disease of the breast?
Simple mastectomy
What is the primary action of aromatase inhibitors in the treatment of breast cancer?
Block conversion of testosterone to estrogen in the periphery
What is the lifetime risk of ovarian cancer for individuals with BRCA II mutations?
20%
What is the recommended age to start BRCA screening with yearly mammogram and breast MRI?
25
What is the prognosis of tumors that are both progesterone receptor and estrogen receptor positive?
Better prognosis than receptor-negative tumors
Which gene mutation is NOT associated with an increased risk of breast cancer?
NF1
At what age should consideration be given to total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) in BRCA families with a history of breast cancer?
25
What is the recommended age to start yearly pelvic exam + U/S and CA-125 for BRCA screening?
25
Which factor is NOT considered in the considerations for prophylactic mastectomy?
Family history of diabetes
In which stage of breast cancer is distant metastasis present?
Stage IV
What percentage of breast cancers are negative for both estrogen and progesterone receptors?
10%
Which syndrome is associated with an increased risk of breast cancer?
Li-Fraumeni syndrome
Which type of breast cancer has the worst prognosis?
Inflammatory carcinoma
What is the recommended age to start BRCA screening with yearly mammogram and breast MRI for individuals with a family history of breast cancer?
25
Which model calculates the 5 year and lifetime risk of breast cancer using age, race, ethnicity, and other factors?
Gail model
In which group of women should the Gail model not be used for risk assessment?
Women with personal history of breast cancer
What is the approximate median survival for untreated breast cancer?
2-3 years
What is the approximate percentage of breast cancers that have negative mammogram and negative ultrasound?
10%
Which imaging technique is recommended for patients under 40 if the clinical exam or ultrasound is indeterminate or suspicious for breast cancer?
Mammogram
Which imaging techniques are recommended for patients over 40 years old for breast mass workup?
Mammograms and ultrasound
What does FNA provide in the evaluation of breast masses?
Cytology (just the cells)
What does CNBx provide in the evaluation of breast masses?
Architecture (histology)
"Rotter's nodes" are located between which muscles?
"Rotter's nodes" are located between the pectoralis major and pectoralis minor muscles
What is the most common site for distant metastasis in breast cancer?
Bone
Which factor is directly related to the number of positive nodes in breast cancer staging?
Tumor size
What is suggested for high-risk individuals in terms of screening for breast cancer?
Annual mammogram and MRI starting age 25-40
Which of the following is an absolute contraindication to breast-conserving therapy?
Presence of diffuse malignant-appearing microcalcifications
What is the main reason for performing an axillary lymph node dissection (ALND) instead of a sentinel lymph node biopsy (SLNB)?
Higher accuracy in detecting tumor deposits with ALND
What is the exception to requiring a formal ALND after a positive finding on sentinel lymph node biopsy (SLNB)?
Women younger than 18 with early stage tumors and less than 3 positive nodes on SLNB
What is the most common nerve injury after mastectomy?
Intercostal brachiocutaneous nerve injury
What is the recommended margin for surgical margins in lumpectomy without radiation therapy?
1 cm
What is the chemotherapy regimen used for positive nodes regardless of menopausal status?
Taxanes, Adriamycin, and cyclophosphamide (TAC)
What is the main side effect of tamoxifen therapy?
Risk of thromboembolism
What percentage of local recurrence is expected within 2 years after the first operation for breast-conserving therapy without radiation?
10%
What are the absolute contraindications to XRT?
Pregnancy, scleroderma, active SLE, and previous XRT exceeding recommended dose
'No ink on tumor' margins following breast-conserving therapy is a requirement before starting which treatment?
$5,000$ rad radiotherapy (XRT)
What is the first-line neoadjuvant chemotherapy for locally advanced or inflammatory breast cancer to shrink tumor and improve resectability?
TAC (taxanes, Adriamycin, and cyclophosphamide)
Which breast lesion is characterized by a slow-growing, well-circumscribed, painless, firm, and rubbery mass that can enlarge in pregnancy?
Giant fibroadenoma
What is the most common color of the discharge associated with fibrocystic disease?
Brown
Which breast lesion presents as a stellate, irregular, spiculated mass that resembles breast cancer but has a central fibroelastic core with ducts and lobules radiating outward?
Radial scar
What is the most common type of breast cancer worldwide?
Ductal carcinoma in situ (DCIS)
Which type of discharge is considered worrisome for cancer if it is persistent, unilateral, bloody, or spontaneous?
Serous
Which breast lesion has a tightly packed epithelial component with sparse connective tissues and is considered benign?
Tubular fibroadenoma
What is the management approach for a patient with spontaneous nipple discharge, regardless of the color or consistency?
Excisional biopsy of duct area causing the discharge
Which breast lesion has a slightly increased risk of cancer and can be identified by the presence of epithelial calcifications, apocrine hyperplasia/metaplasia, sclerosing adenosis, or cysts larger than 3 cm?
Complex fibroadenoma
Which breast lesion can cause large, coarse calcifications known as 'popcorn lesions' on mammography due to degeneration?
Giant fibroadenoma
This quiz covers the different surgical procedures for breast cancer, including modified radical mastectomy and contraindications to breast-conserving therapy. It also touches on the importance of achieving 'no ink on tumor' margins.
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