24 Breast ANATOMY AND PHYSIOLOGY
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Questions and Answers

Which hormone is responsible for the maturation of glandular tissue in the breast?

  • Prolactin
  • FSH
  • Estrogen
  • Progesterone (correct)

    • Which nerve innervates the serratus anterior muscle and can result in winged scapula if injured?

  • Medial pectoral nerve
  • Long thoracic nerve (correct)
  • Thoracodorsal nerve
  • Lateral pectoral nerve

    • After menopause, which hormones' lack results in atrophy of breast tissue?

  • Prolactin
  • Progesterone
  • FSH
  • Estrogen (correct)

    • Which artery supplies the latissimus dorsi muscle and can result in weak arm pull-ups if injured?

    <p>Thoracodorsal artery</p> Signup and view all the answers

    Which hormone synergizes with estrogen and progesterone in breast development?

    <p>Prolactin</p> Signup and view all the answers

    Which nerve provides sensation to the medial arm and axilla and is most commonly injured during axillary dissection?

    <p>Intercostobrachial nerve</p> Signup and view all the answers

    Which condition typically presents with noncyclical mastodynia, erythema, and nipple retraction?

    <p>Periductal mastitis</p> Signup and view all the answers

    What is the most common cause of bloody nipple discharge?

    <p>Intraductal papilloma</p> Signup and view all the answers

    Which condition is characterized by superficial vein thrombophlebitis of the breast, often associated with trauma and strenuous exercise?

    <p>Mondor’s disease</p> Signup and view all the answers

    What is the primary cause of neonatal breast enlargement?

    <p>Circulating maternal estrogens</p> Signup and view all the answers

    Which condition is characterized by breast cysts filled with milk and may occur during breastfeeding?

    <p>Galactocele</p> Signup and view all the answers

    What is a major neurovascular structure to be preserved in an axillary dissection to prevent direct hematogenous metastasis of breast cancer to the spine?

    <p>Batson’s plexus</p> Signup and view all the answers

    Which condition can be associated with increased prolactin levels and amenorrhea?

    <p>Galactorrhea</p> Signup and view all the answers

    In which condition are accessory nipples most commonly found?

    <p>Axilla</p> Signup and view all the answers

    What is the most common lymphatic drainage pathway for breast tissue?

    <p>Axillary nodes</p> Signup and view all the answers

    Which condition is characterized by sequala from infectious mastitis or periductal mastitis?

    <p>Breast abscess</p> Signup and view all the answers

    What is the primary cause of lactational mastitis?

    <p>Blockage of lactiferous ducts</p> Signup and view all the answers

    Which condition requires excisional biopsy including skin if it fails to resolve after 2 weeks or recurs?

    <p>Breast abscess</p> Signup and view all the answers

    What is the main side effect of aromatase inhibitors in the context of breast cancer treatment?

    <p>Fractures</p> Signup and view all the answers

    Which medication is recommended for HER2/neu receptor-positive tumors either > 1 cm or if nodes are positive?

    <p>Trastuzumab</p> Signup and view all the answers

    What is the characteristic skin lesion associated with Paget's disease of the breast?

    <p>Scaly and ulcerated skin lesion on the nipple</p> Signup and view all the answers

    What is the likely diagnosis when breast cancer presents as axillary metastases with unknown primary?

    <p>Occult breast cancer</p> Signup and view all the answers

    What is the recommended treatment if cancer is present in Paget's disease of the breast?

    <p>Simple mastectomy</p> Signup and view all the answers

    What is the primary action of aromatase inhibitors in the treatment of breast cancer?

    <p>Block conversion of testosterone to estrogen in the periphery</p> Signup and view all the answers

    What is the lifetime risk of ovarian cancer for individuals with BRCA II mutations?

    <p>20%</p> Signup and view all the answers

    What is the recommended age to start BRCA screening with yearly mammogram and breast MRI?

    <p>25</p> Signup and view all the answers

    What is the prognosis of tumors that are both progesterone receptor and estrogen receptor positive?

    <p>Better prognosis than receptor-negative tumors</p> Signup and view all the answers

    Which gene mutation is NOT associated with an increased risk of breast cancer?

    <p>NF1</p> Signup and view all the answers

    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?

    <p>25</p> Signup and view all the answers

    What is the recommended age to start yearly pelvic exam + U/S and CA-125 for BRCA screening?

    <p>25</p> Signup and view all the answers

    Which factor is NOT considered in the considerations for prophylactic mastectomy?

    <p>Family history of diabetes</p> Signup and view all the answers

    In which stage of breast cancer is distant metastasis present?

    <p>Stage IV</p> Signup and view all the answers

    What percentage of breast cancers are negative for both estrogen and progesterone receptors?

    <p>10%</p> Signup and view all the answers

    Which syndrome is associated with an increased risk of breast cancer?

    <p>Li-Fraumeni syndrome</p> Signup and view all the answers

    Which type of breast cancer has the worst prognosis?

    <p>Inflammatory carcinoma</p> Signup and view all the answers

    What is the recommended age to start BRCA screening with yearly mammogram and breast MRI for individuals with a family history of breast cancer?

    <p>25</p> Signup and view all the answers

    Which model calculates the 5 year and lifetime risk of breast cancer using age, race, ethnicity, and other factors?

    <p>Gail model</p> Signup and view all the answers

    In which group of women should the Gail model not be used for risk assessment?

    <p>Women with personal history of breast cancer</p> Signup and view all the answers

    What is the approximate median survival for untreated breast cancer?

    <p>2-3 years</p> Signup and view all the answers

    What is the approximate percentage of breast cancers that have negative mammogram and negative ultrasound?

    <p>10%</p> Signup and view all the answers

    Which imaging technique is recommended for patients under 40 if the clinical exam or ultrasound is indeterminate or suspicious for breast cancer?

    <p>Mammogram</p> Signup and view all the answers

    Which imaging techniques are recommended for patients over 40 years old for breast mass workup?

    <p>Mammograms and ultrasound</p> Signup and view all the answers

    What does FNA provide in the evaluation of breast masses?

    <p>Cytology (just the cells)</p> Signup and view all the answers

    What does CNBx provide in the evaluation of breast masses?

    <p>Architecture (histology)</p> Signup and view all the answers

    "Rotter's nodes" are located between which muscles?

    <p>&quot;Rotter's nodes&quot; are located between the pectoralis major and pectoralis minor muscles</p> Signup and view all the answers

    What is the most common site for distant metastasis in breast cancer?

    <p>Bone</p> Signup and view all the answers

    Which factor is directly related to the number of positive nodes in breast cancer staging?

    <p>Tumor size</p> Signup and view all the answers

    What is suggested for high-risk individuals in terms of screening for breast cancer?

    <p>Annual mammogram and MRI starting age 25-40</p> Signup and view all the answers

    Which of the following is an absolute contraindication to breast-conserving therapy?

    <p>Presence of diffuse malignant-appearing microcalcifications</p> Signup and view all the answers

    What is the main reason for performing an axillary lymph node dissection (ALND) instead of a sentinel lymph node biopsy (SLNB)?

    <p>Higher accuracy in detecting tumor deposits with ALND</p> Signup and view all the answers

    What is the exception to requiring a formal ALND after a positive finding on sentinel lymph node biopsy (SLNB)?

    <p>Women younger than 18 with early stage tumors and less than 3 positive nodes on SLNB</p> Signup and view all the answers

    What is the most common nerve injury after mastectomy?

    <p>Intercostal brachiocutaneous nerve injury</p> Signup and view all the answers

    What is the recommended margin for surgical margins in lumpectomy without radiation therapy?

    <p>1 cm</p> Signup and view all the answers

    What is the chemotherapy regimen used for positive nodes regardless of menopausal status?

    <p>Taxanes, Adriamycin, and cyclophosphamide (TAC)</p> Signup and view all the answers

    What is the main side effect of tamoxifen therapy?

    <p>Risk of thromboembolism</p> Signup and view all the answers

    What percentage of local recurrence is expected within 2 years after the first operation for breast-conserving therapy without radiation?

    <p>10%</p> Signup and view all the answers

    What are the absolute contraindications to XRT?

    <p>Pregnancy, scleroderma, active SLE, and previous XRT exceeding recommended dose</p> Signup and view all the answers

    'No ink on tumor' margins following breast-conserving therapy is a requirement before starting which treatment?

    <p>$5,000$ rad radiotherapy (XRT)</p> Signup and view all the answers

    What is the first-line neoadjuvant chemotherapy for locally advanced or inflammatory breast cancer to shrink tumor and improve resectability?

    <p>TAC (taxanes, Adriamycin, and cyclophosphamide)</p> Signup and view all the answers

    Which breast lesion is characterized by a slow-growing, well-circumscribed, painless, firm, and rubbery mass that can enlarge in pregnancy?

    <p>Giant fibroadenoma</p> Signup and view all the answers

    What is the most common color of the discharge associated with fibrocystic disease?

    <p>Brown</p> Signup and view all the answers

    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?

    <p>Radial scar</p> Signup and view all the answers

    What is the most common type of breast cancer worldwide?

    <p>Ductal carcinoma in situ (DCIS)</p> Signup and view all the answers

    Which type of discharge is considered worrisome for cancer if it is persistent, unilateral, bloody, or spontaneous?

    <p>Serous</p> Signup and view all the answers

    Which breast lesion has a tightly packed epithelial component with sparse connective tissues and is considered benign?

    <p>Tubular fibroadenoma</p> Signup and view all the answers

    What is the management approach for a patient with spontaneous nipple discharge, regardless of the color or consistency?

    <p>Excisional biopsy of duct area causing the discharge</p> Signup and view all the answers

    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?

    <p>Complex fibroadenoma</p> Signup and view all the answers

    Which breast lesion can cause large, coarse calcifications known as 'popcorn lesions' on mammography due to degeneration?

    <p>Giant fibroadenoma</p> Signup and view all the answers

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