Breast 1

Question 1

US Features of Simple Cyst

Answer 1

avascular
anechoic
oval, or round
posterior enhancement and an imperceptible wall

Question 2

US Features of Complex Cyst

Answer 2

internal echoes or thin septations
thickened or irregular walls
and lack of posterior enhancement

Question 3

patients younger than 30, a palpable mass should be evaluated initially with

Answer 3

ultrasonography, followed by mammography if there is clinical suspicion for malignancy

Question 4

patients 30 years or older

Answer 4

mammography is usually performed first with attention to the palpable area

'’mammography cannot accurately distinguish cysts from solid masses’’

Question 5

Nipple Adenoma

Answer 5

type of intraductal papilloma
benign tumor of the ductal epithelium

'’Diagnosis made by surgical excision’’

Question 6

MRI screening as an adjunct to mammography in women

Answer 6

BRCA mutation
first-degree relative who is a BRCA carrier
prior history of mantle irradiation
a lifetime risk of breast cancer of at least 20 to 25% based

Question 7

multianalyte genetic expression profiles

Answer 7

For a patient with a node negative, hormone receptor positive, HER2 negative breast cancer

to predict outcome and assist in making decisions about adjunct therapy.

Question 8

occult breast cancer

Answer 8

approximately 1% of all breast cancers still present as axillary adenopathy without a known breast primary

MRM OR whole breast radiation with axillary lympadenectomy are equally recommended

Workup Mammo, US , MRI

Question 9

Physiologic, or benign nipple discharge

Answer 9

bilateral
from multiple ducts
provoked,

character of fluid is milky or dark green

due to pregnancy, breastfeeding, medications, or benign hyperplasia and typically does not require workup other than a detailed history and breast examination.

Question 10

Pathologic nipple discharge

Answer 10

unilateral
from a single duct,
typically spontaneous and persistent

character of fluid is serous (clear, yellow, orange) or bloody

caused by papilloma or benign duct ectasia. Malignancy, including ductal carcinoma in situ and invasive ductal carcinoma, is much less frequently encountered

Question 11

pathologic nipple discharge workup

Answer 11

history and physical examination
mammography and ultrasound
‘‘ultrasound is performed even when mammography is normal’’
galactography
Breast MRI

Question 12

Cyclical mastalgia

Answer 12

Hormonal therapies include tamoxifen, bromocriptine, and danazol.

tamoxifen has the fewest side effects and is considered a first-line therapy

Question 13

in BRCA1 or BRCA2, incidence of metachronous contralateral breast cancer

Answer 13

up to 47%

Without BRCA > Less than 10 %

Question 14

Tamoxifen effective in BRCA 1 or 2 ? and Why

Answer 14

effective for BRCA 2 (higher incidence of ER-positive)

tamoxifen reduced breast cancer incidence among BRCA2 patients by 62% but did not reduce breast cancer incidence in patients with BRCA 1 mutations

Question 15

Patient with calcifications involved with (LCIS) treatment vs Incidental LCIS

Answer 15

-Lumpectomy followed by raloxifene (post menopause) or tamoxifen (Pre menopause), NO SLNB

In case incidental finding no need lumpectomy for LCIS but to keep Surveillance Mammo + MRI and may start hormone

Question 16

Cause of nonlactational abscess

Answer 16

can be peripheral or periareolar

periareolar abscesses occur more often in smokers

The cause is related to “squamous metaplasia” or a flattening out of the cells within the terminal ducts beneath the nipple. This is often manifested clinically as a central cleft in the nipple

Question 17

Patient with ADH did excision Bx, then results no Cancer whats next ?

Answer 17

chemoprevention with either raloxifene or tamoxifen would be a risk-reduction strategy.

Given the risk of nearly 30% of a future breast cancer, annual breast MRI could be used for future surveillance.

Question 18

Predictors for breast Abscess Aspiration Failure

Answer 18

-Abscesses greater than 5 cm in size
-chronic or long durations of infection
-multiloculated collections

Question 19

Patient with diagnosed with inflammatory Breast CA then what next before Sx

Answer 19

Staging
CT Brain, Chest , Abdomen and Pelvis

Question 20

when to do Digital breast tomosynthesis (DBT)

Answer 20

recommended when digital mammography shows dense breasts and the patient is at high risk for breast cancer