Breast

Question 1

Patients with ____ classically have symptoms of mastitis that do not improve (or only initially improve)with antibiotics.

Answer 1

inflammatory breast carcinoma

Question 2

Presents with diffuse breast erythema, pain, and edema with skin thickening and dimpling (peau d’orange appearance).

Answer 2

inflammatory breast carcinoma

Question 3

____ is a rapidly aggressive form of breast cancer, and many patients initially have metastatic disease.

Answer 3

Inflammatory breast carcinoma

Question 4

Solitary, well-circumscribed & mobile mass

± Tenderness

Answer 4

Breast cyst

Question 5

Multiple, diffuse nodulocystic masses

Cyclic premenstrual tenderness

Answer 5

Fibrocystic changes

Question 6

Solitary, firm, well-circumscribed & mobile mass

Cyclic premenstrual tenderness

Answer 6

Fibroadenoma

Question 7

After trauma/surgery
Firm, irregular mass
± Ecchymosis, skin/nipple retraction

Answer 7

Fat necrosis

Question 8

Benign papillary tumor arising from breast duct lining

Unilateral bloody nipple discharge (can be non-bloody)

Answer 8

Intraductal papilloma

Question 9

No associated breast mass or lymphadenopathy

Unilateral bloody nipple discharge (can be non-bloody)

Answer 9

Intraductal papilloma

Question 10

Treatment for Intraductal papilloma

Answer 10

Mammography & ultrasound

Biopsy ± excision

Question 11

Most important prognostic factor in breast cancer?

Answer 11

TNM staging

Tumor burden is based on TNM staging

Question 12

Women <30 with complex cyst/mass, recurrent cysts, or solid mass. Next best step in management?

Answer 12

Core Needle Bx

Question 13

Complex cysts seen on Ultrasound.

Next best step in management?

Answer 13

Core Needle Bx

Question 14

Simple cysts seen on U/S. Asymptomatic.

Next best step in management?

Answer 14

Observe

Question 15

Simple cysts seen on U/S. Tender.

Next best step in management?

Answer 15

FNA

Question 16

Persistent or recurrent breast cyst s/p FNA
or
bloody aspirate in aspirate.
Next best step in management?

Answer 16

Core Needle Bx

+/- more imaging

Question 17

Sudden-onset unilateral pelvic pain
Nausea & vomiting
± Palpable adnexal mass
U/S → Enlarged ovary with decreased or absent Doppler flow

Diagnosis & Next best step in management?

Answer 17

Ovarian Torsion

Laparoscopy with detorsion
or
Ovarian cystectomy
Oophorectomy (if necrotic or malignant)

Question 18

Pt with unilateral breast rash, erythema, and edema. Metastatic disease (axillary lymphadenopathy) is common on initial presentation.

Answer 18

Inflammatory breast carcinoma (IBC)

an aggressive breast cancer w/ rapid spread

Question 19

Inflammatory breast carcinoma (IBC) diagnostics to confirm include (2)

Answer 19

Core needle breast biopsy
&
Full-thickness skin punch biopsy

Question 20

1. Unilateral, spontaneous, bloody nipple discharge accompanied by a palpable breast mass and retraction of overlying skin (invasion of suspensory ligaments).
2. Unilateral bloody discharge without a breast mass. No overlying skin retraction

Answer 20

1. Invasive Ductal Carcinoma

2. Intraductal Papilloma

Question 21

Presents with palpable, fluctuant breast mass with purulent nipple discharge and FEVER

Answer 21

Breast abscess

Question 22

Lymphatic drainage from the breast passes primarily to the ___ lymph nodes.

The ____ muscle is the landmark for distinguishing the surgical levels of lymph nodes during dissection.

Answer 22

axillary

pectoralis minor

Question 23

Sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity

+ Pelvic free fluid on u/s

Answer 23

Ruptured ovarian cyst

Question 24

Fever/chills, vaginal discharge, lower abdominal pain & cervical motion tenderness
± Tuboovarian abscess

Answer 24

PID

Question 25

Amenorrhea, abdominal/pelvic pain & vaginal bleedingPositive β-hCG

Answer 25

Ectopic Pregnancy

Question 26

Breast conserving therapy typically consists of partial ___ and ____ biopsy, followed by whole breast ___ therapy.

Answer 26

mastectomy (Lumpectomy)
sentinel lymph node → axillary LN dissection
radiation

• Adequate surgical excision requires negative margins.

Question 27

Positive sentinel lymph node biopsy warrants axillary lymph node dissection
(typically performed for __ positive nodes).

Answer 27

≥3

Question 28

___ is sometimes used for cancer SCREENING in high-risk patients (ex: BRCA carrier).

Answer 28

Breast MRI

Question 29

Patients with bilateral, diffuse, and cyclic breast pain

1. With mass
2. W/o mass

Answer 29

1. Imaging

2. Observe

Question 30

Patients with unilateral, focal, and noncyclic breast pain

1. With mass
2. W/o mass

Answer 30

1. Core needle Biopsy
2. Imaging

to evaluate for cancer.
Abn imaging = CN bx

Question 31

Breast ultrasound is indicated in this patient with ___ breast tissue.

Answer 31

dense breast tissue

no matter the age!

Question 32

BRCA testing is indicated for FMH of breast cancer in __ 1º relatives (parent, sibling, child) & 1 of whom was diagnosed at age ≤ __.

Answer 32

≥2
≤50

*One 2º relative (cousin, aunts, grandparents, nieces, half siblings) with breast cancer diagnosed at age >50 is not an indication