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MRCS A(My Own) > BREAST > Flashcards

BREAST Flashcards

1
Q

Polymastia in which syndromes

A

Turner
Fleisch3r syndrome

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2
Q

Polymastia vs polythelia

A

M: Multiple breast tissue
T: Multiple Nipples

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3
Q

Axillary tail of spence passes through

A

Foramen of Langer

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4
Q

Floe of milk

A

Lobule»Terminal duct»Segmental duct»lactiferous sinus»lacti duct

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5
Q

Role of estrogen vs proges in breast development

A

E helps in development of ducts
P helps in development of lobules

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6
Q

Breast Ca spreads to brain through

A

Posterior intercostal veins
It drains into paravertebral»Batson»epidural sinus/ Lumbar vertebrae

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7
Q

Batson Venous Plexus

A

Breast Ca metastasize to dura and lumbar vertebrae through this route.

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8
Q

Level of axillary lymph nodes

A

There are three surgical levels of axillary lymph nodes:
level I: below the lower edge of the pectoralis minor muscle.
level II: underneath/posterior the pectoralis minor muscle.
level III: above/medial the pectoralis minor muscle.

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9
Q

Level of axillary lymph nodes is described by which muscle

A

Pectoralis Minor

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10
Q

Level 1 axillary lymph nodes

A

Anterior axillary lymph nodes
Posterior
Lateral

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11
Q

Level 2 axillary lymph nodes

A

Central axillary
Rotter axillary between pectoralis major and minor muscle

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12
Q

Level 3 axillary lymph nodes

A

Apical axillary nodes

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13
Q

Nerve damag3 during breast surgery

A

Long thoracic
Thoracodorsal
Intercostobrachial

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14
Q

If sensation lost of medial side of arm during breast surgery th3n which nerve damage

A

Intercostobrachial nerve

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15
Q

Supply of breast

A

anterior and lateral cutaneous branches of the 4th to 6th intercostal nerves.

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16
Q

Nipple and areola drains into

A

subareolar lymphatic plexus.

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17
Q

Br3ast lymphatic nodes clearance

A

the axillary nodes (75%),
parasternal nodes (20%) and
posterior intercostal nodes (5%).

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18
Q

Adjuvant radiotherapy criteria

A

Adjuvant radiotherapy is offered to all patients after WLE and in post-mastectomy cases with positive resection margins, tumour size >5cm, or 4 or more pathological nodes in axilla.

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19
Q

Side effects of Herceptin (Trastuzumab

A

Cardiotoxicity

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20
Q

which Kind of flap can be used only for small breasts

A

Latissimus Dorsi flap

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21
Q

Typesof Oncoplastic Management

A

mammoplasty
flap formation

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22
Q

Hormanal therapy in pre and post menopausal women

A

Tamoxifen in pre
HerCeptin (T(Trastuzumab) in post

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23
Q

Perform Radical mastectomy only when

A

Underlying muscles are involved

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24
Q

If any implant rupture related problem
Which test to do

A

MRI

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25
Q

U/S age limit

A

<35 years old

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26
Q

straw coloured fluid after surgery

A

Seroma

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27
Q

In which syndrome gynecomastia is present

A

Kallman’s,
Klinefelter’s

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28
Q

Most common drug cause of gynecomastia

A

spironolactone

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29
Q

Mnemonic for causes of gynaecomastia

A

METOCLOPRAMIDE

M etoclopramide
E ctopic oestrogen
T rauma skull/tumour breast, testes
O rchitis
C imetidine, Cushings
L iver cirrhosis
O besity
P araplegia
R A
A cromegaly
M ethyldopa
I soniazid
D igoxin
E thionamide

30
Q

If creamy discharge from breast during involution period then diagnosis will be

A

Duct ectasia

31
Q

Which breast diseases is Strongly associated with smoking

A

Periductal mastitis

32
Q

Most common cause of mastitis

A

S. Aureus

33
Q

Mass develops behind nipple vs around nipple

A

Duct ectasia
Periductal mastitis

34
Q

Diagnosis of breast abscess

A

USS

35
Q

1st line Rx of breast abdcess

A

USS Drainage of abscess

36
Q

A combination of nipple discharge, gynaecomastia and poor vision

A

Prolactinoma

37
Q

MC type of breast carcinoma

A

Invasive ductal carcinomasare the most common type

38
Q

From which structure invasive carcinoma of breast

A

terminal duct lobular unit

39
Q

The Nottingham Prognostic Index (NPI)*

A

Widely used clinicopathological staging system for primary breast cancer prognosis. It is calculated by:

(Size x 0.2) + Nodal Status + Grade

Size is the diameter of the lesion in cm, nodal status is number of axillary lymph nodes involved (0 nodes=1, 1-4 nodes=2, >4 nodes=3), and grade is based on Bloom-Richardson classification

40
Q

Soft, easily moveable ,grey, gelatinous surface of a breast tumor

A

Mucinous carcinoma of breast

41
Q

Nottingham Prognostic Index

A

Tumour Size x 0.2 + Lymph node score+Grade score

42
Q

Survival is 50% if NPI is

A

> 5.4

43
Q

DCIS with Paget is associated with

A

larger tumour size, higher grade, less ER/PR receptor positivity and higher rates of HER2 positivity

44
Q

Histology of paget disease

A

large pale paget cells would be seen in the epidermis and IHC for CEA would likely be positive.

45
Q

ER/PR and HER2 status of paget disease

A

Only half are ER/PR positive and over 90% are HER2 positive inferring poor prognosis

46
Q

Two theories of paget disease

A
  1. Epidermatropic
  2. Transformation
47
Q

IHC for CEA is positive in which breast diseas

A

Paget

48
Q

Paget vs eczema

A

Paget’s disease can be differentiated from eczema on the basis that the former always affects the nipple and only involves the areola as a secondary event, whilst eczema nearly always only involves the areola and spares the nipple.

49
Q

NPI good prognostic vs bad

A

<2.4 is good
>5 is bad

50
Q

Risk of metastasis to the contralateral breast is a classical feature of

A

Invasive lobular carcinoma

51
Q

If suspected invasive lobular and breast conserving surgery has to be done then what test to perform

A

MRI

52
Q

Atypical epithelial hyperplasia is associated with

A

Increased risk of breast Ca

53
Q

Hormonal effect of ER and PR on breast Ca

A

Chances of breast carcinoma increases with over exposure to estrogen and under exposure to progesterone

54
Q

Age time period of ductal versus lobular

A

Ductal in both pre and post menopausal
Lobular only in pre

55
Q

Features of LCIS

A

Multifocal
No palpable lump
Diffuse
Difficult to diagnose
Bilateral distribution

56
Q

How paget disease is differentiated from Eczema

A

Eczema is
Bilateral
Does not destroy nipple and
Is not associated with an underlying lump

57
Q

Metasysis of breast tumor occurs to which organs

A

Lung bone liver and brain
occurs by blood

58
Q

Types of breast tissue on macroscopic appearance

A

Scirrhous
Medullary
Mucinous

59
Q

Schirrous type macroscopic appearance of breast

A

Dense
White
Grates when cut like unripe pear

60
Q

Over expression of which receptors indicates bad prognosis

A

C-erbB-2/HER-2

61
Q

Rare tumors of breast

A

Medullary
Tubular
Mucinous
Papillary

62
Q

Phyllodes tumor

A

Mean age is 45
Can become very large
Recurrence is an issue

63
Q

Major types of DCIS

A

comedo, cribriform, micropapillary, papillary, and solid types

64
Q

Blood stained benign nipple discharge

A

Intraductal papilloma

65
Q

Drugs for high risk females with breast Ca

A

Pre meno : Tamoxifen
Postmeno: Anastrozole
Don’t give for more than 5 years

66
Q

Comedo necrosis is a feature of

A

high nuclear grade ductal carcinoma in situ

67
Q

Women wish to avoid breast prosthesis
What to do

A

offer TRAM or DIEP flaps.

68
Q

Mastectomy vs Wide Local Excision criteria

A

Multifocal tumour Solitary lesion
Central tumour Peripheral tumour
Large lesion in small breast Small lesion in large breast
DCIS >4cm DCIS <4cm
Patient Choice Patient choice

69
Q

Mastectomy vs wide local excision on basis of DCIS

A

If >4cm then perform mastectomy

70
Q

5 years Survival according to NPI for breast Ca

A

2 to 2.4&raquo_space;95%
2.5 to 3.4» 85%
3.5 to 5.4&raquo_space; 70%
>5.4&raquo_space; 40%

71
Q

FEC (Fluorouracil, epirubicin and cyclophosphamide) Regime usually given for breast Ca what to give when high risk tumors

A

docetaxal, doxorubicin and cyclophosphamide

MRCS A(My Own) (28 decks)

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