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Surgery > Breast > Flashcards

Breast Flashcards

1
Q

Breast is a modified

A

Sweat gland

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2
Q

Vertical extent of breast is

A

Between 2nd to 6th rib

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3
Q

Horizontal extent of breast is

A

Sternum to anterior/ mid Axillary line

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4
Q

What is Axillary tail of spence

A

Breast tissue that goes into the axilla.
ST the prominent Axillary tail of spence of mistaken as breast lump.

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5
Q

How many lactiferous duct open into the nipple

A

15-20

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6
Q

Dimpling of skin occurs due to

A

If a cancer involves the suspensory ligament of cooper , it pulls the ligament inside resulting in a dimpling in skin.

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7
Q

What leads to the retraction of a breast

A

If a cancer involves the lactiferous ducts , pulling the nipple inside leads to retraction of the nipple.
Retraction of nipples can be congenital or recent

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8
Q

Recent retraction can be slit (……) or circumferential (…….)

A

Ductal Ectasia OR Malignancy ..

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9
Q

What is Peau d’ orange

A

Skin resembles orange peel due to blockage of subdermal lymphatic.
If present in cancer it is a sign of skin involvement

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10
Q

In Peau d’ orange there is blockage of

A

Subdermal Lymphatics.

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11
Q

what is the most conspicuous sign of malignancy in breast cancer ?

A

Peau d’ orange

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12
Q

What is the functional unit of the breast

A

TDLU (Terminal Duct lobular unit)
Site of origin for major cancer

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13
Q

Lymphatic drainage of breast is by

A

Axillary, lymph node (90%)
internal mammary lymph node (10%)
- from upper and lower quadrant

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14
Q

Surgical division of axillary lymph node

A

By pectoralis minor muscle
Level I : lateral to pectoralis minor
level II : behind pectoralis minor
level III : medial to pectoralis minor

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15
Q

What is the Rotter lymph node?

A

Inter-pectoral lymph node
(between pectoralis major and pectoralis minor. It falls under level II)

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16
Q

Triple assessment of breast include

A

Clinical examination + history + radiological : <40 years : USG ; >40 years mammography
+ histopathology : FNAC , FNNAC , TRU-CUT biopsy

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17
Q

What is the best examination technique

A

Dial clock method

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18
Q

How much radiation is exposed in mammograms

A

(0.1-0.2) cGy radiation is exposed.

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19
Q

What is the latest form of mammography?

A

3D mammography / breast tomosynthesis
More sensitive , Best result in dense breast

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20
Q

Which patient need to start screening by the age of 35 years

A

Strong family history
risk of breast cancer > 20%
(GAIL index : BRCA pro score)

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21
Q

Which patient need to start screening by the age of 25 years

A

BRCA Mutation
First degree relative of patient with BRCA mutation.
MRI is done.
At 30 to 35 years it is switched to mammography. (if MRI is all clear) If breast density is high , MRI will be continued.

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22
Q

What are the mammography findings of benign breast tumor?

A

Well differentiated , hallo surrounding lesion ; macrocalcification

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23
Q

What are the mammography findings of malignant breast tumor?

A

Irregular spiculated lesion
Architectural distortion. lymph nodes Microcalcification

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24
Q

Popcorn, calcification in the breast indicates

A

Fibroadenoma

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25
Q

Lead pipe calcification / egg shell calcification in the breast indicate

A

Fat necrosis (mimics malignancy) secondary to trauma ; resolves with time

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26
Q

Broken needle calcification indicate

A

Duct Ectasia

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27
Q

Teacup calcification indicate

A

Fibrocystic Disease

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28
Q

Order of risk of calcification

A

Cluster > linear > segmental > diffuse

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29
Q

How does lymph node in malignant breast cancer seen on mammogram?

A

Rounded
Loss of hallo and fatty Hilum

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30
Q

How does lymph node in benign breast cancer seen on mammogram?

A

Kidney shaped
Fatty hilum present

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31
Q

What is the investigation of choice in breast implants

A

MRI

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32
Q

Which sign is seen in intracapsular rupture of implant

A

Linguini sign

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33
Q

In USG intracapsular rupture, Seen as

A

Stepladder pattern

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34
Q

In USG Extracapsular rupture, Seen as

A

Snowstorm appearance

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35
Q

Breast conservative surgery is contraindicated in

A

Multicentric malignancy

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36
Q

How many gauge needle is used for FNAC

A

23-30 G
It’s only cytology

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37
Q

FNNAC is done for

A

Superficial lesion(breast and thyroid)

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38
Q

How many gauge needle is used for Tru-Cut biopsy

A

14-16G needle (16G is best)

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39
Q

What is the gold standard investigation for breast lump?

A

Excisional Biopsy

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40
Q

Most common mutated gene in familial cases of breast cancer(10%)

A

BRCAI

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41
Q

Most common mutated gene in sporadic cases of breast cancer(90%)

A

p53

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42
Q

BRCA 1 and BRCA 2 are on chromosome

A

BRCA 1: 17q
BRCA 2 : 13q

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43
Q

BRCA mutation can predispose a patient to

A

HBOC (hereditary breast and ovarian cancer syndrome)

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44
Q

BRCA 1 breast tumor

A

More aggressive
Basal subtype
Poor prognosis
More common histology ; Medullary cx

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45
Q

BRCA 2 breast tumor

A

Luminal subtype
Better prognosis

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46
Q

Best Time to do RRSO

A

After completion of family But before 40 years

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47
Q

Which SERM reduces the risk of breast cancer by 47%

A

Tamoxifen

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48
Q

MC quadrant affected in breast cancer

A

Upper outer quadrant

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49
Q

Least common quadrant affected in breast cancer

A

Lower Inner quadrant

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50
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma (IDC)
Not otherwise specific (NOS)

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51
Q

Which type of Ductal carcinoma has the best prognosis

A

Tubular

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52
Q

Which type of Ductal carcinoma has the worst prognosis

A

Medullary (BRCA1 mutation)

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53
Q

E-cadherin mutation is seen in

A

Invasive lobular Carcinoma (ILC)
Single file pattern

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54
Q

IOC for diagnosis of breast cancer

A

Tru-Cut biopsy

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55
Q

yTNM staging means

A

After neoadjuvant therapy

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56
Q

Lobular carcinoma in situ is considered as

A

Benign condition

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57
Q

Most common site of distant metastasis

A

Bone

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58
Q

Most common bone involved in distant metastasis

A

Vertebral column (Batson’s plexus)

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59
Q

Most common vertebrae involved in distant metastasis

A

Lumbar > Thoracic

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60
Q

Most common type of metastasis in breast cancer

A

Osteolytic > Osteoblastic

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61
Q

What is oncoplasty?

A

It combines principles of cancer surgery and plastic surgery

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62
Q

Most difficult area of breast , where oncoplasty is done is

A

Upper inner quadrant , as there very little breast tissue available here
AKA no Man’s zone

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63
Q

Upper inner quadrant is AKA

A

No man’s zone

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64
Q

During lumpectomy the mass is removed with the

A

Pectoral fascia

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65
Q

Radical mastectomy involves removal of

A

Breast plus nipple areoles complex/NAC + pectoralis major + pectoralis minor + level 1,2,3 Axillary lymph node

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66
Q

Which incision is made in MRM

A

Elliptical stewart incision

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67
Q

MRM involves

A

The removal of breast + NAC + Pectoralis fascia + level 1,2,3 Axillary lymph node ;;; (+—)pectoralis minor

68
Q

In Auchincloss method pectoralis minor is

A

Only retracted

69
Q

In Scanlon and Patey method P. Minor is

A

Cut

70
Q

Simple, mastectomy involves

A

Removal of breast + NAC + pectoralis fascia, but lymph nodes not removed

71
Q

Boundaries of axillary dissection

A

Axillary vein : superior boundary
Thoracodorsal pedicle supplying the latissimus dorsi muscle : lateral boundary
Angular vein : inferior boundary
Halsted ligament : medial boundary 

72
Q

Structures save during MRM are

A

Axillary vein
Thoracodorsal pedicle
Long thoracic nerve
P.Major +- P. Minor
Lateral and medial pectoral nerve

73
Q

Most common nerve injury during MRM is

A

ICBN / intercostobrachial nerve
Patient complains of altered sensation over axilla and arm

74
Q

Which nerve injury during MRM will lead to winging of scapula

A

Long thoracic nerve / nerve of bell / nerve to serratus anterior

75
Q

Which nerve injury can lead to weakness of latissimus dorsi muscle

A

Thoracodorsal nerve injury

76
Q

Lateral and medial pectoral, nerve injury can lead to weakness of

A

Pectoralis major/pectoralis minor

77
Q

What is the most common complication of MRM?

A

Seroma formation / collection of fluid beneath the flap

78
Q

Management of lymphedema includes

A

Lymphedema exercises
Arm stalking
Arm Elevation
Pneumatic compression stocking/lymphopress

79
Q

What is Stewart Trave’s syndrome?

A

It can develop in long-standing lymphedema, which last for more than 8 to 10 years. The patient presents with bluish/reddish nodules over the upper limb called angiosarcoma/ lymphangiosarcoma.

80
Q

Management of angiosarcoma in Stewart Treve’s syndrome

A

Forequarter amputation/disarticulating upper limb with scapula.
Poor prognosis

81
Q

What is cancer en cuirasse

A

In some cases, the recurrence will be scattered/diffuse all over the chest wall.

82
Q

What is Phantom breast syndrome?

A

Occurs due to ICBN neuralgia
Patient complains of pain in the breast and sometimes feels as if the breast tissue is still there。

83
Q

Best flap for reconstruction

A

DIEP flap/ deep inferior epigastric artery perforator flap

84
Q

Which is the most commonly used flap

A

TRAM flap / transverse rectus abdominous myocutaneous flap

85
Q

Which is the first draining lymph node from breast cancer

A

Sentinel/guardian lymph node 

86
Q

What is the most common complication of blue dye technique?

A

Skin tattooing

87
Q

What is the best technique for sentinel lymph node biopsy

A

Blue dye + radionucleotide

88
Q

What is the most common nerve injury complication of sentinel lymph node biopsy?

A

ICBN injury

89
Q

Chemotherapy indication in breast cancer are

A

Positive lymph nodes
locally advanced breast cancer
ER , PR negative tumor
HER 2 neu positive tumors

90
Q

Chemotherapy regimes CAF is

A

Cyclophosphamide
Adriamycin
F 5- fluorouracil

91
Q

Chemotherapy regimes CMF is

A

Cyclophosphamide
Methotrexate
F 5- fluorouracil

92
Q

SE of Cyclophosphamide is

A

 Hemorrhagic cystitis

93
Q

Which metabolic gives rise to hemorrhaging cystitis

A

Acrolin

94
Q

The preventive agent of hemorrhaging cystitis is known as

A

Mesna

95
Q

Adriamycin leads to do which side effect

A

Dilated cardiomyopathy

96
Q

These days we follow which chemotherapy regimen

A

AC followed by T/EC followed by T
Adriamycin
Cyclophosphamide
Epirubicin
Taxanes: Docetaxel , Paclitaxel

97
Q

What is the side effect of paclitaxel?

A

Neuropathy

98
Q

What is Pertuzumab/perjecta?

A

Newer HER 2 neu directed medicine.
A combination of pertuzumab + trastuzumab gives a better response than only trastuzumab.

99
Q

What are the indications of radiotherapy in breast cancer?

A

Positive lymph nodes
Tumor>5cm
Locally advanced breast carcinoma
After BCS 

100
Q

What are the criteria for APBI?

A

50 years or more
T1 Disease.
No lymphovascular invasion / LVI
ER POSITIVE DISEASE
Unifocal tumors

101
Q

Hormonal therapy used in patients with

A

ER , PR positive patients 

102
Q

What are the two sources of estrogen in Peri menopausal woman?

A

Ovary and peripheral conversion

103
Q

Which SERM is used as hormonal therapy in premenopausal women .

A

Tamoxifen (most common)
Dose : 20mg/day

104
Q

What kind of agent used as hormonal therapy in postmenopausal woman?

A

Aromatase inhibitor
Letrozole
anastrozole
exemestane

105
Q

If patient is HER2 neu positive……Will be added

A

Herceptin

106
Q

Which investigation is made to confirm the diagnosis of pregnancy associated breast cancer

A

imaging investigation of choice is ultrasound, but and core needle biopsy /tru cut biopsy is done to confirm the diagnosis

107
Q

What is Ductal carcinoma in situ type of breast cancer?

A

These are carcinoma, which have not invaded the basement membrane 

108
Q

Most common type of DCIS

A

Papillary

109
Q

Which is the most aggressive type of DCIS

A

Comedo

110
Q

Which prognostic index is used in DCIS

A

Van Nyus Prognostic index

111
Q

What to do if HER2neu is 2+

A

 We must do FISH/ fluorescent in situ hybridization before giving Herceptin (transtuzumab)

112
Q

Most common organism responsible for lactational breast abscess

A

Staphylococcus aureus

113
Q

Which surgery is performed in breast abscess associated with the duct ectasia

A

Hadfield’s procedure

114
Q

Which antibiotics are given in lactarional breast abscess

A

Amoxycillin + Clavulinic Acid (or) Cloxacillin

115
Q

Which drug is given to suppress lactation

A

Cabergolin

116
Q

Most common ANDI in 15 to 25 years of patient

A

Fibroadenoma

117
Q

Most common ANDI in 25 to 40 years of patient

A

Fibrocystic disease

118
Q

Most common ANDI in >40 years of patient

A

Fibrocystic disease

119
Q

What is the most common cause of breast lump?

A

Fibroadenoma
Age group (15-25) years

120
Q

what is seen On the mammogram of Fibroadenoma

A

Pop corm calcification

121
Q

Infra mammary incision is known as

A

Gillard Thomas incision

122
Q

Which gauge needle is use in mammotome

A

8G needle

123
Q

Phyllodes tumor is known as

A

Cystosarcoma phyllodes
(FNAC has no role)

124
Q

Most common site of Metastasis of phyllodes tumor

A

Lungs

125
Q

Recurrence is very common in which surgery of phyllodes

A

Lumpectomy ( wide local excision)

126
Q

Cause of non cyclical mastalgia

A

Tietze syndrome(costochondritis)
Rx : intralesional triamcinolone

127
Q

What is mondor’s structure

A

Superficial thrombophlebitis of chest vein

128
Q

Most common vein involved in mondor’s disease Is

A

Lateral Thoracic vein
Treatment: Analgesics

129
Q

Most common cause of bloody nipple discharge

A

Duct papilloma

130
Q

Management of duct papilloma

A

Microdochectomy — Tennis Racquet incision. Single duct and lump excised.

131
Q

What is the most common cause of pathological nipple discharge?

A

Multiple duct ectasia

132
Q

Periductal mastitis is AKA

A

Zuska’s disease

133
Q

What is the management of Duct ectasia ?

A

Antibiotics
If the conditions persist Hadfield procedure is done (cone excision of multiple ducts)

134
Q

What is a common site of accessory breast tissue?

A

Egg Zila 

135
Q

What is Poland syndrome ?

A

Anastia with Absence of breast tissue
Absence of unilateral pectoralis major and breast tissue

136
Q

What is polythelia

A

Accessory nipples

137
Q

What is Athelia

A

Absences of nipples

138
Q

Distance between two nipples in breast reduction

A

19-21 cm

139
Q

Why do we have to perform breast reduction surgery?

A

For breast hypertrophy

140
Q

Drug induced cause of gynecomastia

A

DISCO
Digoxin
INH (isoniazid)
Spironolactone, steroids
Cimetidine , K = ketoconazole
Oestrogen

141
Q

Most common cause of greenish nipple discharge

A

Duct Extasia

142
Q

Which cancer in women is represented as bilateral and multicentric breast lumps

A

LCIS

143
Q

What is the most common cause of blood stained nipple discharge from a single duct?

A

Ductal papilloma

144
Q

What is the most common cause of blood stained nipple discharge from a multiple duct?

A

Carcinoma

145
Q

Which gene mutation are associated with triple negative tumor

A

tP53

146
Q

ER negative HER2 negative (triple negative) molecular subtype commonly involves the following hydrological subtype

A

Medullary
Adenoid cystic
Secretory
Metaplastic
Spindle cell
Squamous
Matrix producing

147
Q

ER positive HER2-negative status on immunohistochemisty is suggestive of

A

Luminal Type of breast carcinoma

148
Q

ER positive HER2-negative molecular subtype (luminal type) commonly includes the following histological subtype

A

Well and poorly differentiated lobular carcinoma
Tubular carcinoma
Mucinous carcinoma
Papillary carcinoma

149
Q

BRCA 1 and BRCA 2 are

A

Tumor suppressor genes

150
Q

BRCA 1 is located on chromosome

A

17

151
Q

BRCA 2 is located on chromosome

A

13

152
Q

Athelia and amastia refers to

A

Athelia : absence of nipples
Amastia : congenital absence of the breast and nipple.

153
Q

Amazia is

A

Breast tissue is absent but NAC is present

154
Q

Tietze’s syndrome

A

Is a benign inflammation of one or more costal cartilage

155
Q

What is zuska disease

A

It is the subcutaneous abscess of the breast tissue beneath the areola of nipple. Aka subareolar accesses

156
Q

Stewart Trevert syndrome

A

It is characterized by lymph angiosarcoma in chronic long-standing lymphedema following mastectomy

157
Q

Most common variant of breast carcinoma

A

Invasive Ductal carcinoma AKA Infiltrating Ductal carcinoma

158
Q

Which type of breast cancer is most common in males

A

Infiltrating, ductal carcinoma

159
Q

Bilateral and multicentric breast lump are associated with

A

Lobular carcinoma, in situ

160
Q

Most common, and most sensitive malignant finding on USG

A

Lump will be taller than wider

161
Q

Most specific finding of malignancy on USG

A

Central Vascularity

162
Q

Which signs are specific for intra capsular receptor of breast implants

A

Linguine sign ;on MRI
Stepladder sign : on USG

163
Q

Tis classification is used for the staging off

A

Ductal carcinoma in situ(DCIS)
Paget’s disease

164
Q

Indication for surgery in fibroadenoma

A
  1. Size >3 cm
  2. Multiple
  3. Giant type
  4. Recurrence
  5. Cosmesis
  6. Complex type
165
Q

what do you know about breast mouse (Fibroadenoma)

A

• Fibroadenoma aka Breast mouse is the most common benign tumor of breast.
• It is MC seen in young age group females (15-30 yrs)
• Clinically, it is slow growing, painless solitary mass, which is mobile in nature (that’s why known as breast mouse).
• IOC: FNAC
• Upon mammography: Popcorn calcification

Surgery (30 decks)

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