Breast

Question 1

Risk factors of breast CA

Answer 1

Family Hx
Hx of prev breas Bx
Hx of LCIS on breast Bx (10x)
Hx of ADH on breast Bx (4x)
Early menarche
Late menopause
BRCA gene mutation

High risk patients may benefit from prophylactic Tamoxifen therapy (50%reduction at 5yrs)

Question 2

Chromosomes BRCA 1 and 2 genes located on

Answer 2

BRCA 1 - 13 — strong association w Ovarian CA
BRCA 2 - 17

Question 3

Route of matastasis for breast CA

Answer 3

Batson’s plexus

Question 4

Her-2 (erb-2) positivity of breast tumor

Answer 4

Increase tumor aggresiveness
–tyrosine kinase for epidermal hrowth factor

HERCEPTIN (monoclonal antibody) - Beneficial

Question 5

Herceptin (Trastuzumab) toxicity

Answer 5

Cardiac toxicity when combined w doxyrubicin and cyclophosphamide

Question 6

Role of p53 in breast CA

Answer 6

Mutation of the tumor suppressor gene results in unrestricted propagation of cells w/ mutated DNA (cancer cells)
– allows overexpression of apoptosis inhibiting oncogenes such as bcl-2 in breast CA

Question 7

Adverse effect of methylene blue and isosulfan

Answer 7

Isosulfan – cause allergic reaction w intraoperative hypotension

Methyline blue – cause skin necrosis if injected intradermally

Question 8

When should screening mammogram obtained?

Answer 8

Starts at age of 40 years every 1 to 2 years and annually after age 50 years

Question 9

Tender
Firm
Cord mass on lateral aspect of breast
Dx?
Tx?

Answer 9

Dx: mordor’s disease - thrombophlebitis of superficial vein on the breast
Tx: NSAIDs

Question 10

Definitive tx of DCIS in breast mass

Answer 10

Lupectomy + RT

Question 11

Tx high grade DCIS in multiple quadrant of breast w/o any invasive carcinoma

Answer 11

Mastectomy w sentinel LN biopsy

Question 12

Sensory innervation of breast

Answer 12

Lateral and Anterior Cutaneous branches of 2nd through 6th intercoastal nerves

Question 13

Location of Rotter’s node

Answer 13

Interpectorial region

Question 14

Tx for subareolar abscess in a 35yo

Answer 14

Needle aspiration
MC cause STAPHYLOCOCCUS

Question 15

LN located behind pectoralis minor muscle

Answer 15

Level II LN

Question 16

Positive supraclavicular LN in breast cancer confer what stage?

Answer 16

Stage IIIC (former stage IV)

Question 17

UTZ: disrupted tissue and fascial planes
Hyperechoic border to the mass
Displacement of surrounding breast tissue

Answer 17

Dx: Invasive breast CA

Question 18

Tumor markers negatively associated withoutcome in breast CA

Answer 18

ER (-)
PR (-)
Her-2 Nu (+)

Question 19

Indication of ductography

Answer 19

Evaluation of bloody nipple discharge

Question 20

MC cause of bloody nipple discharge

Answer 20

Intraductal Papilloma

Question 21

Tx for mammary fistula w recurrent subareolar abscess

Answer 21

Probe-guided fistulectomy

Question 22

Initial diagnostic procedure with palpable breast mass

Answer 22

Fine needle aspiration (FNA)

Question 23

Current technique for localizing nonpalpable breast masses

Answer 23

Mammographic needle localization

Question 24

Treatment for hypercalcemia associated with metastatic breast CA

Answer 24

Calcitonin (inhibits osteoclast)
IV fluid
Lasix
Bisphosphonates (bind hydroxyapetite)

Question 25

Fungal infections affects the breast

Answer 25

Blastomycosis Sporotrichosis

Question 26

Borders of formal axillary dissection

Answer 26

Latissimus dorsi Chest wall Axillary vein Thoracodorsal nerve

Question 27

Nerve innervates the muscle responsible for arm ADDuction

Answer 27

Thoracodorsal nerve Innervates Latissimus dorsi

Question 28

Nerve responsible for sensation of medial aspect of arm

Answer 28

Intercostobrachial

Question 29

Hypoplastic shoulder Amastia Absence of pectoralis muscle

Answer 29

Poland syndrome

Question 30

Management for Mordpr's disease

Answer 30

Salicylates Warm compress Restriction of range of motion Shoulder and brassiere support

Question 31

Side effects of Tamoxifen

Answer 31

Increase Endometrial CA Increase DVT and cataracts Inhibits p450 system -- increase level of Coumadin Ca channel blockers etc

Question 32

Ethiology of skin dimpling in women with breast CA

Answer 32

Glandular fibrosis and shortening of Cooper's ligaments

Question 33

Perimenopausal woman Palpable lumpiness beneath areola Nipple discharge

Answer 33

Ductal ectasia

Question 34

Characteristic gross appearance of a fibroadenoma

Answer 34

Sharp circumscription w smooth boundaries and glistening, white cut surface

Question 35

Most frequently employed hornonal manipulation in patients with breast cancer

Answer 35

Estrogen blockade (Tamoxifen - receptors; Arimidex/Anastazole - synthesis)

Question 36

MC initial site of metastasis in breast CA

Answer 36

Bone

Question 37

Type of breast CA most frequently presents with palpable mass

Answer 37

Infiltrating ductal carcinoma

Question 38

Primary ductal CA presents with Chronic, erythematous Oozing Eczematoid rash Involving nipple and areola

Answer 38

Paget's disease of the breast

Question 39

Tx for Inflammatory breast CA

Answer 39

1. Chemotherapy 2. Surgical excision and XRT *Dermal lymphatic invasion of tumor cells on skin biopsy is diagnostic key for inflammatory breast CA

Question 40

MC primary sarcoma of breast

Answer 40

Cystosarcoma (phyllodes tumor) Tx: wide excision w/o LN biopsy as sarcomas spread hematogenously

Question 41

Woman hx of ovarian CA has increased risk of breast CA T/F

Answer 41

True

Question 42

Tx for patient w/ small localized phyllodes tumor

Answer 42

Local excision w/o LN biopsy

Question 43

Most important prognostic indicatir for recurrent breast CA and metastatic disease in women with breast cancer

Answer 43

Nodal status at time of initial dx

Question 44

Average age of diagnosis of invasive breast CA

Answer 44

60years

Question 45

Distinguishing feature of LCIS

Answer 45

Cytoplasmic mucoid globules

Question 46

MC complications of breast cancer radiation therapies

Answer 46

Skin erythema and desquamatikn Lymphedema after axillary therapy

Question 47

Medical tx of radiation mastitis

Answer 47

Trenal (pentoxifylline)