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SRGRY3 > BRST 2 > Flashcards

BRST 2 Flashcards

1
Q

Dose delivered by conventional mammography

A

0.1cGy

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2
Q

What mammographic view shows the greatest volume of breast tissue?

A

MLO view

mediolateral oblique

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3
Q

What is the advantage of CC

(craniocaudal) view?

A

provides better visualization of the medial aspect of the breast and permits greater breast compression

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4
Q

Specific mammographic features that suggest a diagnosis of breast cancer (3)

A

Solid mass with or without stellate features
Asymmetric thickening of breast tissues
Clustered microcalcifications

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5
Q

NCCN guideline for breast exam for normal-risk women >=20 years

A

Breast exam at least every 3 years

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6
Q

NCCN guidelines for breast exam/mammogram at age 40 years

A

yearly breast exam and mammogram

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7
Q

Primary indication for ductography

A

nipple discharge

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8
Q

Breast Ultrasound does not reliably detect breast lesions of this size

A

<= 1 cm in diameter

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9
Q

Who among the following patients will benefit from Breast MRI in characterizing mammographic findings

a. 30 y.o female, no family history of breast cancer, 2cm palpable mass
b. 25 y.o. female, strong family history of breast cancer, nulliparous, early menarche, obese
c. 40 y.o. female, newly diagnosed Invasive carcinoma of the breast
d. A and B
e. B and C

A

E

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10
Q

Clinical determination of axillary lymph node metastases has an accuracy of only

A

33%

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11
Q

True of axillary lymph node disease EXCEPT

a. The number of axillary lymph nodes involved with metastatic disease is one of the most important predictors of 10- and 20 year survival
b. The internal mammary node or a low axillary node when positive alone carried the same prognostic weight
c. Drainage to the internal mammary nodes is more frequent with lateral quadran cancers
d. NOTA

A

C

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12
Q

In postmenopausal women, hormone replacement therapy consisting of estrogen plus progesterone increases the risk of breast cancer by _____

A

26%

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13
Q

Tumors positive for ER and PR have a response rate to estrogen therapy of

A

> 50%

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14
Q

Tumors negative for both er/pr have a response rate to estrogen therapy of

A

10%

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15
Q

Tumors positive for either estrogen or progesterone receptors have a response rate to estrogen therapy of

A

33%

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16
Q

True about HER2/neu receptor positivity

a. associated with mutated p53, ki67 overexpression, ER negativity
b. An important prognostic and predictive factor in breast cancer
c. the receptor Promotes growth and proliferation and increases invasive and metastatic capabilites
d. correlated with a more aggressive type of cancer
e. NOTA
f. AOTA

A

F

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17
Q

GIve 2 indices of proliferation of breast cancer

A

Ki67

PCNA

18
Q

Her2/neu receptor: Trastuzumab as VEGF receptor:______

A

Bevacizumab

19
Q

Patients not suitable or sentinel lymph node (SLN)
biopsy include all o the following EXCEPT
A. Inflammatory carcinoma o the breast.
B. Prior axillary surgery.
C. Biopsy-proven distant metastases.
D. Lower inner quadrant o breast primary carcinoma.
E. Pregnancy

A

D and E

20
Q

The following are prognostic and predictive tumor factors for invasive breast cancer EXCEPT

a. Nodal status
b. Tumor size
c. Vascular invasion
d. Hormone receptor status
e. AOTA
f. NOTA

A

F

nodal status
tumor size
histologic/nuclear grade
lymphatic/vascular invasion
pathologic stage
hormone receptor status
DNA content
Extent of intraductal component
Her-2/neu expression
21
Q

The following are prognostic and predictive Host factors for invasive breast cancer EXCEPT

a. Age
b. menopausal status
c. Previous benign breast mass
d. Nutrition
e. Immunosuppression
f. AOTA
g. NOTA

A

C

Age manopausal status
family history
previous breast cancer
immunosuppression
Nutrition
Prior chemotherapy
Prior radiation therapy
22
Q

diagnostic studies for breast cancer patients Stage 0

a. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status
b. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu
c. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test
d. Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR

A

A

23
Q

In Stage 0 breast CA, workup involves Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status. What test is added to this list for Stage I?

A

Her 2/neu expression

24
Q

What diagnostic workup is required for Stage II Breast CA

A

Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR

25
Q

What diagnostic workup is required for Stage III and IV breast CA?

A

Hx ,PE, CBC + Plt Ct , Bilateral mammograms/US, Hormone receptor status, Her2/neu, Liver function test, CXR, Bone scan, abdominal CT or UTS, or MRI (with or without pelvis)

26
Q

Treatment options for LCIS cancer

A

observation
chemoprevention
bilateral total mastectomy

27
Q

True about LCIS EXCEPT

a. goal of treatment is to prevent or detect at an early stage the invasive cancer that subsequently develops in 25% to 35% of these women.
b. Excising LCIS is prevents cancer formation
c. Tamoxifen as risk reduction strategy should be conisdered
d. ATOA
e. NOTA

A

B; no benefit

28
Q

Indication for mastectomy in DCIS

A

extensive disease (>4cm of disease or disease in more than one quadrant)

29
Q

Treatment recommendations for women with limited DCIS

A

Lumpectomy and radiation therapy

30
Q

T/F adjuvant tamoxifen is considered for all DCIS patients

A

F; those with ER-positive disease

31
Q

Gold standard treatment for DCIS

A

mastectomy

32
Q

Duration of tamoxifen treatment in women with ER-positive DCIS, after surgery and radiation therapy

A

5 years

33
Q

What are the equivalent treatments for patients with stage I and II breast cancer?

A

Mastectomy with axillary staging or

Breast conserving surgery with axillary staging and radiation therapy

34
Q

What are relative contraindications to breast conservation therapy? (4)

A

PMS
Prior radiation therapy to the breast or chest wall
Persistently positive surgical margins after re-excision
Multicentric disease
Scleroderma or lupus erythematosus

35
Q

T/F patients who are planned for postmastectomy radiation therapy are not ideal candidates for nipple-sparing mastectomy

A

T

36
Q

What are the benefits of SLN dissection for those qualified?

A 
Decreased morbidity (arm swelling and range of motion)
Improved quality of life vs. patients who underwent ALND
37
Q

What is the most common immediate effect of SLN dissection?

A

Axillary seroma

38
Q

Indications for adjuvant chemotherapy for patients with early stage invasive breast cancer

A

node positive cancers
patients with cancers >1cm
patients with node negative cancers of >0.5cm when an adverse prognostic factor is present

39
Q

What are the adverse prognostic factors of early stage breast cancer?

A 
NB(H3)
Negative hormone receptor
blood vessel or lymph vessel invasion
high nuclear grade
high histologic grade
Her-2/neu overexpression or amplification
40
Q

What does “switch” regime for adjuvant hormonal therapy for breast cancer?

A

3 years aromatase inhibitor + 2 years tamoxifen;

but 5 years AI regimen is preferred

41
Q

What is the treatment for Stage III breast cancer?

A

Neoadjuvant chemotherapy
Surgery
Radiation
Adjuvant Chemotherapy

SRGRY3 (44 decks)

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