Skin, Soft Tissue, and Breast

Question 1

What is the treatment of Bowen’s disease?

Answer 1

Intraepithelial squamous cell carcinoma –> excision and repair of the area, ensuring clear surgical margins

Question 2

The anticipated infection rate is what for the following wounds?

• clean wound
• contaminated wound
• dirty wound

Answer 2

clean: 1.5-5%
contaminated: 15%
dirty: 40%

Question 3

If spillage is substantial or infected tissue has entered, the wound is classified as

Answer 3

contaminated

Question 4

A wound that has been used for drainage of an abscess or debridement of infected tissue is:

Answer 4

dirty

Question 5

If a burn extends to the subcutaneous fat layer, it is what degree?

Answer 5

third

Question 6

What are 2 contraindications to split-skin-thickness grafting?

Answer 6

1) presence of bacteria growth >10^5 organisms/cm2

2) growth of B-hemolytic streptococci

Question 7

In melanomas, what does Clark classification mean? Breslow?

Answer 7

Clark: depth
Bresolow: width

Question 8

In hidradenitis supperativa, which are usually infected which which organisms?, milder cases may be responsive to hygiene and tetracycline, but more severe cases require wider excision.

Answer 8

staph and strep

Question 9

What are the layers of epidermis from superficial to dermis?

Answer 9

stratum corneum, stratum granulosum, stratum spinosum (prickle layer), stratum basale

Question 10

What is Gorlin’s syndrome?

Answer 10

multiple BCCs, skin ribs on palms and soles, epithelial jaw line cysts, rib abnormalities, ectopic calcifications in the dura, and mental retardation. Benign until puberty.

Question 11

What is Zuska’s disease?

Answer 11

Dilated laciferous ducts, which develop chronic inflammation presenting with periareolar draining sinuses = mammary fistula. Will continue to recur until completely excised (may require removal of the terminal duct into the nipple, leaving the wound open)

Question 12

What is Mondor’s disease?

Answer 12

superficial thrombophlebitis, usually induced by surgery, infection, or trauma. Process is self-limiting and resolves within 2-10 weeks.
“lateral subcutaneous cord felt just under the skin and causing pain”

Question 13

How can intraductal papilloma be found?

Answer 13

ductography

Question 14

Which type of calcifications on mammography are usually benign: coarse or fine?

Answer 14

coarse

Question 15

T/F: Any history of breast biopsy, even if benign, increases risk of breast cancer.

Answer 15

True

Question 16

Megace is used for which kind of breast cancer?

Answer 16

metastatic

Question 17

Raloxifene, toremifene, and tamoxifen are all what kind of drug?

Answer 17

Selective estrogen receptor modulators (SERMS)

Question 18

What are the most effective drugs in treating breast cancer in postmenopausal women?

Answer 18

aromatase inhibitors

Question 19

What is the most aggressive type of DCIS? What is the treatment?

Answer 19

Comedo. As long as not multicentric, breast conservation can occur with radiotherapy following (as in all DCIS following breast conserving procedures)

Question 20

T/F: LCIS is a premalignant lesion.

Answer 20

FALSE! Though it does portend a lifetime risk of 30% of breast cancer (either breast!). Patients should be followed with examinations every 6 months and yearly mammogram

Question 21

Histologic examination of Paget’s disease of the breast reveals:

Answer 21

swollen, vacuolated Paget cells. Surgical therapy is curative.

Question 22

Which agents used for sentinel node identification can cause allergic reactions?

Answer 22

methylene blue, isosulfan

Question 23

Patients who have breast cancers under -__cm and which are node negative are given hormonal therapy and radiation therapy but spared chemo.

Answer 23

1cm or node positive

Question 24

When is tamoxifen given?

Answer 24

In ER and/or PR positive tumors in patients that are premenopausal

Question 25

T/F: Breast cancer is the most common cancer during pregnancy.

Answer 25

True

Question 26

Breast cancer during pregnancy usually has (positive/negative) ER and PR.

Answer 26

Usually PR- and ER-

Question 27

Why is mastectomy indicated in breast cancer in pregnancy unless the patient is towards the end of their gestation?

Answer 27

Radiation is required for breast-conserving procedures, but radiation is contraindicated in pregnancy.

Ostensibly breast conservation therapy could be performed if radiotherapy could be given postpartum.

Question 28

What is the most common site of distant metastasis for breast cancer? How is it treated?

Answer 28

Bone. They are usually lytic lesions (in the vertebral pedicles) treated with bisphosphonates to stop bone demineralization and reduce pathologic fractures/need for radiation.

Question 29

What is the follow-up after breast cancer?

Answer 29

Routine clinical exams every 3-6 months for the first 5 years and yearly mammogram

Question 30

Breast implants in what plane show better mammography results than the subglandular?

Answer 30

submuscular

Question 31

Breast cancer in males constitutes ___% of all breast cancer cases.

Answer 31

<1%

Question 32

What is the histology of cystosarcoma phyllodes?

Answer 32

large polygonal cells with abundant cytoplasm and lymphoid infiltration

Question 33

What are the potential treatments for occult primary breast cancer and how is the prognosis different than for other patients with breast cancer?

Answer 33

same prognosis as other node-positive breast cancer
can either do
1) modified radical mastectomy with chemotherapy; or
2) axillary node dissection with radiation and chemotherapy

Question 34

What type of breast cancers have a large surrounding lymphoid reaction and are poorly differentiated?

Answer 34

medullary; tend to be hormone receptor negative, but still with pretty favorable prognosis

Question 35

Which breast cancers have a typical “indian file, lining up” pattern of cells?

Answer 35

infiltrating lobular carcinoma (tend to be multicentric, higher rates of bilaterality). Tend to be hormone receptor positive