Breast

Breast 1. What nerve when transected during mastectomy will results in numbness of the upper medial aspect of the upper arm? a. Thoracoacromial nerve b. Branchial nerve c. Intercostal nerve d. Intercostobrachial nerve e. Long thoracic nerve 2. A 45- year old woman has a mobile lump in the upper outer quadrant of her right breast. There is no nipple discharge and there are no skin changes. Physical examination is otherwise unrevealing. An open excisional biopsy reveals a 1.5 cm lobular carcinoma in situ (LCIS) with negative margins. Which of the following statements is not true? a. The chance of developing invasive carcinoma approaches 25% at 20 years b. Careful clinical follow-up without further surgical intervention is sufficient at this time c. The lesion most likely to develop later is invasive lobular carcinoma d. Lobar carcinoma in situ is a marker for a future invasive carcinoma in either breast e. Mirror-image breast biopsy is not indicated 3. A 20 year old female presents with a 2 cm well defined left breast mass. You would advise: a. Mammography to determine the nature of the mass b. Observation and reassessment after one month c. Open biopsy d. Ultrasonography e. Treatment with danazole to shrink the mass 4. In which of the following patient is mammography most indicated? a. 30 female with a 5cm left breast mass, FNAB + for cancer b. 25 female with breast pain, mother had breast cancer c. 35 female asymptomatic, requests for breast cancer screening d. 25 female with 2 cm firm, slightly tender lump in her right breast e. 50 female with a 3 cm hard breast mass 5. A 45 y.o female has a 2 cm firm, movable breast mass. a. The patient most probably has a benign fibroadenoma because the mass is movable b. A biopsy procedure should be done to rule out breast cancer c. Mammography should also be requested to further investigate the nature of the mass d. Because of the clinical diagnosis, fibroadenoma, the patient could be safely advised to just observe the mass, do monthly self-breast exam and come back after 6 months for checkup.

6. The following operations will need prophylactic antibiotics EXCEPT: a. MRM b. Elective cholecystectomy c. Appendectomy for ruptured appendicitis d. Gastrectomy 7. The most important prognostic factor in breast cancer patient is: a. Age of the patient b. Size of the mass c. DNA ploidy d. Lymph node status 8. A modified radical mastectomy which is considered equally effective as the conventional radical mastectomy in most case, is less disfiguring because it preserves the : a. Pectoralis major muscle b. Long thoracic nerve c. Axillary artery d. Axillary vein e. Pectoralis minor muscle 9. A 15 year old boy, with tender lump on his right breast for the past two months, should be treated by: a. Excision biopsy b. Hormonal treatment c. Observation d. Antiniotic therapy e. Radiotherapy 10. Fibroadenoma: a. Highly malignant b. Excised surgically only when symptomatic c. Adherent to overlying skin and underlying muscle d. Usually presents as fixed non delineated mass e. The most common neoplasm in young women 11. Younger patients who have early occurrence of breast cancer are associated with: a. Hypertension b. Blood type A c. Blood type O d. Dm 12. The benign lesion most likely to produce skin dimpling: a. Fibrocystic disease b. Sclerosing adenosis c. Intraductal papilloma

d. Acute abscess e. Fat necrosis 13. A 60 year old woman undergoes a MRM for a 3 cm infiltrating ductal carcinoma. 3 of 16 axillary nodes are positive for metastatic disease. In this patient if the tumor is estrogen receptor (+) and progesterone receptor (+), the best form of adjuvant chemotherapy is: a. Tamoxifen and chemotherapy b. Radiation plus tamoxifen c. Radiation to the chest and axilla d. Radiation and chemotherapy 14. A 60 year old woman undergoes MRM for a 1 cm infiltrating ductal carcinoma. The nodes are negative for metastases. What else should be done. a. Radiation therapy b. Combined chemotherapy and radiation therapy c. Adjuvant therapy d. Give tamoxifen 15. Over a number of months, a 45 yearl old woman occasionally notices bloody discharge from her left nipple. In this patient: a. An excision of the areola- nipple complex is indicated b. A ductal papilloma is likely to be the cause c. Pagets disease is probably present d. The cause is likely to be ductal carcinoma 16. With regard to current therapy of stage I and II breast cancer, which of the following statements is true? a. The Halsted Radical Mastectomy has resulted in a cure rate superior to that of other treatment option b. The MR involves preservation of the nipple to improve cosmesis following reconstruction. c. Wide local excision with axillary dissection and radiation therapy to the remainder of the breasts is reserved for patients too debilitated to undergo the more radical mastectomy. d. Clinical trials have shown equivalent disease free survival for selected patients randomized to receive either MRM or WLE, axillary dissection and breast radiation therapy.

17. Which of the following breast lesions are non invasive malignancies? a. Tubular carcinoma and lobular carcinoma b. Infiltrating ductal carcinoma and lobular carcinoma c. Intraductal carcinoma and lobular carcinoma in – situ d. Mucinous carcinoma and medullar y carcinoma 18. Mammography is indicated in which of the following except: a. Palpable 4 cm breast mass b. Follow up after mastectomy c. Large breast d. Indeterminate mass e. Pendulous breast 19. Prognosis of breast cancer depends largely on, except: a. Type of surgery b. Size of the tumor c. Axillary lymph node metastases d. Presence of estrogen receptor e. Distant metastasis 20. The most appropriate surgery for cystosarcoma phylloides is: a. Wide excision b. Lumpectomy c. Standard Masetectomy d. Total Mastectomy e. Modified Mastectomy 21. The single most significant predictive factor of 10 – 20 year survival in breast CA is: a. Chest wall involvement b. Absolute number of metastatic lymphnodes c. Hormonal assay d. Tumor size 22. A 19 year old single female has a 9x 8 cm mobile mass in her left breast for the past 3 years. Incision biopsy revealed a highly cellular fibrous stroma with cystic areas and a leafy appearance on cut section. The most likely diagnosis for this case is: a. Fat necrosis b. Papilloma c. Phyloides tumor d. Fibrocystic disease

23. All the following statements concerning fat necrosis of the breast are true except: a. It is usually associated with history of trauma b. It usually occurs in large pendulous breast c. It predisposes patient to the development of breast cancer d. Treatment of choice is local excision 24. In male patients with breast carcinoma, the poorest prognosis is relative to patients with: a. Mammary mass size b. Nipple ulceration c. One or more axillary lymph nodes d. Nipple discharge 25. A 38 y.o female complains of bloody nipple discharge from her right breast. There is a vaguely palpable slightly tender mass beneath the right areola which exudes blood discharge on pressure, this patient most likely has: (2x) a. Fibroadenoma b. Intaductal papilloma c. Paget’s disease d. Fibrocystic disease 26. Signs of breast cancer include each of the following except: a. Bloody nipple discharge b. Skin dimpling c. Paget’s disease of the nipple d. Breast discomfort 27. A 60 year old woman undergoes a MRM for a 3 cm infiltrating ductal carcinoma. 3 of 16 axillary nodes are positive for metastatic disease. In this patient if the tumor is estrogen receptor (+) but progesterone receptor (- ), the best form of adjuvant therapy is: a. Tamoxifen b. Radiation plus tamoxifen c. Radiation to the chest and axilla d. Tamoxifen and 5-FU 28. The treatment of choice for malignant cytosarcoma phylloides: a. Irradiation b. Irradiation and chemotherapy c. Simple mastectomy d. Modified radical mastectomy 29. A 35 y. o woman complains of bloody discharge from her nipple. On physical examination, there is a small painful mass beneath the nipple and bloody fluid is expressed by pressure on the mass. The most likely diagnosis is: a. Fibrocystic disease b. Breast cancer

c. Fat necrosis d. Paget’s disease e. Intraductal papilloma 30. The benign tumor in the middle aged female in which is notorious for recurrence: a. Chronic mastitis b. Ductal papilloma c. Fibrocystic disease d. Fibroadenoma e. Cyst 31. Breast malignancy that is known to have the highest incidence of multicentricity: a. Medullary carcinoma b. Papillary carcinoma c. Lobular carcinoma d. Paget’s disease 32. True of Paget’s disease of the nipple except: a. Presents as an eczematoid lesion of the nipple b. Associated with good prognosis c. Most common form of breast cancer d. Primary carcinoma of mammary ducts of the nipple which invaded the skin 33. Hidradenitis suppurative originates from: a. Axillary tail of spence b. Hair follicle c. Mammary lobule d. Sebaceous gland e. Sweat glands 34. The benign lesion of the breast that has potential of malignancy a. Cystosarcoma phylloides b. Mammary duct atresia c. Cystic hyperplasia d. Intraductal papilloma 35. A 40 y. o woman has an enlarged and engorged right breast with some draining sinuses. She probably has: a. Breast TB b. Paget’s disease c. Breast cancer d. Cystosarcoma phylloides 36. A 40 y.o woman with cystosarcoma phylloides is best managed by:

a. b. c. d.

Total mastectomy with radiotherapy Total mastectomy Radical mastectomy with radiotherapy Radical mastectomy

37. After thoracostomy drainage for empyema, ot was noted on chest x ray that there was no reexpansion of the lungs. The proper thing to do is: a. Bronchoscopy to rule out intraluminar obstruction b. Continue tube drainage with flushing of antiseptic c. Remove tube and send patient home d. Perform decortication 38. The main goal of post mastectomy radiotherapy is : a. Replace chemotherapy as adjuvant therapy b. To improve 5 year survival rate c. To reduce local recurrence d. To reduce systematic recurrence 39. Most important prognosticator for breast cancer : a. Age of the patient b. Size of the tumor c. Status of axillary lymph nodes d. Ploidy pattern of the tumor e. Presence or absence of estrogen receptor 40. Most common site of distant metastases in breast CA: a. Brain b. Lungs c. Liver d. Bones 41. The most common site of recurrence of breast CA is: a. Bone b. Lung c. Skin of chest wall d. Axillary lymph nodes 42. The statement concerning fat necrosis of the woman’s breasts are true except: a. It predisposes patients to the development of breast cancer b. It is usually associated with a history of trauma c. Liquefication of fat may produce cystic spaces d. It usually occurs in large, pendulous breasts

43. A 30 y. o woman consults at the OPD for a self-detected hard breast mass. What is the procedure of choice for this patient? a. Mammography b. Ultrasonography c. Needle aspiration cytology d. Excision biopsy 44. Intraductal carcinoma is rock hard on palpation because of which of the following? a. Tumor calcification b. Calcification of the central necrotic core c. Desmoplastic response 45. The surgical management of breast cancer, 7 cm in diameter, without nodal involvement incudes which of the following? a. Lumpectomy b. Lumpectomy and radiotherapy c. Segmental resection plus radiotherapy d. Modified mastectomy 46.