Breast

Front 1

42 yo F for routine eval. not regularly seen by physician. physical exam normal. advice going forward regarding breast CA screening (2)?

Back 1

1. monthly self-breast exams
2. yearly mammorgram and breast exam

Front 2

Women with first degree relative with breast CA or ovarian CA is high risk for breast CA. what are screening recs for high risk patients (3)?

Back 2

1. breast exam biannually starting at age 25
2. mammogram starting at age 30, then every 1-2 yrs (annually > 40)

Front 3

mammogram has greatest efficany in detecting lesions not detectable on physical exam in what age range?

Back 3

50-64 yo

Front 4

mammography starting how long before breast cancer in first degree relative?

Back 4

10 yrs

Front 5

highest false negative rates in mammogram in what populations (2)?

Back 5

1. younger women
2. women with more glandular tissue

Front 6

60 yo woman referred byt PCP for 1.5cm mass in upper outer quadrant of breast. No hx of breast CA, taking HRT; 1. types of abnormalities of mammorgram include what (3)?
2. Mammogram findings are reported on 0-5 scale. which should be biopsied with risk of malignancy?

Back 6

1. mass, microcalcifications, assymetric densities
2. 3-5 should be biopsied (3=probably benign, <2%), (4=suspicious, 15-30%), (5=highly suggestive)

Front 7

44 yo F with microcalcifications.
1. most likely diagnosis?
2. next step (2 options)

Back 7

1. DCIS
2. 1)stereotactic core biopsy or 2)needle localization open surgical biopsy

Front 8

stereotactic biopsy reveals DCIS -
1. management (and why)?
2. sentinel node biopsy?

Back 8

wide excision + radiation; invasive potential is high (10-20% have infiltrative component at excision)
2. NO - nodal mets are rare

Front 9

histological pattern of DCIS that has particularly higher malignant potential?

Back 9

comedo pattern

Front 10

management for diffuse and multicentric DCIS?

Back 10

simple mastectomy

Front 11

Usual incidental finding not found on mammography?

Back 11

LCIS

Front 12

1. Management of LCIS?
2. what is its significance with percentages?

Back 12

1. close observation / increased surveillence
2. it is a marker for increased risk (15-20% chance of dev invasive CA in 20 yr period)

Front 13

1. next steps for atypical ductal hyperplasia, if any?
2. why?

Back 13

1. needle localization and excision
2. cancer risk 4-5x higher

Front 14

60 yo woman with breast mass palpated by PCP . No symptoms, family hx of breast CA. on exam, freely mobile, firm mass - procedures?

Back 14

1. mammogram
2. ultrasound
3. biopsy if mass appear solid

Front 15

workup of a solitary breast mass in a 28-year old woman (give flow of workup)?

Back 15

1. ultrasound (fluid-filled versus solid?)
2. fluid filled / cystic --> FNA (+/- biopsy)
---> observation (one or two menstrual cycles), then core-needle biopsy if mass persists

Front 16

35 yo F with tender breasts before menstrual cycles - complains of "lumpy breasts";
1. diagnosis?
2. symptoms / characteristics (3-4)?
3. if mass or solitary cyst present, change in workup?

Back 16

1. fibrocystic change
2. tender breasts (esp before menstrual periods), bilateral, age 30-40ish, low risk of cancer
3. no change from normal

Front 17

20 yo F with mass in breast, __ cm in diameter - firm, rubbery, nontender and freely movable. opposite breast abnormal.
1. 1.5 cm, likely diagnosis?
2. 14 cm, likely diagnosis?
3. difference in management?

Back 17

1. fibroadenoma
2. physllodes tumor
3. excision often for both (although observation possible for fibroadenoma); difference in excision is that phyllodes excision needs margins

Front 18

34 yo woman with nipple discharge. no contributory history. no masses or tenderness on exam, but small drop of blood noticed on right nipple.
1. clear discharge, most likely diagnosis?
2. most common cause of bloody discharge?
3. single duct bloody discharge, next step?
4. three important steps in eval of suspicious discharge, and management once localized?

Back 18

1. fibrocystic change
2. intraductal papilloma
3. surgical biopsy
4. close exam (identify duct producing discharge), mammogram, ductogram'
management once localized: surgical excision

Front 19

57 yo F with positive core needle biopsy revealing infaltrative ductal carcinoma.
1. most important quality in prognosis?
2. steps in staging?

Back 19

1. staging (TNM system)
2.
a. excision with sentinel mode / axillary node dissection (as well as analsysis of tumor extension and tumor size)
b. CXR, LFTs, ?bone / CT scan if metastases suspected

Front 20

1. signs of inflammatory carcinoma of breast (2 signs)?
2. possible signs of invasion of supports structures of breast (2)?
3. extension to chest wall of breast cancer - what stage?
4. palpable supraclavicular lymph node - what stage?

Back 20

1. ulcerated breast lesion, peau d'orange (nipple edema)
2. nipple retraction, skin retraction (over mass)
3. stage 3
4. stage 4 (supraclavicular node represents metastatic disease)

Front 21

61 yo woman with crusty lesion of nipple of right breast.
1. what needs to be ruled out?
2. likelihood of carcinoma (if present)?
3. treatment if mass is present?

Back 21

1. paget's disease (eczematoid lesion of breast)
2. 95% chance of DCIS/invasive ductal if paget's disease present
3. mastectomy

Front 22

breast CA:
1. localized tumor (option)?
2. large tumor, multicentric tumor
3. linear decrease in survival with what?
4. where is the role of systemic adjuvant therapy?

Back 22

1. wide excision + radiation
2. mastectomy + chemo (if axillary involvement)
3. # of positive lymph nodes
4. if axillary nodal involvement

Front 23

axillary clearance is crucial for both staging and therapy (true/false)

Back 23

false; only staging (not therapeutic)

Front 24

name the procedure:
1. removal of breast tissue, skin, pec major and minor, and axillary nodes; when used?
2. removal of breast tissue, nipple-areolar complex and skin; when used?
3. removal of breast tissue, skin, axillary nodes; when used?
4. removal of primary lesion with clear margins with axillary node sampling; when used? what indicated post-op?

Back 24

1. radical mastectomy; tumor with extension to chest wall
2. simple mastectomy; LCIS/DCIS
3. modified radical mastectomy; diffuse DCIS; larger tumors
4. lumpectomy/segmental mastectomy; solitary tumor (<5cm); radiation post-op

Front 25

two methods used for lymph node sampling in staging breast ca?

Back 25

1. sentinel node evaluation
2. excision of level I/II axillary nodes

Front 26

1.5 cm, invasive ductal carcinoma of breast - what do you tell patient when couseling them on surgical options?

Back 26

no difference in survival/prognosis b/w lumpectomy/radiation versus modified radical mastectomy

Front 27

contraindication to reconstruction of breast (keeping skin/breast tissue to reconstruct)?

Back 27

stage III/IV disease; lesions involving chest wall

Front 28

post-lumpectomy with staging of breast CA - long term management?
1. <1cm tumor, no + nodes
2. 1-2 cm tumor, no + nodes
3. stage II (larger tumors or + nodes)

Back 28

1. radiation, hormone therapy if ER+
2. radiation, hormone therapy if ER+, adjuvant therapy (chemo)
3. option for modified radical verus radiation, +adjuvant

Front 29

What constitutes adjuvant therapy in breast CA (3)?

Back 29

1. Tamoxifen in ER+ cancers in postemenopausal women
2. Adjuvant chemo in ER- and premenopausal women

Front 30

surveillence in breast CA patients after initial treatment (2 components)?

Back 30

1. annual CXR and LFTs
2. mammogram every 6 months (first two years)

Front 31

what is the main treatment approach (3 steps) to large tumor (>5cm) with positive, matted lymph nodes?

Back 31

1. neoadjuvant chemo
2. radical mastectomy
3. adjuvant therapy (e.g. homonal, chemo)

Front 32

38 yo F with 3 month hx of enlarging breast mass - 6x7 cm fixed mass, with edema on outer aspect of breast. axilla positive with enlarge, firm lymph nodes.
1. suspected diagnosis?
2. histologic features?
3. managements/treatment?

Back 32

1. inflammatory carcinoma
2. cancer cell infaltrating ducts/vessels
3. CBC, calcium, LFTs, CT-chest, bone scan;
treatment: adjuvant chemo (see what response is)

Front 33

What suggests breast cancer mets? Name 4-5.

Back 33

1. elevated LFTs
2. pathologic fracture
3. neuro deficit (spinal metastasis with impingement of cord)
4. new-onset seizures
5. acute hypercalcemia (due to PTH-related peptide)

Front 34

28 yo F 3 weeks postpartum presents with painful right breast - currently breastfeeding, +low grade fever. firm, red, indurated breast mass- shotty nodes palpable;
1. diagnosis?
2. treatment?
3. what if area of fluctuance?
4. no improvement with treatment after 6-8 wks, what then?

Back 34

1. mastitis
2. warm compress, antibiotics
3. abcess; requires surgical drainage
4. biopsy of lesion (unlikely to be mastitis)

Front 35

what is the complicating factor in treating cancer in pregnancy?

Back 35

chemo is contraindicated in 1st trimester (and therefore abortion may be necessary in stage III/IV cancers in 1st trimester)
RT is contraindicated throughout all of pregnancy

Front 36

stage for stage, how does breast cancer prognosis compared in men versus women? However, who typically presents at later stage?

Back 36

same; men usually present at later stage (w/ fixation)

Front 37

hypertrophy of breast tissue in men occurs at what age?

Back 37

bimodal (adolescence and 40s-50s)

Front 38

gynecomastia tends to resolve spontaneously in adolescents, age40-50, both, or neither?

Back 38

adolescent group

Front 39

6 yo F with firm 1 cm unilateral mass - most likely going on? next step?

Back 39

breast bud; reassurance

Front 40

breast hypertrophy is associated with cancer in older men and therefore excision is indicated (true/false)

Back 40

false; no association with cancer; excision indicated if fails to regress