Surgery Essence Pritesh Kumar Singh
INDEX
×
Chapter Notes

Save Clear


1ENDOCRINE SURGERY
CHAPTERS

BreastCHAPTER 1

MULTIPLE CHOICE QUESTIONS
 
NIPPLE DISCHARGE
2. Bleeding from nipple is seen in: (PGI June 2001, June 97)
  1. Fibroadenoma
  2. Duct ectasia
  3. Ductal papilloma
  4. Chronic breast abscess
  5. CA breast
3. Green discharge is most commonly seen with: (WBPG 2015, AIIMS Nov 98)
  1. Duct papilloma
  2. Duct ectasia
  3. Retention cyst
  4. Fibroadenosis
4. A 25-years old female complains of discharge of blood from a single duct in her breast. The most appropriate treatment is: (All India 2008)
  1. Radical excision
  2. Microdochectomy
  3. Radical mastectomy
  4. Biopsy to rule out carcinoma
5. True statement (s) about nipple discharge is/are: (PGI June 2004)
  1. Mammography
  2. Cone excision done in single intraductal tumour
  3. Mammography done when duct papilloma is 4.5cm
  4. Red discharge indicate malignancy
  5. Blue-black discharge indicate duct ectasia
6. A 25-years old lady presents with spontaneous nipple discharge of 3-months duration. On examination the discharge is bloody and from a single duct. The following statements about management of this patient are true except: (AIIMS Nov 2004)
  1. Ultrasound can be a useful investigation
  2. Radical duct excision is the operation of choice
  3. Galactogram, though useful, is not essential
  4. Majority of blood stained nipple discharges are due to papillomas or other benign condition
 
CARCINOMA BREAST INVESTIGATIONS
8. Best diagnostic method for breast lump is: (AIIMS June 95)
  1. USG
  2. Mammogram
  3. Biopsy
  4. FNAC
9. A 45-years old woman presents with a hard and mobile lump in the breast. Next investigation is: (All India 2001)
  1. FNAC
  2. USG
  3. Mammography
  4. Excision biopsy
10. A female patient present with a hard mobile lump in her right breast. Which investigation would be most helpful in making the diagnosis? (AIIMS Nov 2001)
  1. FNAC
  2. Needle biopsy
  3. Excision biopsy
  4. Mammography
 
MAMMOGRAPHY
12. Most sensitive imaging for ductal carcinoma in situ of breast is: (AIIMS Nov 2010)
  1. Mammography
  2. MRI
  3. PET
  4. USG
13. True about screening mammography: (PGI June 2004)
  1. Indicated in 50–70 years of age
  2. Mortality reduced by 30%
  3. Radiation due to mammography can cause carcinoma
  4. MRI is better than mammography
  5. USG is better than mammography
14. On mammogram all of the following are the features of a malignant tumor except: (AIIMS Nov 2003)
  1. Spiculation
  2. Microcalcification
  3. Macrocalcification
  4. Irregular mass
15. BIRADS stands for: (AIIMS Nov 2012)
  1. Breast Imaging Reporting and Data System
  2. Best Imaging Reporting and Data System
  3. Brain Imaging Reporting and data system
  4. Best imaging reporting and data system
16. All are indicators of malignancy in a mammography except: (PGI Dec 99)
  1. Nodular calcification
  2. Speckled margin
  3. Attenuated architecture
  4. Irregular mass
17. Popcorn calcification in mammography is seen in: (AIIMS June 2000)
  1. Fibroadenoma
  2. Fat necrosis
  3. Cystosarcoma phyllodes
  4. CA Breast
18. A 55-years old post menopausal woman, on hormone replacement therapy (HRT), presents with heaviness in both breasts. A screening mammogram reveals a high density speculated mass with cluster of pleomorphic microcalcification and ipsilateral large axillary lymph nodes. The mass described here most likely represents: (AIIMS Nov 2003)
  1. Cystosarcoma phyllodes
  2. Lymphoma
  3. Fibroadenoma
  4. Carcinoma
419. With reference to mammography, which one of the following statements is correct? (UPSC 2005)
  1. A baseline study should be done for all women at age 30
  2. It uses less radiation energy than a chest X-ray
  3. It should be part of the regular follow up of a woman following therapy for unilateral breast cancer
  4. It provides an effective substitute for biopsy of suspicious lesions
 
CARCINOMA BREAST RISK FACTORS
21. Risk factor for carcinoma breast: (PGI Nov 2011, Nov 2010)
  1. Nulliparity
  2. OCP
  3. Family history
  4. BRCA-1 mutation
  5. Estrogen
22. Which of the following is a predisposing factor for carcinoma of breast? (MHSSMCET 2005)
  1. Sclerosing adenosis
  2. Epithelial hyperplasia
  3. Fibrocystic disease of breast
  4. Fibroadenoma
23. Moderately increased risk of invasive breast carcinoma is associated with which of the following benign lesions of the breast? (All India 2009)
  1. Sclerosing adenosis
  2. Atypical lobular hyperplasia
  3. Apocrine metaplasia
  4. Squamous metaplasia
25. True regarding breast carcinoma is: (MCI March 2008)
  1. Occurs most commonly in upper inner quadrant
  2. Late menarche and early menopause predisposes for breast malignancy
  3. Commoner in nulliparous women
  4. Unrelated with the family history of breast cancer
27. BRCA-1 positive woman have ______% increased risk of breast carcinoma: (JIPMER 2011)
  1. 10
  2. 20
  3. 40
  4. 60
30. Breast cancer more commonly seen in: (PGI Dec 2002)
  1. Increased risk in relatives
  2. Early marriage <20 years
  3. Nullipara
  4. High fat diet
  5. Who avoided breast feeding
31. Least risk of CA breast is seen in: (AIIMS Nov 2006)
  1. BRCA-1
  2. BRCA-2
  3. Li-Fraumeni syndrome
  4. Ataxia telangiectasia
32. BRCA-1 gene is associated with: (DPG 2008)
  1. Ductal carcinoma
  2. Lobular carcinoma
  3. Medullary carcinoma
  4. Colloid carcinoma
33. Type of fibroadenosis most likely to undergo malignant change is: (AIIMS June 93)
  1. Adenosis
  2. Epitheliosis
  3. Sclerosing adenosis
  4. Cystic
34. Doesn't lead to carcinoma breast: (DPG 2006)
  1. Sclerosing adenosis
  2. Epithelial hyperplasia
  3. Fibrocystic change
  4. Papillomatosis
35. Which of the following is an increased risk of breast cancer? (PGI Dec 2005)
  1. Sclerosing adenosis
  2. Atypical hyperplasia
  3. Fibroadenoma
  4. Florid hyperplasia
36. Risks for carcinoma breast are: (PGI Dec 2000)
  1. First degree relative
  2. Atypical hyperplasia
  3. Sclerosing adenosis
  4. Increased fat intake
37. Breast carcinoma is seen in women who: (PGI June 2002)
  1. Consume fatty food
  2. Have early menopause
  3. Smoke
  4. Have multiple sex-partners
  5. Did not breastfed their children
38. Breast cancer is more common in: (PGI Dec 2001)
  1. Those who avoid breast-feeding to the infant
  2. Multiparity
  3. Nulliparity
  4. High fat diet
  5. Family history of breast cancer
39. Following are risk factors for CA breast except: (PGI Dec 96)
  1. Maternal grand mother had history
  2. Paternal grand mother had history
  3. Long term estrogen
  4. Fat necrosis
40. The incidence of carcinoma of the breast is increased in woman who: (AIIMS 78, 84)
  1. Have an early menarche and late menopause
  2. Take an estrogen progestogen oral contraceptive
  3. Have their first child after the age of 35 years
  4. Avoid breast feeding
  5. Are nuns
41. Risk factor for carcinoma breast: (All India 89)
  1. Fibroadenoma on one side
  2. Sister died from cancer
  3. Jewish origin
  4. All
42. Which one predisposes to breast cancer? (AIIMS 92)
  1. Adenosis
  2. Fibrosis
  3. Blue domed cysts
  4. Epitheliosis
43. Which of the following is the most significant risk factor for developing breast cancer is? (Karnataka 96)
  1. The presence of sclerosing adenosis
  2. Nullipartiy
  3. Atypical lobular hyperplasia
  4. Atypical ductal hyperplasia
44. Statistically important risk factors identified for breast cancer: (PGI 2002)
  1. Early age at marriage
  2. Females of non vegetarian diet
  3. Those who have not breast fed their children
  4. Smoking
5
 
CARCINOMA BREAST
46. In which of the following types of carcinoma breast, comedo growth pattern is seen?
  1. Ductal carcinoma in-situ
  2. Medullary carcinoma
  3. Lobular carcinoma in-situ
  4. Infiltrating lobular carcinoma
47. Bilateral, multicentric type of carcinoma in breast is usually: (COMEDK 2011)
  1. Mucoid carcinoma
  2. Invasive lobular carcinoma
  3. Infiltrating ductal carcinoma
  4. Noninfiltrating ductal carcinoma
49. True about histology in infiltrating lobular breast carcinoma: (JIPMER 2012, 2011)
  1. Single file\pattern
  2. Pleomorphic cells in sheets
  3. Cribiform pattern
  4. Pin wheel pattern
50. Lymph node first involved in CA breast is/are: (PGI Nov 2009)
  1. Axillary LN
  2. Internal mammary LN
  3. Supraclavicular LN
  4. Contralateral axillary LN
51. In breast cancer following are expressed: (PGI Dec 2007)
  1. Her-2-neu
  2. p53
  3. BRCA-1
  4. BCL-1
  5. CEA
53. Carcinoma breast is most commonly seen in which quadrant of breast: (MHSSMCET 2005)
  1. Upper outer
  2. Upper inner
  3. Lower inner
  4. Lower outer
54. Nottingham Prognostic Index for CA breast is: (MHSSMCET 2008)
  1. I = (0.2 x size) + grade + nodes
  2. I = (0.4 x size) + grade + nodes
  3. I = (0.6 x size) + grade + nodes
  4. I = (0.8 x size) + grade + nodes
55. Rare histological variants of carcinoma breast with better prognosis include all except: (DPG 2009 March)
  1. Colloid carcinoma
  2. Medullary carcinoma
  3. Inflammatory carcinoma
  4. Tubular carcinoma
56. All of the following are invasive carcinoma breast except: (PGI 89)
  1. Comedocarcinoma
  2. Colloid carcinoma
  3. Lobular carcinoma in-situ
  4. Medullary carcinoma
57. Which carcinoma breast is not invasive? (DPG 79,93)
  1. Comedocarcinoma
  2. Schirrhous carcinoma
  3. Lobular carcinoma
  4. Paget's disease
58. In which of the following types of carcinoma breast, comedo growth pattern is seen? (Karnataka 2006)
  1. Ductal carcinoma in-situ
  2. Medullary carcinoma
  3. Lobular carcinoma in-situ
  4. Infiltrating lobular carcinoma
60. Breast cancer which is multicentric and bilateral? (DPG 2008, AIIMS Feb 97, May 95, All India 96, PGI June 95)
  1. Ductal carcinoma
  2. Lobular carcinoma
  3. Mucoid carcinoma
  4. Colloid carcinoma
61. Single file pattern is seen breast cancer type: (APPG 2004)
  1. Intraductal
  2. Infiltrating lobular
  3. Infiltrating ductular
  4. None
62. In which of the following type of carcinoma of the breast, is a biopsy of the opposite breast advised? (UPSC 2002)
  1. Inflammatory carcinoma
  2. Medullary carcinoma
  3. Lobular carcinoma
  4. Scirrhous carcinoma
63. In which of the following type of breast carcinoma, would you consider biopsy of opposite breast? (All India 2006)
  1. Adenocarcinoma poorly differentiated
  2. Medullary carcinoma
  3. Lobular carcinoma
  4. Comedo carcinoma
64. The type of mammary ductal carcinoma is situ (DCIS) most likely to result in a palpable abnormality in the breast is: (All India 2006)
  1. Apocrine DCIS
  2. Neuroendocrine DCIS
  3. Well differentiated DCIS
  4. Comedo DCIS
65. Not true about CA breast in India: (AIIMS June 98)
  1. Incidence is 20/1,00,000
  2. Average age 42 years
  3. Positive family history is a risk factor
  4. More common in muslims
66. Best prognosis amongst the following histological variants of breast carcinoma is seen with: (All India 98)
  1. Intraductal
  2. Colloid (Mucinous)
  3. Lobular
  4. Medullary
67. Which of the following carcinoma is familial? (All India 99)
  1. Breast
  2. Prostate
  3. Cervix
  4. Vaginal
68. Group of lymph node involved in breast carcinoma are all of the following except: (MCI March 2005)
  1. Supraclavicular
  2. Pretracheal
  3. Axillary
  4. Internal mammary
69. Both breasts are affected in which type of breast carcinoma? (MCI Sept 2009)
  1. Inflammatory
  2. Infiltrative
  3. Ductal
  4. Lobular
70. True about breast carcinoma are all except: (MCI March 2007)
  1. Positive family history
  2. Median age of presentation is about 40 years
  3. More common in muslims
  4. Peau d'orange is due to subcutaneous lymphatic involvement
6
72. ‘Peau-d-orange’ is seen in: (PGI 88)
  1. Carcinoma breast
  2. Fibroadenoma
  3. Chronic abscess
  4. Mondor's disease
74. Carcinoma breast with high incidence of involving opposite breast is: (AIIMS Nov 94)
  1. Lobular carcinoma
  2. Medullary carcinoma
  3. Scirrhous adenocarcinoma
  4. Atrophic scirrhous carcinoma
75. All are true about CA breast, except: (AIIMS May 93)
  1. Affected sibling is a risk factor
  2. Paget's disease of nipple is intraductal type of CA
  3. Common in aged nulliparous
  4. Increased incidence with prolonged breast feeding
76. Which of the following indicate CA breast? (PGI Dec 2002)
  1. Serous discharge
  2. Recent retraction of nipple
  3. Ulceration of nipple
  4. Cracked nipple
  5. Cellular atypia
78. ‘Peau-d-orange’ of breast is due to: (MCI Sept 2005, 2010, March 2007)
  1. Obstruction of Vein
  2. Obstruction of lymphatic ducts
  3. Obstruction of glandular ducts
  4. Obstruction of arteries
79. True about lymphatic spread of CA Breast: (PGI June 2005)
  1. Axillary nodes are most commonly involved
  2. Internal mammary nodes are also involved
  3. If supraclavicular lymph node is involved then it is N3
  4. Axillary nodes are treated by surgical resection
 
CARCINOMA BREAST STAGING
86. A 45-years old postmenopausal lady presents with an 8-cm breast lump that is adherent to the skin, with one firm apical lymph node in the axilla and one more node in the ipsilateral supraclavicular area with no clinical evidence of distant metastasis. The staging is: (COMEDK 2010)
  1. T3 N2 M1
  2. T4 N3c M0
  3. T4 N2c M1
  4. T3 N3 M0
88. Ipsilateral supraclavicular lymph nodes are positive in a patient of CA breast. Stage is: (Recent Question 2013, AIIMS Nov 2008)
  1. II
  2. III B
  3. III C
  4. IV
89. CA breast stage T4b involves all except: (AIIMS May 2012)
  1. Nipple retraction
  2. Skin ulcer over the swelling
  3. Dermal edema
  4. Satellite nodule
90. 4 cm breast nodule with ipsilateral mobile LN in axilla staging: (PGI June 2000, Dec 99)
  1. T2N1M0
  2. T2N2M0
  3. T1N1M0
  4. T3N2M1
91. Which of the following stage of breast cancer corresponds with following feature: Breast mass of 6×3 cm size with hard mobile ipsilateral axillary lymph node and ipsilateral supraclavicular lymph node: (AIIMS June 2000)
  1. T4N2M0
  2. T3N1M1
  3. T4N1M1
  4. T3N3M0
92. A 43-years old lady presents with a 5cm lump in right breast with a 3cm node in the supraclavicular fossa. Which of the following TNM stage she belongs to as per the latest AJCC staging system? (AIIMS June 2004)
  1. T2N0M1
  2. T1N0M1
  3. T2N3M0
  4. T2N2M0
7
94. A 45-years old lady present with a lump in her right breast. The lump is 4 cms in diameter with evidence of cutaneous edema (Peau d’ orange), not fixed to pectoralis major muscle. The axillary lymph nodes are not enlarged. What is the status of T in TNM classification: (ICS 2000)
  1. T1>2 cm
  2. T2 is 2-5 cm
  3. T3>5 cm
  4. T4 is any size
 
CARCINOMA BREAST MANAGEMENT
96. True about modified radical mastectomy is: (Punjab 2007)
  1. Pectoralis major is removed
  2. Axillary lymph nodes are preserved
  3. Pectoralis minor is divided
  4. Internal mammary lymph nodes are removed
97. Breast conservation surgery includes: (PGI Dec 2007)
  1. Lumpectomy
  2. Radiotherapy
  3. Chemotherapy
  4. Axillary LN dissection
  5. Sentinel LN biopsy
98. Contraindication for radical mastectomy in CA breast: (PGI Dec 2006)
  1. Distant metastasis
  2. Fixity to chest wall
  3. Axillary LN involvement
  4. Supraclavicular LN involvement
99. Breast conservation surgery indicated in: (PGI Nov 2011)
  1. Tumor size < 4 cm
  2. Central
  3. Mobile
  4. Pendulous breast
  5. Diffuse microcalcification
100. All of the following are removed in radical mastectomy except: (MHPGMCET 2005, AIIMS 92)
  1. Pectoralis major
  2. Pectoralis minor
  3. Axillary lymph node
  4. Supraclavicular lymph node
101. In Patey's modified mastectomy, which of the following is preserved? (MHSSMCET 2006)
  1. Intercostobrachial nerve
  2. Pectoralis major
  3. Pectoralis minor
  4. Axillary fascia
102. Patey's mastectomy following are preserved except: (MHSSMCET 2009)
  1. Teres Major
  2. Teres Minor
  3. Axillary vein
  4. Breast
103. Drug used in estrogen dependent breast cancer: (AIIMS May 2012)
  1. Tamoxifene
  2. Clomiphene citrate
  3. Estrogen
  4. Adriamycin
104. Components of QUARTZ except: (MHSSMCET 2009)
  1. Q uadrantectomy
  2. Axillary dissection
  3. Radiotherapy
  4. Tamoxifen
105. Chronic treatment with tamoxifen can cause carcinoma of: (COMEDK 2010, 2007)
  1. Ovary
  2. Endometrium
  3. Cervix
  4. Vulva
106. Use of tamoxifen for breast cancer can cause all of the following adverse effects, except: (AIIMS May 2011, DPG 2011, PGI Dec 2001)
  1. Thromboembolism
  2. Endometrial carcinoma
  3. Carcinoma in contralateral breast
  4. Cataract
107. A 75-years old hypertensive lady has a 2 × 2cm infiltrating duct cell carcinoma in the subreolar region. There are not palpable lymph nodes and distant metastases. However, she had been treated for pulmonary tuberculosis 20 years ago. The best course of management would be: (UPSC 2004)
  1. Modified radical mastectomy followed by radiotherapy
  2. Modified radical mastectomy followed by 6 cycles of chemotherapy
  3. Breast conservation surgery followed by radiotherapy
  4. Modified radical mastectomy followed by hormone therapy
108. True about treatment of early breast cancer: (AIIMS May 2008)
  1. Aromatase inhibitors are replacing tamoxifen in premenopausal women
  2. Postmastectomy radiation therapy is given when 4 or more lymph nodes are positive
  3. Tamoxifen is not useful in post-menopausal women
  4. In premenopausal women, multidrug chemo-therapy is given in selected patients
109. Simple mastectomy includes removal of: (MCI Sept 2005, 2006)
  1. Only breast
  2. Breast and axillary nodes
  3. Breast + axillaries nodes + pectoralis major muscle
  4. Breast + axillaries nodes + pectoralis major muscle+ pectoralis minor muscle
111. A 50-years old female has under gone mastectomy for CA breast. After mastectomy patient is not able to extend adduct and internally rotate the arm. Now supply to which of the following muscle is damaged? (AIIMS May 2012)
  1. Pectoralis major
  2. Teres minor
  3. Lattisimus dorsi
  4. Long head of triceps
112. In Patey's mastectomy, the step not done is: (PGI 95)
  1. Nipple and areola removed
  2. Surrounding normal tissue of tumor is removed
  3. Pectoralis major removed
  4. Pectoralis minor removed
113. Which is used in CA Breast? (DPG 2007)
  1. Daunorubicin
  2. Doxorubicin
  3. Cisplatin
  4. Actinomycin D
114. Malti, a 45-years female patient with a family history of breast carcinoma, showed diffuse microcalcifi-cation on mammography. Indraductal carcinoma is situ was seen on biopsy. Most appropriate management is: (NEET 2013) (AIIMS June 2001)
  1. Quadrantectomy
  2. Radical mastectomy
  3. Simple mastectomy
  4. Chemotherapy
115. CA Breast stage I and II managed by: (PGI Dec 2002)
  1. Total mastectomy
  2. Modified radical mastectomy
  3. Lumpectomy and axillary clearance
  4. Lumpectomy, axillary clearance and radiotherapy
116. For CA breast best chemotherapeutic regimen: (AIIMS Sept 96, PGI June 96)
  1. Cyclophosphamide, methotrexate, 5-fluorouracil
  2. Methotrexate, cisplatin
  3. Cisplatin, adrimaycin, steroid
  4. Methotrexate, adriamycin, steroid
8
117. A 30-years old female presented with unilateral breast cancer associated with axillary lymph node enlargement. Modified radical mastectomy was done, further treatment plan will be: (AIIMS May 2007)
  1. Observation and follow-up
  2. Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status
  3. Adriamycin based chemotherapy only
  4. Tamoxifen only
118. True about adjuvant therapy in breast cancer: (PGI Dec 2003)
  1. Prognosis is better, if given in young female
  2. Increases survival by 20%
  3. Nodal status positive gives good result
  4. Hormone receptor positive gives good result
  5. Not associated with increased survival
119. Conservative surgery in breast cancer is not to be done in: (PGI Dec 2002)
  1. Low socio-economic status
  2. Age >40 years
  3. Multicentricity
  4. Lymph nodes involvement in axilla
  5. Family history of breast cancer
120. Breast conservative surgery is done in all except: (DPG 2010, UPPG 2000)
  1. Young patients
  2. Ductal carcinoma in situ
  3. Lobular carcinoma
  4. Infiltrative ductal carcinoma
121. Breast conservation surgery is not indicated in: (PGI Dec 2005)
  1. Large pendular breast
  2. SLE
  3. Diffuse microcalcification
  4. Bilateral carcinoma
  5. Family history
122. Absolute contraindication of conservative breast cancer therapy is: (PGI Dec 2005)
  1. Large pendulous breast
  2. History of previous radiation
  3. Axillary node involvement
  4. Subareolar lump present
  5. 1st trimester pregnancy
125. Post operative radiotherapy in breast is given for: (JIPMER 95)
  1. To prevent metastasis
  2. For ablation of remnant of cancer tissue
  3. To prevent recurrence
  4. Prevents distant metastasis
126. A 40-years old female with a 2 cms nodule in the breast and a proved metastatic node in the axilla, treatment is: (PGI 96)
  1. Quadrantectomy
  2. Mastectomy with local radiotherapy
  3. Patey's with adjuvant chemotherapy
  4. Halstedt's operation with tamoxifen
127. Treatment of hormone dependent fungating carcinoma of breast with secondaries in the lung in a female patient aged 30 years is: (MAHE 2005)
  1. Simple mastectomy followed by oophorectomy
  2. Radical mastectomy followed by oophorectomy
  3. Adrenalectomy
  4. Lumpectomy followed by castration
128. A premenopausal lady presents with pulmonary metastasis. She underwent mastectomy 3 years back. True statement regarding her management: (PGI Nov 2011)
  1. It was better if she took adjuvant therapy after mastectomy
  2. First analyze estrogen and progesterone receptor levels on the tumor
  3. Response of chemotherapy is dose dependent
  4. Combined chemotherapy is better than monotherapy
  5. She should now be given chemotherapy with radiotherapy
129. Aromatase inhibitors used in CA breast are: (PGI June 2007)
  1. Letrozole
  2. Anastrozole
  3. Exemestane
  4. Tamoxifen
 
CARCINOMA BREAST PROGNOSTIC INDICATORS
131. The most important prognostic factor of carcinoma breast is: (COMEDK 2010)
  1. Tumour size
  2. DNA content of tumour
  3. Histologic subtype
  4. Tumour grade
132. Prognosis of breast cancer depends mostly upon: (Punjab 2008)
  1. Size of tumour
  2. Axillary lymph node status
  3. Grade of tumour
  4. Estrogen and progesterone receptor
133. Good prognostic markers in breast cancer: (PGI Dec 2006)
  1. ER +ve
  2. PR +ve
  3. HER-2-neu +ve
  4. CD44 +ve
  5. p53 +ve
134. Not a poor prognostic factor in breast carcinoma: (PGI May 2011)
  1. Her-2-neu +ve
  2. Progesterone receptor +ve
  3. Extranodal metastasis
  4. Vascularity of tumor
  5. ER +ve
135. Good prognosis in carcinoma breast are all except: (UPPG 2010)
  1. Positive estrogen progesterone hormone receptor
  2. High HER-2-neu oncogene
  3. DNA flow cytometry shows-diploidy
  4. Low cathepsin-D
  5. Tumour labeling index <3%
136. The most important prognostic factor in carcinoma breast is: (DPG 2009 Feb)
  1. Size of tumour
  2. Skin involvement
  3. Involvement of muscles
  4. Axillary LN involvement
137. Prognosis of breast cancer is best determined by: (APPG 2008)
  1. Estrogen/progesterone receptors
  2. Axillary lymph node status
  3. Clinical assessment
  4. CT
138. Most unfavorable/poor prognosis is seen in which type of breast cancer? (MCI Sept 2007)
  1. Tubular carcinoma
  2. Medullary carcinoma
  3. Colloid carcinoma
  4. Inflammatory carcinoma
9
139. Most important prognostic factor for breast carcinoma is: (MCI March 2005)
  1. Age of the patient
  2. Lymph node involvement
  3. Genetic factors
  4. Family history
140. In case of CA breast most important prognostic factor is: (AIIMS Nov 96, Feb 97)
  1. Size of tumor
  2. Lymph node status
  3. Presence of estrogen receptor
  4. Age of menopause
141. Prognosis in male breast cancer depends mainly on: (AIIMS May 95)
  1. Duration of disease
  2. Nipple discharge
  3. Ulceration of nipple
  4. Lymph node status
142. The risk factor for increased incidence of relapse in stage I carcinoma breast includes all except: (All India 98)
  1. Negative estrogen/progesterone receptor status
  2. High ‘S’ phase
  3. Aneuploidy
  4. Decreased Her-2-neu oncogene
143. In breast cancer following are expressed: (PGI Dec 2007)
  1. Her-2-neu
  2. p53
  3. BRCA-1
  4. BCL-1
  5. CEA
144. In breast carcinoma metastasis, prognosis depends best upon: (All India 98)
  1. Estrogen receptor status
  2. Axillary lymph node status
  3. Size of tumour
  4. Site of tumour
145. Features, which are evaluated for histological grading of breast carcinoma, include all of the following except: (AIIMS Nov 2005)
  1. Tumour necrosis
  2. Mitotic count
  3. Tubule formation
  4. Nuclear pleomorphism
146. The most important prognostic factor in breast carcinoma is: (All India 2006)
  1. Histological grade of the tumour
  2. Stage of the tumour at the time of diagnosis
  3. Status of estrogen and progesterone receptors
  4. Over expression of p53 tumor suppressor gene
148. Estrogen receptor studies in carcinoma breast is done on: (JIPMER 87)
  1. Blood
  2. Urine
  3. Tumour tissue
  4. Ovary
 
COMPLICATIONS OF MASTECTOMY
149. Distressing complication after modified radical mastectomy? (APPG 2008, Orissa 90)
  1. Lymphedema
  2. Axillary vein thrombosis
  3. Seroma
  4. Death
150. The tumour, which may occur in the residual breast or overlying skin following wide local excision and radiotherapy for mammary carcinoma is: (All India 2004)
  1. Leiomyosarcoma
  2. Squamous cell carcinoma
  3. Basal cell carcinoma
  4. Angiosarcoma
151. Complication of post mastectomy lymphedema is: (JIPMER 95)
  1. Metastases of cancer
  2. Recurrence
  3. Lymphosarcoma
  4. Pain
 
BREAST RECONSTRUCTION
153. Reconstruction surgery in breast carcinoma, best myocutaneous flap is: (UPPG 2009)
  1. Pectoralis minor
  2. Pectoralis major
  3. Latissimus dorsi
  4. Transverse rectus abdominis
154. Flap commonly used in breast reconstruction is: (TN 2003)
  1. Serratus anterior
  2. TRAM
  3. Flap from arm
  4. Delto pectoral flap
155. All of the following are used for reconstruction of breast except: (AIIMS Nov 2000)
  1. Transverse rectus abdominis myocutaneous flap
  2. Latissimus dorsi myocutaneous flap
  3. Pectoralis major myocutaneous flap
  4. Transversus rectus abdominis free flap
156. Which of the following flaps gives best cosmetic results for breast reconstruction? (MHPGMCET 2008)
  1. Pectoralis major muscle flap
  2. Latissimus dorsi flap
  3. Transversus rectus abdominis muscle flap
  4. Serratus anterior muscle flap
 
INFLAMMATORY CARCINOMA BREAST
157. Most malignant type of carcinoma breast is: (NIMHANS 86, JIPMER 87)
  1. Paget's disease
  2. Anaplastic carcinoma
  3. Scirrhous carcinoma
  4. Atrophic Scirrhous carcinoma
  5. Mastitis carcinomatosa
158. In inflammatory carcinoma breast with metastasis of axilla, treatment of choice is: (PGI Dec 96)
  1. Radical mastectomy + chemotherapy
  2. Radical mastectomy + radiotherapy
  3. Simple mastectomy + radiotherapy
  4. Chemotherapy + radiotherapy
 
MALE BREAST CANCER
159. True about breast carcinoma in men: (NIMHANS 86, JIPMER 87)
  1. Estrogen receptor positive
  2. Associated with gynaecomastia
  3. Radiotherapy contraindicated due to close proximity to chest wall
  4. Seen in young males
160. What is true about male breast carcinoma? (DPG 2008)
  1. Gynaecomastia is a predisposing factor
  2. More common on right side
  3. Tamoxifen is not given
  4. No estrogen present
10
161. True regarding male breast cancer: (PGI June 2009)
  1. MC lobular type
  2. Estrogen receptor positive
  3. History of gynaecomastia may be present
  4. Paget's disease of nipple is more common in male than female
  5. Undescended testis is a risk factor
162. True about male breast cancer is all except: (MHPGMCET 2009)
  1. Less than 2% of all cases of breast cancer
  2. Most commonly it is infiltrating duct carcinoma
  3. Most commonly it is infiltrating lobular carcinoma
  4. Exocrine or endocrine estrogen exposure can predispose to it
 
CARCINOMA BREAST IN PREGNANCY
163. True about breast cancer in pregnancy:
  1. Occurs in 1 of every 3000 pregnant women
  2. MC non-gynecologic malignancy associated with pregnancy
  3. Ductal carcinoma is MC type, accounting for 75-90% of breast cancer in pregnancy
  4. All of the above
 
MONDOR'S DISEASE
164. Mondor's disease is: (DNB 2014, All India 96)
  1. Thrombophlebitis of the superficial veins of breast
  2. Carcinoma of the breast
  3. Premalignant condition of the breast
  4. Filariasis of the breast
165. About Mondor's disease: (PGI Dec 2006, Dec 2002)
  1. Superficial thrombophlebitis
  2. Lymphatic infiltration tumour cell
  3. Cord like appearance of subcutaneous veins
  4. Occurs all over the body
166. Mondor's disease is superficial thrombophlebitis of: (COMEDK 2005)
  1. Axillary vein
  2. Long saphenous vein
  3. Veins of the breast
  4. Internal mammary vein
 
DUCTAL ANOMALIES
167. Treatment of choice in duct papilloma of breast is: (All India 98, All India 96)
  1. Simple mastectomy
  2. Microdochectomy
  3. Local wide excision
  4. Chemotherapy
168. Treatment for duct ectasia: (MAHE 2008)
  1. Hadfield's operation
  2. Patey's mastectomy
  3. Modified radical mastectomy
  4. Radical mastectomy
169. A woman noticed mass in her left breast with bloody discharge. Histopathology revealed duct ectasia. Treatment is: (AIIMS Nov 2008)
  1. Simple mastectomy
  2. Microdochotomy
  3. Lobectomy
  4. Hadfield operation
 
CYSTOSARCOMA PHYLLODES
171. Treatment of cystosarcoma phyllodes in a young woman: (JIPMER 2011)
  1. Wide excision with a margin
  2. Wide excision with chemotherapy
  3. Wide excision with radiotherapy
  4. MRM
172. Cystosarcoma phyllodes is treated by: (AIIMS May 93)
  1. Simple mastectomy
  2. Radical mastectomy
  3. Modified radical mastectomy
  4. Antibiotic with conservative treatment
173. Which one of the following statements is true of cystosarcoma phyllodes? (UPSC 96)
  1. It is a malignant tumour
  2. It often metastasizes to axillary nodes
  3. It is usually bulky and may fungate through the skin
  4. It is treated by radical mastectomy
174. A mobile, variegated large lump in the breast of a 20-years old female is most likely to be due to: (UPSC 97)
  1. Medullary carcinoma
  2. Inflammatory carcinoma
  3. Cystosarcoma phyllodes
  4. Lobular carcinoma
175. True about cystosarcoma phyllodes is: (DNB 2007)
  1. Calcification
  2. Cystic compondent
  3. Tendency to recur
  4. All of the above
 
GYNECOMASTIA
176. Gynecomastia may be seen in all of the following conditions except: (All India 98)
  1. Klinefelter's syndrome
  2. Cirrhosis of liver
  3. Cryptorchidism
  4. Sex-cord tumour of sertoli cells
177. All of the following statements about gynecomastia are true except: (All India 2007)
  1. Subcutaneous mastectomy is the initial treatment of choice
  2. Seen in liver disease
  3. There may be estrogen/testosterone imbalance
  4. Can be drug induced
178. All are true regarding gynaecomastia except: (AIIMS Nov 93)
  1. May be seen in Addison's disease
  2. Usually unilateral in young males
  3. Acini are not involved
  4. Bilaterality is due to endocrinopathy
179. Gynaecomastia may be seen in patient with all except: (UPSC 88)
  1. Cimetidine therapy
  2. Cirrhosis of liver
  3. Klinefelter's syndrome
  4. Turner's syndrome
180. An adolescent boy presents with bilateral prominence of breasts and wants the breasts to be removed. Which one of the following incisions would be ideal? (UPSC 97)
  1. Radial
  2. Incision along the areolar margin
  3. Submammary incision
  4. Elliptical incision
181. Which of the following is least likely to be associated with gynecomastia? (All India 2012)
  1. Prolactinoma
  2. Adrenal tumors
  3. hCG secreting tumors
  4. Estrogen secreting tumors
 
11PAGET'S DISEASE OF NIPPLE
182. Paget's disease of breast, true statements are: (PGI Nov 2009)
  1. Intraductal carcinoma
  2. Mastectomy needed
  3. Malignant
  4. Bilateral
183. Consider the following statements regarding Paget's disease of the breast: (UPSC 2008)
  1. It is a malignant disease
  2. Diagnosis can be established by scrape cytology
  3. Lymph nodes involvement is an associated clinical feature
  4. Treatment of choice is simple mastectomy
Which of the statements given above is/are correct?
  1. 1, 2 and 4 only
  2. 1, 2 and 3 only
  3. 3 and 4 only
  4. 1, 2, 3 and 4
184. Paget's disease: (DPG 2006)
  1. Incidence is 1:1000
  2. Has underlying intralobular carcinoma
  3. May have underlying carcinoma
  4. Blood stained discharge
186. Paget's disease of breast following are true except: (PGI Dec 97)
  1. Treated by simple mastectomy
  2. Represents underlying malignancy
  3. Presents as eczema
  4. Cytology diagnostic
187. Characteristic feature of Paget's cell is: (Kerala 94)
  1. Eosinophilic cytoplasm
  2. Abundant clear cytoplasm
  3. Glycogen mass
  4. Multinucleated giant cell
188. True about Paget's disease of the nipple is: (Kerala 95)
  1. Always there is underlying carcinoma
  2. Often bilateral eczema of nipple seen
  3. Histology reveals giant cells
  4. Highly malignant
190. Following are true of Paget's disease of breast except: (Karnataka 98)
  1. Usually bilateral
  2. Associated intraductal carcinoma
  3. Prognosis good in absence of lump
  4. Treatment simple mastectomy with axillary clearance
191. Which is not having underlying malignancy? (APPG 2008)
  1. Paget disease of bone
  2. Paget disease of nipple
  3. Paget disease of vulva
  4. Paget disease of anal region
 
MASTITIS AND BREAST ABSCESS
192. Retromammary abscess arises from: (JIPMER 86, 87, Kerala 87)
  1. Tuberculous rib
  2. Infected hematoma
  3. Chronic empyema
  4. All of the above
193. Acute mastitis commonly occurs during: (DNB 2000, UPSC 86, JIPMER 88)
  1. Pregnancy
  2. Puberty
  3. Lactation
  4. Infancy
194. A lactating female presented with breast abscess. Most common organism responsible for her mastitis and abscess formation is: (Punjab 2011)
  1. S. aureus
  2. E. coli
  3. Streptococci
  4. Anaerobes
 
ANDI FIBROADENOMA AND FIBROADENOSIS
195. Fibroadenoma of the breast are: (TN 89)
  1. Fixed mass
  2. Diffuse mass
  3. Multiple diffuse mass
  4. Solitary mobile mass
196. Pre-menstrual fullness in breast in 21-years old unmarried female is: (AIIMS 98)
  1. Galactocele
  2. Fibroadenoma
  3. Fibroadenosis
  4. Breast cancer
197. Regarding cystic disease of breast, which one is true? (AIIMS Nov 97)
  1. Common in 25 years of age
  2. Excision is the treatment
  3. May turn into malignant
  4. Aspiration is the treatment
 
MISCELLANEOUS
200. Cracked nipple may be: (AIIMS 84)
  1. Due to syphilitic chancre
  2. Cause of retention cyst
  3. Paget's disease of nipple
  4. Forerunner of breast abscess
201. Lymphatic drainage of breast: (PGI Dec 2003)
  1. Axillary
  2. Supraclavicular
  3. Internal mammary
  4. Mediastinal
  5. Celiac
202. Breast examination is done yearly in patients with: (PGI 88)
  1. Multiple fibroadenoma
  2. Family history of CA breast
  3. Carcinoma cervix
  4. Endometrial carcinoma
203. A 50-years old woman complains of intermittent bleeding from the left nipple over the past 3 months. No mass is palpable, but a bead of blood can be expressed from the nipple. The ideal procedure in this case would be: (UPSC 97)
  1. Cytological examination of discharge and if no malignant cells, to be kept under careful observation
  2. Segmental excision of breast
  3. Microdochotomy
  4. Simple mastectomy
12
204. Tylectomy literally means: (DNB 91)
  1. Excision of a lump
  2. Excision of LN
  3. Excision of breast
  4. Excision of skin
205. True about galactorrhoea: (PGI Dec 2008)
  1. Always bilateral
  2. Found in pregnancy and lactation
  3. Associated with prolactinoma and other endocrinopathies
  4. Surgery is done
  5. Hypothyroidism can cause galactorrhoea
206. Large breast is not seen in: (AIIMS Dec 95)
  1. Filariasis
  2. Giant fibroadenoma
  3. Cystosarcoma phylloides
  4. Schirrhous carcinoma
207. A 14-years old healthy girl of normal height and weight for age, complains that her right breast has developed twice the size of her left breast since the onset of puberty at the age of 12. Both breasts have a similar consistency on palpation with normal nipples areolae. The most likely cause for these findings is: (AIIMS Nov 2003)
  1. Cystosarcoma phyllodes
  2. Virginal hypertrophy
  3. Fibrocystic disease
  4. Early state of carcinoma
208. Haagensen's sing of inoperability of carcinoma include all except: (DNB 91)
  1. Edema of skin of breast or arm
  2. Satellite tumor nodules in skin of breast
  3. Proved supraclavicular or distant metastases
  4. Parasternal tumorous growth
  5. None of the above
209. Unilateral amastia is associated 90% of the time with absence or hypoplasia of following muscle: (COMEDK 2004)
  1. Latissimus doris
  2. Subclavian
  3. Pectoral
  4. Serratus anterior
210. True about leiomyosarcoma breast: (PGI Nov 2010)
  1. Axillary lymph node dissection is mandatory
  2. Well encapsulated
  3. Follow up not required
  4. Mastectomy is mainstay treatment
  5. Metastasize by lymphatic channel
211. Most frequent site of accessory breast: (Orissa 2011)
  1. Axilla
  2. Groin
  3. Buttock
  4. Thigh
214. A lady 35 years old lactating mother presented with a painful breast lump. Most appropriate initial investigation should be: (AIIMS Nov 2012)
  1. Mammography
  2. USG
  3. MRI
  4. X-ray
215. In sentinel node biopsy for breast cancer, the most commonly injured nerve is: (AIIMS May 2013)
  1. Lateral pectoral nerve
  2. Nerve to lattissimus dorsi
  3. Intercostobrachial nerve
  4. Long thoracic nerve (Nerve to serratus anterior)
13EXPLANATIONS
 
NIPPLE DISCHARGE
1. Ans. c. Ductal papilloma (Ref: Schwartz 10/e p554, 9/e p467; Sabiston 19/e p828; Bailey 26/e p802, 25/e p831)
Nipple Discharge
Colour
Cause
Blood-stained
  • Duct PapillomaQ
  • Intraductal carcinomaQ
  • Duct ectasiaQ
Serous
  • Fibrocystic diseaseQ
  • Duct ectasiaQ
  • CarcinomaQ
Black, green, paste like or grumous discharge
  • Duct ectasiaQ
  • MC cause of greenish discharge: Duct ectasiaQ
  • MC cause of blood-stained discharge: Duct papillomaQ
2. Ans. b. Duct ectasia, c. Ductal papilloma, e. CA breast
3. Ans. b. Duct ectasia.
4. Ans. b. Microdochectomy (Ref: Bailey 26/e p802, 25/e p831; CSDT 12/e p299; Schwartz 10/e p526, 9/e p448)
5. Ans. a. Mammography, b. Cone excision done in single intraductal tumour, d. Red discharge indicate malignancy, e. Blue-black discharge indicate duct ectasia
6. Ans. b. Radical duct excision is the operation of choice.
 
CARCINOMA BREAST INVESTIGATIONS
7. Ans. d. Clinical examination, Mammogr am and FNAC (Ref: Schwartz 10/e p522-523, 9/e p444-446; Sabiston 19/e p840-842; Bailey 26/e p799-801, 25/e p829-832)
  • 14Triple Assessment includes a combination of clinical assessment, radiological imaging (USG/ Mammography) and tissue sample analysis (FNAC/Biopsy)Q
  • The positive predictive value of Triple Assessment should exceed 99.9%Q
8. Ans. c. Biopsy (Ref: Schwartz 10/e p529-530, 9/e p450; Sabiston 19/e p830-831; Bailey 26/e p800, 25/e p829; Devita 9/e p1407)
Biopsy Techniques for Breast Lesions
Technique
Advantages
Disadvantages
  • FNAC
  • Rapid, painless, inexpensive.
  • No incision prior to selection of local therapy
  • Does not distinguish invasive from in situ cancerQ.
  • Markers (ER, PR, HER-2) not routinely availableQ.
  • Requires experienced cytopathologistQ.
  • False negatives and insufficient specimens occur.
True-cut (core-cut) Biopsy
  • Rapid, relatively painless, inexpensive. No incision.
  • Can be read by any pathologistQ, markers (ER, PR, HER-2) routinely availableQ.
  • False-negative results, incomplete lesion characterization can occur.
Excisional biopsy
  • False-negative results rare.
  • Complete histology before treatment decisions.
  • May serve as definitive lumpectomy.
  • Expensive, more painful.
  • Creates an incision to be incorporated into definitive surgery.
  • Unnecessary surgery with potential for cosmetic deformity in patients with benign abnormalities.
9. Ans. a. FNAC (Ref: Schwartz 10/e p523-529, 9/e p447-450; Sabiston 19/e p830-832; Bailey 26/e p799-801, 25/e p828-829)
  • First investigation: FNACQ
  • Best and diagnostic investigation: BiopsyQ
Investigations in CA Breast
Mammography
  • Initial investigation for symptomatic breast in women >35 years and for screeningQ
  • IOC for microcalcificationQ
Ultrasound
  • Initial investigation for palpable lesions in women <35 yearsQ
  • Not useful in screening
MRI
  • Indicated in scarred breast, implants and borderline lesions for breast conservation
  • IOC for implant related complicationsQ
  • Gold standard for imaging breast in females with implantsQ
PET scan
  • IOC for detecting recurrences in scarred breastQ
  • Useful in multifocal disease and in helping detect axillary involvement
10. Ans. a. FNAC
11. Ans. a. MRI
 
MAMMOGRAPHY
12. Ans. a. Mammography (Ref: Grainger 5/e p1190, 1188)
13. Ans. a. Indicated in 50–70 years of age, b. Mortality reduced by 30% (Ref: Schwartz 10/e p523-525, 9/e p447; Sabiston 19/e p831-832; Bailey 26/e p799, 25/e p828)
14. Ans. c. Macrocalcification (Ref: Schwartz 10/e p523-525, 9/e p447; Sabiston 19/e p831-832; Bailey 26/e p799, 25/e p828)
Mammography
Benign
Malignant
Opacity
  • Smooth margin
  • Low density
  • Homogeneous
  • Thin halo
  • Ill definedQ margin, irregular stellate, spiculatedQ margin, comet tailQ
  • High densityQ
  • Heterogeneous
  • Wide haloQ
Calcification
  • MacrocalcificationQ
    >0.5 mm in diameter)
  • MicrocalcificationQ
    (<0.5 mm in diameter)
Breast Parenchyma
  • Normal
  • Architectural distortionQ
Nippl/eareola
  • Normal
  • ± Retracted
Skin
  • Normal
  • ThickenedQ
Cooper ligaments
  • Normal
  • ThickenedQ, increased number
Subcutaneous retro mammary space
  • Normal
  • ObliteratedQ
1715. Ans. a. Breast Imaging Reporting And Data System (Ref: Sabiston 19/e p834)
BIRADS (Breast Imaging Reporting And Data System)
Category
Definition
0
Incomplete assessment, need additional imaging evaluationQ
1
Negative, routine mammogram in 1 year is recommendedQ
2
Benign findings, routine mammogram in 1 year is recommendedQ
3
Probably benign findings, short term follow-up suggestedQ
4
Suspicious abnormality, biopsy should be consideredQ
5
Highly suggestive of malignancy, appropriate action should be takenQ
6
Known biopsy-proven malignancy
16. Ans. a. Nodular calcification
17. Ans. a. Fibroadenoma (Ref: Robbins 7/e p1149)
Pattern of Calcification in Breast Diseases
Carcinoma
Microcalcification, punctate, branchingQ
Fibroadenoma
PopcornQ (coarse, granular, crushed stone)
Fibrocystic disease
Powdery
Fat necrosis
Curvilinear
18. Ans. d. Carcinoma
19. Ans. c. It should be part of the regular follow up of a woman following therapy for unilateral breast cancer
20. Ans. c. 40 years
 
CARCINOMA BREAST RISK FACTORS
21. Ans. a. Nulliparity, c. Family history, d. BRCA-1 mutation, e. Estrogen (Ref: Schwartz 10/e p511-512, 9/e p436-438; Sabiston 19/e p834; Bailey 26/e p808-809, 25/e p837)
22. Ans. b. Epithelial hyperplasia (Ref: Schwartz 10/e p508, 9/e p433-434; Sabiston 19/e p835; Bailey 26/e p809, 25/e p837)
Proliferative Lesions Relative Risks for Developing Invasive Breast Cancer
Nonproliferative changes: 70% Relative Risk = 1.0
  • Adenosis
  • Cysts and apocrine change
  • Ductal ectasia
  • Mild epithelial hyperplasia of usual type
Proliferative disease without atypia: 26% Relative Risk =1.5–2.0
  • Hyperplasia of usual type, moderate or florid
  • Papilloma
  • Sclerosing adenosis
Proliferative disease with atypia: 4% Relative Risk = 4–5
  • Atypical ductal hyperplasiaQ
  • Atypical lobular hyperplasiaQ
1823. Ans. b. Atypical lobular hyperplasia (Ref: Schwartz 10/e p508, 9/e p434; Sabiston 19/e p835; Bailey 26/e p809, 25/e p837)
Cancer Risk Associated (with Benign Breast Disorders and In Situ Carcinoma of the Breast)
Abnormality
Relative Risk
Nonproliferative lesions of the breast
No increased risk
Sclerosing adenosis
No increased risk
Intraductal papilloma
No increased risk
Florid hyperplasia
1.5 to 2-fold
Atypical lobular hyperplasiaQ
4–fold
Atypical ductal hyperplasiaQ
4–fold
Ductal involvementQ by cells of atypical ductal hyperplasia
7–fold
Lobular carcinoma in situQ
10–fold
Ductal carcinoma in situQ
10–fold
24. Ans. d. Atypical ductal hyperplasia
25. Ans. c. Commoner in nulliparous women
26. Ans. b. First child at a younger age
27. Ans. d. 60 (Ref: Schwartz 10/e p514-515, 9/e p437-440; Sabiston 19/e p835-837; Bailey 26/e p817-818, 25/e p846; Harrison 18/e p754-755; Devita 9/e p1373)
BRCA-1
BRCA-2
  • Chromosome: 17Q
  • BRCA-1 associated breast cancers:
    • Invasive ductal carcinomas
    • Poorly differentiatedQ
    • Hormone-receptor negativeQ
    • Early age of onset
    • – Bilateral
  • Associated ovarian, colon and prostate cancersQ.
  • Chromosome: 13Q
  • BRCA-2 associated cancers:
    • Invasive ductal carcinomas
    • Well differentiatedQ
    • Hormone-receptor positiveQ.
    • Early age of onset
    • Bilateral
  • Associated ovarian, colon, prostate, pancreas, gall bladder, stomach cancers and melanomaQ. (95 m)
28. Ans. c. CA breast
zoom view
29. Ans. c. Lung
1930. Ans. a. Increased risk in relatives, c. Nullipara, d. High fat diet, e. Who avoided breast feeding
31. Ans. d. Ataxia telangiectasia (Ref: Schwartz 10/e p514-515, 9/e p438; Sabiston 19/e p835-836; Bailey 26/e p817, 25/e p846)
Incidence of Sporadic, Familial and Hereditary Breast Cancer
Sporadic breast cancerQ
65-75%
Familial breast cancerQ
20-30%
Hereditary breast cancer
  • BRCA1Q
  • BRCA2Q
  • p53 (Li-Fraumeni syndrome)Q
  • STK11/LKB1a (Peutz-Jeghers syndrome)Q
  • PTENa (Cowden disease)Q
  • MSH2/MLH1a (Muir-Torre syndrome)Q
  • ATMa (Ataxia-telangiectasia)Q
  • Unknown
5-10%
45%
35%
1%
<1%
<1%
<1%
20%
32. Ans. a. Ductal carcinoma (Ref: Schwartz 10/e p514-515, 9/e p438-440; Sabiston 19/e p835-836; Bailey 26/e p817, 25/e p846)
33. Ans. b. Epitheliosis
34. Ans. c. Fibrocystic change (Ref: Robbins 7/e p1127)
  • Fibrocystic change doesn't lead to carcinoma breast.
  • Robbins says “ Fibrocystic changes (Non-proliferative breast changes): Non-proliferative changes are most likely part of the spectrum of histologic features that can be observed in normal breast.”
35. Ans. b. Atypical hyperplasia, d. Florid hyperplasia
36. Ans. a. First degree relative, b. Atypical hyperplasia, d. Increased fat intake
37. Ans. a. Consume fatty food, e. Did not breastfed their children
38. Ans. a. Those who avoid breast-feeding to the infant, c. Nulliparity, d. High fat diet, e. Family history of breast cancer
39. Ans. b. Paternal grandmother had history, d. Fat necrosis
40. Ans. a. Have an early menarche and late menopause, c. Have their first child after the age of 35 years, d. Avoid breast feeding, e. Are nuns
41. Ans. b. Sister died from cancer, c. Jewish origin
42. Ans. d. Epitheliosis
43. Ans. c. Atypical lobular hyperplasia, d. Atypical ductal hyperplasia
44. Ans. c. Those who have not breast fed their children
45. Ans. d. Early full term pregnancy
 
CARCINOMA BREAST
46. Ans. a. Ductal carcinoma in-situ (Ref: Schwartz 10/e p520, 9/e p444; Sabiston 19/e p840-842; Bailey 26/e p810, 25/e p838)
47. Ans. b. Invasive lobular carcinoma (Ref: Schwartz 10/e p519-522, 9/e p444-446; Sabiston 19/e p842; Bailey 26/e p809, 25/e p838)20
48. Ans. c. Poor Prognosis
49. Ans. a. Single file pattern
50. Ans. a. Axillary LN, b. Internal mammary LN (Ref: Bailey 26/e p810, 25/e p839; BDC 4/e pvol-I /42-43)
51. Ans. a. Her-2-neu, b. p53, c. BRCA-1, e. CEA (Ref: Schwartz 9/e p438; Sabiston 19/e p835-836; Bailey 26/e p817, 25/e p846; Harrison 17/e p604, 483)
  • BCL-1 gene is expressed in mantle cell lymphomaQ.
  • Her-2-neu, p53, BRCA-1 and CEA is expressed in CA breastQ.
52. Ans. b. Breast mass
53. Ans. a. Upper outer
54. Ans. a. {I= (0.2 x size) + grade + nodes} (Ref: Bailey 25/e p841)
55. Ans. c. Inflammatory carcinoma (Ref: Schwartz 10/e p520-522, 9/e p468; Sabiston 19/e p864-865; Devita 7/e p1420)21
56. Ans. a. Comedocarcinoma, c. Lobular carcinoma in situ
57. Ans. a. Comedocarcinoma
58. Ans. a. Ductal carcinoma in situ
59. Ans. d. Tubular
60. Ans. b. Lobular carcinoma
61. Ans. b. Infiltrating lobular
62. Ans. c. Lobular carcinoma
63. Ans. c. Lobular carcinoma
2264. Ans. d. Comedo DCIS
65. Ans. d. More common in Muslims
66. Ans. b. Colloid (Mucinous)
67. Ans. a. Breast (Ref: Robbins 7/e p285; Sabiston 19/e p705)
2368. Ans. b. Pretracheal
69. Ans. d. Lobular (Ref: Schwartz 10/e p550-552, 9/e p444; Sabiston 19/e p840-842; Bailey 26/e p809, 25/e p838)
LCIS
DCIS
Age (years)
44–47 (Early)
54–58 (Late)Q
Incidence
2-5% (Less common)
5-10% (More common)Q
Clinical signs
None
Mass, pain, nipple discharge
Mammographic signs
None
MicrocalcificationsQ
Premenopausal
2/3Q
1/3
Incidence of synchronous invasive carcinoma
5%
2–46%Q
Multicentricity
60–90%Q
40–80%
Bilaterality
50–70%Q
10–20%
Axillary metastasis
1%
1–2%Q
Subsequent carcinomas:
Incidence
25-35%
25–70%Q
Laterality
BilateralQ
Ipsilateral
Interval to diagnosis
15–20 yearsQ
5-10 years
Histologic type
Ductal
Ductal
70. Ans. c. More common in muslims
71. Ans. c. Lymphatic permeation (Ref: Bailey 26/e p811, 25/e p840)
72. Ans. a. Carcinoma breast, c. Chronic abscess
73. Ans. d. Lumbar vertebra (Ref: Bailey 26/e p811)
  • Most common site of metastasis from breast carcinoma is lumbar vertebra.
74. Ans. a. Lobular carcinoma
75. Ans. d. Increased incidence with prolonged breast feeding
76. Ans. b. Recent retraction of nipple, e. Cellular atypia
77. Ans. b. Blockage of subdermal lymphatics
78. Ans. b. Obstruction of lymphatic ducts
79. Ans. a. Axillary nodes are most commonly involved, b. Internal mammary nodes are also involved, c. If supraclavicular lymph node is involved then it is N3, d. Axillary nodes are treated by surgical resection (Ref: Bailey 25/e p839; BDC 4/e pvol-I /42-43) See question no. 49.
80. Ans. d. Bone
81. Ans. d. Invasive ductal carcinoma
82. Ans. d. Lower inner quadrant (Ref: Bailey 25/e p840)
83. Ans. b. Subareolar duct (Ref: Bailey 25/e p834)
2484. Ans. b. DCIS (Ref: Bailey 25/e p838)
85. Ans. c. Raloxifene is a SERM that prevents breast cancer but increases risk of endometrial cancer
 
CARCINOMA BREAST STAGING
86. Ans. d. T3 N3 M0 (Ref: Schwartz 10/e p532, 9/e p452; Sabiston 19/e p847; Bailey 25/e p841)
87. Ans. b. Pectoralis major (Ref: Schwartz 9/e p452; Sabiston 19/e p847; Bailey 25/e p841)
  • Chest wall involvement means involvement of ribsQ, intercostal musclesQ or Serratus anteriorQ as chest wall is formed by these structures not the pectoralis major.
88. Ans. c. IIIC
89. Ans. a. Nipple retraction
90. Ans. a. T2 N1M0
91. Ans. d. T3N3M0
92. Ans. c. T2N3M0
93. Ans. c. T1cN1bM0
94. Ans. d. T4 is any size
95. Ans. d. M1
 
CARCINOMA BREAST MANAGEMENT
96. Ans. c. Pectoralis minor is divided (Ref: Schwartz 10/e p547-549, 9/e p460-461; Sabiston 19/e p849-853; Bailey 26/e p813-814, 25/e p842)
2697. Ans. a. Lumpectomy, b. Radiotherapy, d. Axillary LN dissection, e. Sentinel LN biopsy (Ref: Schwartz 10/e p547, 9/e p460-461; Sabiston 19/e p850-851; Bailey 26/e p813-814, 25/e p843)
98. Ans. a. Distant metastasis (Ref: Breast diseases by Jay R. Harris 2/e p354; Bailey 25/e p839, 840)
zoom view
99. Ans. a. Tumor size <4cm c. Mobile.
100. Ans. d. Supraclavicular lymph node (Ref: Schwartz 9/e p461; Bailey 26/e p813, 25/e p842)
101. Ans. b. Pectoralis major
102. Ans. d. Breast
27103. Ans. a. Tamoxifene (Ref: Schwartz 10/e p552, KDT 6/e p304; Goodman and Gillman's 10/e p1440, 1441)
104. Ans. d. Tamoxifen
  • QUARTZ: Quadrantectomy + Axillary LN dissection + RadiotherapyQ
105. Ans. b. Endometrium (Ref: KDT 6th /304; Goodman and Gillman's 10/e p1440, 1441)
106. Ans. c. Carcinoma in contralateral breast
107. Ans. d. Modified radical mastectomy followed by hormone therapy (Ref: Schwartz 10/e p537-544, 9/e p454-457; Sabiston 19/e p858-864; Bailey 26/e p812-816, 25/e p841-842)
108. Ans. b. Postmastectomy radiation therapy is given when 4 or more lymph nodes are positive (Ref: Schwartz 10/e p550, 9/e p463; Sabiston 19/e p858; Bailey 26/e p814, 25/e p843)
  • Metastatic disease is the principal cause of death from breast cancerQ.
109. Ans. a. Only breast
110. Ans. d. Axillary vein (Ref: Gray's 39/e p841)
111. Ans. c. Latissimus dorsi (Ref: BDC 4/e vol-I/p62)
112. Ans. c. Pectoralis major removed
113 Ans. b. Doxorubicin (Ref: Bailey 26/e p815, 25/e p844; Schwartz 10/e p550-551, 9/e p263)
114. Ans. c. Simple mastectomy
29115. Ans. b. Modified radical mastectomy, d. Lumpectomy, axillary clearance and radiotherapy
116. Ans. a. Cyclophosphamide, methotrexate, 5-fluorouracil
117. Ans. b. Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status
118. Ans. a. Prognosis is better, if given in young female, b, Increases survival by 20%, d. Hormone receptor positive gives good result (Ref: Bailey 26/e p811, 25/e p844)
119. Ans. a. Low socio-economic status, c. Multicentricity
120. Ans. c. Lobular carcinoma (Ref: Schwartz 9/e p460-461; Sabiston 19/e p850-851; Bailey 26/e p811, 25/e p843)
  • Lobular carcinoma is frequently multifocal, multicentric and bilateral and is contraindication for breast conservative surgeryQ.
121. Ans. a. Large pendular breast, b. SLE, c. Diffuse microcalcification
122. Ans. b. History of previous radiation, e. 1st trimester pregnancy
123. Ans. a. 1 cm (Ref: Mastery of Surgery 5/e p525)
124. Ans. c. Sentinel node biopsy
125. Ans. c. To prevent recurrence
126. Ans. c. Patey's with adjuvant chemotherapy
127. Ans. a. Simple mastectomy followed by oophorectomy
128. Ans. a. It was better if she took adjuvant therapy after mastectomy, b. First analyze estrogen and progesterone receptor levels on the tumor
129. Ans. a. Letrozole, b. Anastrozole, c. Exemestane (Ref: Schwartz 10/e p552-553, 9/e p465-467; Sabiston 19/e p862-864; Bailey 25/e p844)
130. Ans. a. 5 years
 
CARCINOMA BREAST PROGNOSTIC INDICATORS
131. Ans. a. Tumor size (Ref: Schwartz 10/e p535-536, 9/e p453-454; Bailey 26/e p811, 25/e p841; Harrison 17/e p566)30
132. Ans. b. Axillary lymph node status (Ref: Schwartz 10/e p535-536, 9/e p453-454; Bailey 26/e p811, 25/e p841)
133. Ans. a. ER +ve, b. PR +ve
134. Ans. b. Progesterone receptor +ve, e. ER +ve
135. Ans. b. High HER-2-neu oncogene
136. Ans. d. Axillary LN involvement
137. Ans. b. Axillary lymph node status
138. Ans. d. Inflammatory carcinoma
139. Ans. b. Lymph node involvement
140. Ans. b. Lymph node status
141. Ans. d. Lymph node status (Ref: Schwartz 10/e p555, 9/e p468; Sabiston 19/e p865-866; Bailey 26/e p819, 25/e p848)
142. Ans. d. Decreased Her-2-neu oncogene
143. Ans. a. HER-2-neu, b. p53, c. BRCA-1, e. CEA
144. Ans. a. Estrogen receptor status
145. Ans. a. Tumour necrosis (Ref: Bailey 25/e p838)
146. Ans. b. Stage of the tumour at the time of diagnosis
147. Ans. d. Gene expression profiling (Ref: Robbins 8/e p1084; Harrison 18/e p757; Schwartz 9/e p453; Sabiston 19/e p842-845; Bailey 26/e 816, 25/e p838)
Molecular classification of breast cancer is based on gene expression profiling.
zoom view
Luminal criteria
Luminal criteria
Type
Properties
Luminal A
ER and PR +ve, Her-2-neu –veQ
Luminal B
ER, PR and Her-2-neu +ve (Triple positive)Q
Normal breast-like
Well-differentiated, ER-positive
Basal cell type
Triple negative, positive for myoepithelial markersQ (basal keratins, P-cadherin, p63, or laminin), CK-5, 6 and 17, EGFR
Her-2 type
Her-2-neu +ve, ER and PR –veQ
148. Ans. c. Tumour tissue (Ref: Schwartz 9/e p453; Sabiston 19/e p842-845; Sabiston 19/e p844; Bailey 26/e p816, 25/e p838)
 
COMPLICATIONS OF MASTECTOMY
149. Ans. a. Lymphedema (Ref: Schwartz 9/e p461; Sabiston 19/e p852-853; Bailey 26/e p813, 25/e p842)
150. Ans. d. Angiosarcoma (Ref: Schwartz 9/e p469; Sabiston 19/e p845; Bailey 26/e p816, 25/e p845)
151. Ans. c. Lymphosarcoma
152. Ans. b. Intercostobrachial neuralgia (Ref: Medical Care of Cancer Patients by Sai-Ching Jim Yeung, Carmen P. Escalanate, Robert F)
 
BREAST RECONSTRUCTION
153. Ans. d. Transverse rectus abdominis (Ref: Schwartz 10/e p549-550, 9/e p462-463; Sabiston 19/e p871-875; Bailey 26/e p816-817, 25/e p845)
154. Ans. b. TRAM (Ref: Schwartz 10/e p549-550, 9/e p462-463; Sabiston 19/e p871-875; Bailey 26/e p816-817, 25/e p845)
155. Ans. c. Pectoralis major myocutaneous flap
156. Ans. c. Transversus rectus abdominis muscle flap
 
INFLAMMATORY CARCINOMA BREAST
157. Ans. e. Mastitis carcinomatosa (Ref: Schwartz 10/e p555, 9/e p468; Sabiston 19/e p864-865)
  • MC type of CA breast: Invasive ductal carcinomaQ
  • Most malignant type of CA breast: Inflammatory breast cancerQ
34158. Ans. None (Ref: Schwartz 10/e p555, 9/e p468; Sabiston 19/e p864-865)
 
MALE BREAST CANCER
159. Ans. a. Estrogen receptor positive, b. Associated with gynaecomastia (Ref: Schwartz 10/e p555, 9/e p468; Sabiston 19/e p1935; Bailey 26/e p819, 25/e p848)
160. Ans. a. Gynaecomastia is a predisposing factor (Ref: Schwartz 9/e p468; Sabiston 19/e p865-866; Bailey 25/e p848)
  • Male breast cancer is preceded by gynecomastia in 20% of menQ.
161. Ans. b. Estrogen receptor positive, c. History of gynaecomastia may be present, e. Undescended testis is a risk factor
162. Ans. c. Most commonly it is infiltrating lobular carcinoma
 
CARCINOMA BREAST IN PREGNANCY
163. Ans. d. All of the above (Ref: Schwartz 10/e p554, 9/e p467; Sabiston 19/e p2035-2037; Bailey 26/e p818, 25/e p846)
 
MONDOR'S DISEASE
164. Ans. a. Thrombophlebitis of the superficial veins of breast (Ref: Schwartz 10/e p507, 9/e p433; Sabiston 19/e p1594; Bailey 26/e p805, 25/e p833)
165. Ans. a. Superficial thrombophlebitis, c. Cord like appearance of subcutaneous veins
166. Ans. c. Veins of the breast
 
DUCTAL ANOMALIES
167. Ans. b. Microdochectomy (Ref: Bailey 26/e p802, 25/e p830)
168. Ans. a. Hadfield's operation (Ref: Bailey 26/e p805, 25/e p834)
169. Ans. d. Hadfield's operation
170. Ans. a. Nipple discharge
 
CYSTOSARCOMA PHYLLODES
171. Ans. a. Wide excision with a margin (Ref: Schwartz 10/e p555, 9/e p468; Sabiston 19/e p845; Bailey 25/e p836)
172. Ans. a. Simple mastectomy
173. Ans. c. It is usually bulky and may fungate through the skin
174. Ans. c. Cystosarcoma phyllodes
175. Ans. d. All of the above
 
GYNAECOMASTIA
176. Ans. c. Cryptorchidism (Ref: Schwartz 10/e p505-506, 9/e p430-432; Sabiston 19/e p828; Bailey 25/e p847)
39177. Ans. a. Subcutaneous mastectomy is the initial treatment of choice (Ref: Schwartz 10/e p505-506, 9/e p430-432; Sabiston 19/e p828; Bailey 25/e p847; Williams Endocrinology 10/e p741)
178. Ans. a. May be seen in Addison's disease, b. Usually unilateral in young males
179. Ans. d. Turner's syndrome
180. Ans. b. Incision along the areolar margin
181. Ans. a. Prolactinoma (Ref: Harrison 18/e p2889)
 
PAGET'S DISEASE OF NIPPLE
182. Ans. a. Intraductal carcinoma, b. Mastectomy needed c. Malignant (Ref: Schwartz 10/e p506-521, 9/e p444-445; Sabiston 19/e p865; Bailey 25/e p838)
183. Ans. d. 1, 2, 3 and 4
184. Ans. c. May have underlying carcinoma
185. Ans. b. Paget's disease
186. Ans. d. Cytology diagnostic
187. Ans. b. Abundant clear cytoplasm
188. Ans. a. Always there is underlying carcinoma
189. Ans. a. 1% associated with underlying invasive carcinoma of breast
190. Ans. a. Usually bilateral
191. Ans. a. Paget disease of bone
 
MASTITIS AND BREAST ABSCESS
193 Ref: c. Lactation (Ref: Schwartz 10/e p506, 9/e p432; Sabiston 19/e p839; Bailey 25/e p832-833)
194. Ans. a. S. aureus (Ref: Schwartz 10/e p506, 9/e p432; Sabiston 19/e p839; Bailey 25/e p832-833)
 
41ANDI FIBROADENOMA AND FIBROADENOSIS
195. Ans. d. Solitary mobile mass (Ref: Bailey 25/e p836; Schwartz 10/e p510, 9/e p433-434; Sabiston 19/e p827)
196. Ans. c. Fibroadenosis (Ref Schwartz 10/e p507, 9/e p433-435; Sabiston 19/e p827-828; Bailey 25/e p835)
  • Fibroadenosis or fibrocystic disease is the cause of pre-menstrual fullness in breast in 21 years old unmarried female.
  • Rest of the options are highly unlikely.
197. Ans. d. Aspiration is the treatment (Ref: Schwartz 10/e p51; Bailey 25/e p836)
198. Ans. b. Fibroadenoma
199. Ans. b. Tightly arranged ductal epithelial cells with dyscohesive bare nuclei (Ref: Winfred Grays diagnostic cytopathology 2/e p279-280)
Non-tender, firm and mobile breast lump in a female of age 17 years is suggestive of fibroadenoma, in which tightly arranged ductal epithelial cells with dyscohesive bare nuclei are seen on FNAC. (AIIMS May 2013 repeat)
Fibroadenoma:
  • Diagnostic findings on needle biopsy consist of:?
    • Abundant stromal cells which appear as bare bipolar nuclei
    • Sheets of fairly uniform-size epithelial cellsthat are typically arranged in either an antler like pattern or a honeycomb pattern.
    • Foam cells and apocrine cells may also be seen, although these are less diagnostic features.
 
MISCELLANEOUS
200. Ans. d. Forerunner of breast abscess (Ref: Bailey 25/e p830)
201. Ans. a. Axillary, b. Supraclavicular, c. Internal mammary
43202. Ans. b. Family history of CA breast
203. Ans. c. Microdochotomy
204. Ans. a. Excision of a lump
  • Lumpectomy (Tylectomy): Surgical procedure designed to remove a discrete lump
205. Ans. c. Associated with prolactinoma and other endocrinopathies, d. Surgery is done, e. Hypothyroidism can cause galactorrhoea (Ref: Harrison 17/e p2204-2205; Dutta Gynecology 5/e p548-549)
206. Ans. d. Schirrhous carcinoma (Ref: Norman Brows/e277)
207. Ans. b. Virginal hypertrophy (Ref: CPDT 16/e p1128)
208. Ans. e. None of the above (Ref: NMS surgery 4/e p456)
Haagensen's Criteria of Inoperability
1. Extensive edema of the breastQ
5. A parasternal tumorQ, indicating spread to the internal mammary LNs
2. Satellite noduleQ of carcinoma
6. Edema of armQ
3. Inflammatory carcinomaQ
7. Distant metastasisQ
4. Supraclavicular metastasisQ
209. Ans. c. Pectoral (Ref: Bailey 25/e p831)
210. Ans. b. Well encapsulated, d. Mastectomy is mainstay treatment (Ref: Cancer of Breast by Donegau 5/e p933-936; Breast Cancer by Roses 2/e p207-208)
211. Ans. a. Axilla (Ref: Bailey 26/e p803, 25/e p831)
212. Ans. b. Chronic areolar abscess (Ref: Schwartz 10/e p506, 9/e p433)
213. Ans. d. Parasternal (Ref: Bailey 25/e p839)
214. Ans. b. USG (Ref: Sutton's Radiology 7/e p1456; Schwartz 9/e p467; Sabiston 19/e p2035-2037; Bailey 25/e p846)
215. Ans. c. Intercostobrachial nerve
216. Ans. b. i.e., Isosulfan blue dye (Ref: Schwartz 9/e p259)
Lymphetic mapping is performed by using isosulfan blue dye, technetium-labled sulfur colloid ablumin or a combination of both
217. Ans. b. Breast mass but no lymph node palpable. (Ref: Schwartz 9/e p258)