Breast Surgery Practice Questions

Q: All are true about the condition shown except?

Surgical excision. ***Surgical excision*** - Mondor's disease, or **thrombophlebitis** of the **superficial veins** of the breast or chest wall, is a **self-limiting condition** that typically resolves with conservative management and does not require surgical excision. - Treatment usually involves **warm compresses**, **analgesics**, and **anti-inflammatory medication**, with symptoms resolving within weeks to months. *Thrombophlebitis* - The image shows a **reddened**, **indurated** chord-like structure on the breast, consistent with **Mondor's disease**, which is a **superficial thrombophlebitis**. - This condition involves inflammation and **thrombosis** of subcutaneous veins, leading to the characteristic palpable cord. *Thoracoepigastric vein involved* - Mondor's disease most commonly affects the **lateral thoracic**, **thoracoepigastric**, or **superior epigastric veins**. - The palpable cord seen in the image corresponds to one of these superficial veins that has become thrombosed. *Thrombosed subcutaneous cord* - A hallmark of Mondor's disease is the presence of a **palpable**, **tender**, **cord-like structure** beneath the skin. - This cord represents a thrombosed and inflamed superficial vein, which is clearly depicted in the provided image.

Q: What is the most possible diagnosis?

Mondor's disease. ***Mondor's disease*** - The image shows a **palpable, tender cord-like structure** with skin retraction, characteristic of **thrombophlebitis of superficial veins** in the breast or chest wall, which is Mondor's disease. - This condition is often **self-limiting** and can be associated with trauma, surgery, or inflammation, leading to a firm, subcutaneous cord. *Poland syndrome* - This is a **congenital anomaly** characterized by **underdevelopment or absence of the pectoralis muscle** and often involves syndactyly or brachydactyly. - It would present as a **missing or underdeveloped chest muscle**, not a palpable cord-like lesion. *Tietze disease* - Involves **inflammation of the costochondral junctions**, typically presenting as localized pain and swelling in the chest wall, usually at the second or third rib. - It is an inflammation of cartilage and does not involve a **visible, cord-like structure** on the breast surface. *Duct ectasia* - This condition involves the **dilation of breast ducts**, often leading to nipple discharge, periareolar inflammation, or a palpable mass beneath the nipple. - It does not typically present as a **superficial, firm cord** with skin retraction, as seen in the image.

Q: A perimenopausal woman presents with chronic multiduct green-brown nipple discharge and the following image. Ultrasound shows subareolar duct dilatation. The diagnosis is:

Duct ectasia. ***Duct ectasia*** - The image suggests **nipple retraction**, indicated by the arrow pointing towards the inverted nipple, which is a classic clinical sign of duct ectasia. - The clinical context of a perimenopausal woman with chronic multiduct green-brown discharge and subareolar duct dilatation on ultrasound strongly supports a diagnosis of duct ectasia. - **Duct ectasia** can also cause nipple discharge, an inflamed nipple, or a lump behind the nipple. *Duct papilloma* - **Duct papillomas** are benign growths within the breast ducts, typically presenting with spontaneous nipple discharge, often bloody or serous. - They usually do not cause nipple retraction unless they are large and located close to the nipple. - Multiduct green-brown discharge and subareolar duct dilatation are not characteristic features. *Carcinoma breast* - **Nipple retraction** alone cannot reliably distinguish duct ectasia from breast carcinoma, as acquired nipple retraction can indicate breast carcinoma. - However, the combination of perimenopausal age, chronic multiduct green-brown discharge, and subareolar duct dilatation on imaging favors duct ectasia over carcinoma in this clinical context. - Breast carcinoma would more typically present with a palpable mass, skin dimpling, unilateral bloody discharge, or suspicious imaging findings. *Galactocele* - A **galactocele** is a milk-filled cyst that typically occurs during or after lactation. - It usually presents as a discrete, mobile, non-tender lump and does not cause nipple retraction.

Q: What technique has been depicted in the image shown below?

Sentinel lymph node biopsy. ***Sentinel lymph node biopsy*** - The image shows a **skin incision in the axilla**, which is the typical site for accessing **axillary lymph nodes for biopsy**. - A surgical instrument is poised to enter the incision, consistent with the procedure for **identifying and removing the sentinel lymph node**. *Brachytherapy* - This involves placing **radioactive sources** inside or next to the area requiring treatment, usually for cancer. - The image does not depict any radioactive sources or the specialized equipment used for brachytherapy. *USG* - **Ultrasonography (USG)** uses sound waves to create images of internal body structures. - The image shows a surgical incision and instrument, not an ultrasound transducer or screen. *Lateral pectoral nerve block* - A **nerve block** involves injecting an anesthetic close to a nerve to relieve pain or numb an area. - While it involves an injection, the image shows an incision in the axillary region, which is typically for surgical access, not solely for nerve block administration.

Q: A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :

cT₂ N₁ Mₓ. **cT₂ N₁ Mₓ** - The tumor size of **3 x 4 cm** falls within the T2 classification (>2 cm but ≤5 cm). The description of the lump being "not fixed to the skin or the underlying structures" further supports a T2 (or lower) classification, as fixation would suggest a more advanced T stage (T4). - The presence of "firm mobile lymph nodes (level I)" indicates involvement of regional lymph nodes, which is classified as **N1** in breast cancer staging. An "Mx" designation means that distant metastasis cannot be assessed clinically without further investigation. *cT₃ N₁ Mₓ* - A **T3 classification** would apply if the tumor measured **greater than 5 cm** in its largest dimension, which is not the case here, as the lump is 3 x 4 cm. - While the **N1 and Mx** components are consistent with the findings, the T component is incorrect for the given tumor size. *cT₁ N₁ Mₓ* - A **T1 classification** is used for tumors that are **2 cm or less in greatest dimension**. The given tumor size of 3 x 4 cm clearly exceeds this limit. - The **N1 and Mx** components are consistent, but the T component is inappropriate for the described tumor size. *cT₃ N₂ Mₓ* - This option is incorrect on two counts: the **T3 classification** is wrong for a 3 x 4 cm tumor (should be >5 cm), and the **N2 classification** is also incorrect. - **N2** would indicate metastases to **ipsilateral axillary lymph nodes that are fixed or matted**, or in ipsilateral internal mammary lymph nodes in the absence of clinically apparent axillary lymph node metastases. The description states "firm mobile lymph nodes (level I)," which corresponds to N1, not N2.

Q: The best cosmetic result following breast reconstruction is achieved with :

Transverse rectus abdominis myocutaneous flap. ***Transverse rectus abdominis myocutaneous flap*** - The **TRAM flap** offers excellent aesthetic outcomes by utilizing the patient's own **abdominal tissue**, providing a natural look and feel that mimics breast tissue. - This method results in a soft, pliable breast mound with good long-term stability and can provide a **simultaneous abdominoplasty** effect. *Latissimus dorsi flap* - While a viable option, the **latissimus dorsi flap** is typically smaller and may require an **implant** to achieve adequate breast volume, potentially leading to a less natural result than a TRAM flap. - It uses tissue from the back, which can leave a noticeable scar and may cause **weakness in the shoulder** or back. *Silicone gel implant with reconstruction* - Implants can provide good cosmetic results but carry risks such as **capsular contracture**, rupture, and the need for future revisions, which can affect long-term satisfaction. - They do not offer the same **natural feel or warmth** as autologous tissue reconstruction, as the reconstructed breast is not made of living tissue. *Acellular dermal matrix flap* - **Acellular dermal matrix (ADM)** is often used as an adjunct in implant-based reconstruction to support and reinforce the breast tissue, rather than as a primary reconstructive flap for optimal cosmetic results. - While it aids in tissue expansion and support, it does not provide the **volume or natural contour** that an autologous flap like the TRAM can achieve on its own.

Q: Which of the following is the FIRST step in triple assessment of breast lumps? 1. Clinical assessment 2. Radiological assessment 3. Histopathological assessment 4. Sentinel lymph node biopsy

Clinical assessment. ***Clinical assessment*** - The **first step** in triple assessment involves taking a thorough history and performing a physical examination to identify concerning features of a breast lump. - This step helps to guide the subsequent radiological and histopathological investigations. *Radiological assessment* - This is the **second step** of triple assessment and typically involves mammography, ultrasound, or MRI to characterize the lump's features and extent. - It provides imaging information but does not precede the initial clinical evaluation. *Histopathological assessment* - This is the **third step**, involving a biopsy (fine needle aspiration, core needle biopsy) to obtain tissue for microscopic examination and definitive diagnosis. - While crucial for diagnosis, it follows both clinical and radiological assessments in the triple assessment pathway. *Sentinel lymph node biopsy* - This procedure is performed to determine if **cancer cells have spread** to the regional lymph nodes, typically after a confirmed diagnosis of breast cancer. - It is not part of the initial diagnostic triple assessment for a breast lump but rather a staging procedure.

Question 1

All are true about the condition shown except?

Accepted Answer

Surgical excision

Answer

Thrombophlebitis

Answer

Thoracoepigastric vein involved

Answer

Thrombosed subcutaneous cord

Question 2

All of the following are true regarding this picture except: (Recent NEET Pattern 2016-17)

Accepted Answer

Usually bilateral

Answer

Associated with an underlying ductal carcinoma, which may be in situ or invasive.

Answer

Itching is a common symptom

Answer

Paget cells (adenocarcinoma cells) are present in the epidermis of the nipple and areola

Question 3

What is the most possible diagnosis?

Accepted Answer

Mondor's disease

Answer

Poland syndrome

Answer

Tietze disease

Answer

Duct ectasia

Question 4

A 25-year-old woman presents with a painless lump in her right breast that has been gradually enlarging over the past 6 months. On examination, the lump is firm, mobile, and non-tender. USG breast shows a well-defined, hypoechoic, oval solid mass measuring 3.5 cm with smooth margins. FNAC is concordant with fibroadenoma. What is true regarding the management of this condition? (Recent NEET Pattern 2016-17)

Accepted Answer

Excision is the treatment for large, enlarging, symptomatic, or diagnostically uncertain fibroadenoma

Answer

Common aged between 50-60 years

Answer

Pre-malignant condition

Answer

Aspiration is the treatment

Question 5

A perimenopausal woman presents with chronic multiduct green-brown nipple discharge and the following image. Ultrasound shows subareolar duct dilatation. The diagnosis is:

Accepted Answer

Duct ectasia

Answer

Carcinoma breast

Answer

Duct papilloma

Answer

Galactocele

Question 6

All are true about the condition shown in the image except:

Accepted Answer

It is always ER-positive and does not respond to hormonal therapy

Answer

Occurs due to obstruction of dermal lymphatics by tumor emboli

Answer

Peau d'orange

Answer

Presents as erythema and edema involving at least one-third of the breast skin

Question 7

What technique has been depicted in the image shown below?

Accepted Answer

Sentinel lymph node biopsy

Answer

Brachytherapy

Answer

USG

Answer

Lateral pectoral nerve block

Question 8

A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :

Accepted Answer

cT₂ N₁ Mₓ

Answer

cT₃ N₁ Mₓ

Answer

cT₁ N₁ Mₓ

Answer

cT₃ N₂ Mₓ

Question 9

The best cosmetic result following breast reconstruction is achieved with :

Accepted Answer

Transverse rectus abdominis myocutaneous flap

Answer

Latissimus dorsi flap

Answer

Silicone gel implant with reconstruction

Answer

Acellular dermal matrix flap

Question 10

Which of the following is the FIRST step in triple assessment of breast lumps?

1. Clinical assessment
2. Radiological assessment
3. Histopathological assessment
4. Sentinel lymph node biopsy

Accepted Answer

Clinical assessment

Answer

Radiological assessment

Answer

Sentinel lymph node biopsy

Answer

Histopathological assessment

Breast Surgery — MCQs

Breast Surgery — MCQs

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