Breast Surgery Practice Questions

Q: Which of the following is NOT related to Mondor's disease?

Variant of thrombophlebitis. **Explanation:** **Mondor’s Disease** is a rare, benign condition characterized by **superficial thrombophlebitis** of the subcutaneous veins of the breast and anterior chest wall. It most commonly involves the lateral thoracic, thoracoepigastric, or superior epigastric veins. 1. **Why Option C is the Correct Answer:** The question asks which is **NOT** related to Mondor's disease. However, based on standard medical definitions, Mondor's disease **is** a variant of thrombophlebitis. *Note: If the question asks for the "NOT" related option, there may be a typographical error in the provided key, as A, B, and D are all incorrect statements, while C is a true clinical fact about the disease.* 2. **Analysis of Other Options:** * **Option A (Lymphedema):** Mondor’s disease does not cause lymphedema. It is a venous pathology, not a lymphatic one. * **Option B (Risk factor for cancer):** Mondor’s disease is **not** a risk factor for breast cancer. It is a self-limiting, benign condition, though it can occasionally be associated with underlying malignancy in rare cases. * **Option D (Mastectomy):** Mastectomy is never indicated. The treatment is **conservative**, involving reassurance, warm compresses, and NSAIDs for pain relief. **Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Patients present with a sudden onset of a **painful, palpable "cord-like" structure** on the breast or chest wall. * **Skin Changes:** "Groove sign" or skin tethering may be seen when the arm is elevated. * **Etiology:** Often idiopathic but can follow trauma, vigorous exercise, or breast surgery. * **Management:** It is self-limiting and usually resolves spontaneously within 4 to 8 weeks. No anticoagulation is required.

Q: A 30-year-old female presents with complaints of cord-like structures on her arm and breast, with no history of injury or infection. These cords are best demonstrated on elevation of the hand. What is the most possible diagnosis?

Mondor's disease. **Explanation:** The clinical presentation of palpable, cord-like structures on the breast and arm that become more prominent upon limb elevation is pathognomonic for **Mondor’s Disease**. **1. Why Mondor’s Disease is Correct:** Mondor’s disease is a **superficial thrombophlebitis** affecting the veins of the breast and anterior chest wall (most commonly the lateral thoracic, thoracoepigastric, or superior epigastric veins). The "cord-like" feel represents the thrombosed vein. Elevating the arm stretches the skin over the vein, making the cord more visible—a classic clinical sign. It is usually self-limiting and managed with NSAIDs. **2. Why Other Options are Incorrect:** * **Poland Syndrome:** A congenital anomaly characterized by the unilateral absence of the pectoralis major muscle, often associated with syndactyly. It does not present with cord-like structures. * **Tietze Disease:** An inflammatory condition causing painful swelling of the costochondral junctions (rib cartilage). It presents as localized chest wall pain/swelling, not superficial venous cords. * **Duct Ectasia:** A benign condition involving dilation of the lactiferous ducts, typically presenting with nipple discharge (green/brown) and subareolar masses, not superficial chest wall findings. **3. NEET-PG High-Yield Pearls:** * **Triad of Veins:** Lateral thoracic, Thoracoepigastric, and Superior epigastric veins. * **Clinical Sign:** The "Iron Wire" or "Bowstring" sign (prominence on abduction/elevation of the arm). * **Etiology:** Often idiopathic, but can follow vigorous exercise, breast surgery, or trauma. * **Association:** While usually benign, in rare cases, it can be a marker for underlying breast malignancy; hence, a mammogram is often recommended in older patients.

Q: A female patient presented with a firm mass of 2 x 2 cm in the upper outer quadrant of the breast. She gives a family history of ovarian carcinoma. What investigation needs to be done to assess for mutation?

BRCA-2. ### Explanation **Correct Answer: B. BRCA-2** The clinical presentation of a breast mass in a patient with a strong family history of ovarian carcinoma strongly suggests **Hereditary Breast and Ovarian Cancer (HBOC) syndrome**. 1. **Why BRCA-2 is correct:** Mutations in the **BRCA1** and **BRCA2** genes are the most common causes of hereditary breast cancer. While both are associated with ovarian cancer, **BRCA2** is specifically linked to a higher risk of male breast cancer and is frequently tested when there is a dual history of breast and ovarian malignancies in a family. In the context of this question, it is the most relevant gene to assess for a germline mutation. **Analysis of Incorrect Options:** * **A. p53:** Mutations in the *TP53* gene are associated with **Li-Fraumeni Syndrome**. While this syndrome increases the risk of breast cancer, it is typically characterized by a broad spectrum of tumors, including sarcomas, brain tumors, and adrenocortical carcinomas, rather than a specific link to ovarian cancer. * **C. Her 2/Neu:** This is a proto-oncogene used as a **prognostic and predictive biomarker** in biopsy samples to guide treatment (e.g., Trastuzumab). It is an acquired somatic mutation, not a germline mutation used to assess familial risk. * **D. C-myc:** This is an oncogene often overexpressed in various cancers (like Burkitt lymphoma), but it is not a standard screening target for hereditary breast-ovarian cancer syndromes. **High-Yield Clinical Pearls for NEET-PG:** * **BRCA1:** Located on **Chromosome 17**. Associated with Triple Negative Breast Cancer (TNBC) and a higher lifetime risk of ovarian cancer (up to 40%). * **BRCA2:** Located on **Chromosome 13**. Associated with Luminal-type breast cancers and is the most common gene implicated in **Male Breast Cancer**. * **HBOC Screening:** Indicated if there are multiple family members with breast/ovarian cancer, bilateral breast cancer, or young age of onset (<50 years).

Q: Which of the following conditions is NOT related to Aberrations of Normal Development and Involution (ANDI) of the breast?

Intraductal papilloma. **Explanation:** The concept of **ANDI (Aberrations of Normal Development and Involution)**, proposed by Hughes and Mansel, classifies benign breast disorders based on the normal physiological processes of the breast: development, cyclical change, and involution. It distinguishes between normal variations, minor aberrations, and true disease. **Why Intraductal Papilloma is the correct answer:** Intraductal papilloma is considered a **true neoplastic process** (a discrete benign tumor of the lactiferous ducts) rather than a deviation from normal physiological development or involution. Therefore, it does not fall under the ANDI classification. **Analysis of Incorrect Options:** * **Fibroadenoma (Option A):** This is an aberration of the **Development** phase (ages 15–25). It arises from the overgrowth of a single lobule. Giant fibroadenomas are considered "disease," while standard ones are "aberrations." * **Duct Ectasia (Option B):** This is an aberration of **Involution** (specifically stromal and ductal involution). It occurs when the subareolar ducts dilate and fill with debris, typically in the 50s. * **Cyclical Mastalgia (Option C):** This is an aberration of **Cyclical Changes** during the reproductive years. While mild tenderness is normal, severe cyclical pain is classified as an ANDI aberration. **NEET-PG High-Yield Pearls:** * **ANDI Categories:** 1. **Development (15–25 yrs):** Fibroadenoma, Adolescent hypertrophy. 2. **Cyclical Changes (Period of activity):** Cyclical mastalgia, Nodularity. 3. **Involution (35–55 yrs):** Cysts, Sclerosing adenosis, Duct ectasia, Periductal fibrosis. * **Clinical Note:** Intraductal papilloma is the most common cause of **bloody nipple discharge** from a single duct. * **Management:** Most ANDI conditions are managed conservatively once malignancy is ruled out (Triple Assessment).

Q: What condition is characterized by greenish-black discharge from the breast?

Duct ectasia. **Explanation:** **Duct Ectasia** is the correct answer because it is a chronic inflammatory condition characterized by the dilation of subareolar ducts. As the ducts dilate, they become filled with stagnant lipid-rich secretions and cellular debris. Over time, these secretions thicken and undergo chemical changes, resulting in a characteristic **multiductal, thick, "toothpaste-like" or greenish-black (creamy) nipple discharge**. It is most commonly seen in perimenopausal women and is often associated with smoking. **Why the other options are incorrect:** * **Intraductal Papilloma:** This is the most common cause of **bloody (serosanguinous)** nipple discharge. It is typically a spontaneous, single-duct discharge. * **Carcinoma of the Breast:** While breast cancer can cause discharge (usually bloody or serous), it is more frequently associated with a painless, hard lump, skin tethering, or nipple retraction. * **Paget Disease of the Nipple:** This presents as an **eczematous-like lesion** of the nipple-areola complex (itching, redness, crusting). It is an intraepithelial manifestation of an underlying ductal carcinoma. **High-Yield Clinical Pearls for NEET-PG:** * **Duct Ectasia** can lead to "Plasma Cell Mastitis" due to the inflammatory response to leaked secretions. * **Clinical Presentation:** It may present with a slit-like nipple retraction (transverse) and a subareolar mass that mimics malignancy. * **Management:** If troublesome, the definitive treatment is a **Hadfield’s operation** (total excision of the major duct system). * **Mnemonic for Discharge:** Green/Black = Ectasia; Bloody = Papilloma; Milky = Galactorrhea (Prolactinoma).

Q: What is the most common quadrant for breast carcinoma?

Upper outer. **Explanation:** The distribution of breast carcinoma is directly proportional to the amount of glandular tissue present in each quadrant. The **Upper Outer Quadrant (UOQ)** contains the largest volume of breast parenchyma (glandular tissue) and extends into the axilla as the **Axillary Tail of Spence**. Consequently, approximately **50% to 60%** of all breast cancers originate in this quadrant, making it the most common site. **Analysis of Options:** * **A. Lower Outer (LOQ):** This quadrant contains significantly less glandular tissue than the upper half. It accounts for approximately 10% of breast cancers. * **B. Lower Inner (LIQ):** This is the least common site for breast carcinoma, accounting for roughly 5% of cases. * **D. Upper Inner (UIQ):** While more common than the lower quadrants (accounting for about 15%), it lacks the density and the additional "tail" of tissue found in the UOQ. **NEET-PG High-Yield Pearls:** 1. **Order of Frequency:** UOQ (50%) > Central/Subareolar (20%) > UIQ (15%) > LOQ (10%) > LIQ (5%). 2. **Axillary Tail of Spence:** This is a normal extension of the UOQ that pierces the deep fascia (Foramen of Langer) to enter the axilla. Tumors here can sometimes be mistaken for axillary lymphadenopathy. 3. **Multicentricity:** Breast cancer is often multicentric (multiple tumors in different quadrants), which is a key consideration when deciding between Breast Conserving Surgery (BCS) and Mastectomy. 4. **Clinical Presentation:** The most common presentation is a **painless, hard, fixed lump**. The UOQ is also the most common site for benign lesions like fibroadenomas.

Q: A 27-year-old woman requests a mammogram due to a strong family history of early-onset breast cancer. Which of the following factors would significantly increase this patient's risk for breast cancer?

BRCA1 mutation. **Explanation:** **1. Why BRCA1 mutation is correct:** The **BRCA1 mutation** is a high-penetrance germline mutation that significantly increases the lifetime risk of breast cancer (up to 60-80%) and ovarian cancer (up to 40%). In a young patient (27 years old) with a strong family history, genetic predisposition is the most significant risk factor. BRCA1-associated breast cancers are often "triple-negative" and occur at an earlier age compared to the general population. **2. Why the other options are incorrect:** * **Multiparity (A):** This is actually a **protective factor**. Early first full-term pregnancy and having multiple children reduce the total number of ovulatory cycles and promote terminal differentiation of breast epithelium, lowering risk. * **High-fiber diet (B):** This is generally considered a **protective or neutral factor**. Diets high in fiber and low in fat are associated with lower circulating estrogen levels, potentially reducing risk. * **Oral contraceptive use (C):** While some studies suggest a very slight, transient increase in risk during active use, it is **not as significant** as a genetic mutation. Furthermore, OCPs are known to significantly *decrease* the risk of ovarian and endometrial cancers. **Clinical Pearls for NEET-PG:** * **Screening in High Risk:** For BRCA carriers, screening starts early (age 25) with **Annual MRI**, as mammography is less sensitive in the dense breast tissue of young women. * **BRCA1 vs. BRCA2:** BRCA1 is on Chromosome **17q** (associated with Triple Negative Breast Cancer); BRCA2 is on Chromosome **13q** (associated with Male Breast Cancer). * **Gail Model:** The most commonly used tool to estimate the 5-year and lifetime risk of invasive breast cancer. * **Li-Fraumeni Syndrome:** Another high-yield genetic cause involving the **p53 mutation**, leading to early-onset breast cancer and sarcomas.

Question 1

Which of the following is NOT related to Mondor's disease?

Accepted Answer

Variant of thrombophlebitis

Answer

Lymphedema of upper limb

Answer

Risk factor for breast cancer

Answer

Mastectomy is the treatment of choice

Question 2

Breast conservation surgery is contraindicated in which of the following conditions?

Accepted Answer

All of the above

Answer

Tumor size > 4 cm

Answer

Multicentric tumor

Answer

Axillary lymph node involvement

Question 3

A 30-year-old female presents with complaints of cord-like structures on her arm and breast, with no history of injury or infection. These cords are best demonstrated on elevation of the hand. What is the most possible diagnosis?

Accepted Answer

Mondor's disease

Answer

Poland syndrome

Answer

Teitz disease

Answer

Duct ectasia

Question 4

A female patient presented with a firm mass of 2 x 2 cm in the upper outer quadrant of the breast. She gives a family history of ovarian carcinoma. What investigation needs to be done to assess for mutation?

Accepted Answer

BRCA-2

Answer

p53

Answer

Her 2/Neu gene

Answer

C-myc gene

Question 5

Which of the following conditions is NOT related to Aberrations of Normal Development and Involution (ANDI) of the breast?

Accepted Answer

Intraductal papilloma

Answer

Fibroadenoma

Answer

Duct ectasia

Answer

Cyclical mastalgia

Question 6

Breast conservative surgery is indicated in all of the following conditions except:

Accepted Answer

Lobular carcinoma

Answer

Young patients

Answer

Ductal carcinoma in situ

Answer

Infiltrative ductal carcinoma

Question 7

What condition is characterized by greenish-black discharge from the breast?

Accepted Answer

Duct ectasia

Answer

Intraductal papilloma

Answer

Carcinoma of the breast

Answer

Paget disease of the nipple

Question 8

A 45-year-old female patient with a family history of breast carcinoma presented with diffuse microcalcification on mammography. Biopsy revealed intraductal carcinoma in situ. What is the most appropriate management?

Accepted Answer

Simple mastectomy

Answer

Quadrantectomy

Answer

Radical mastectomy

Answer

Chemotherapy

Question 9

What is the most common quadrant for breast carcinoma?

Accepted Answer

Upper outer

Answer

Lower outer

Answer

Lower inner

Answer

Upper inner

Question 10

A 27-year-old woman requests a mammogram due to a strong family history of early-onset breast cancer. Which of the following factors would significantly increase this patient's risk for breast cancer?

Accepted Answer

BRCA1 mutation

Answer

Multiparity

Answer

High-fiber diet

Answer

Oral contraceptive use

Breast Surgery — MCQs

Breast Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?