Breast Surgery Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Breast Surgery. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Breast Surgery Indian Medical PG Question 1: Which of the following statements are correct regarding sutures in surgery?
I. Barbed sutures have the advantage of eliminating the need for knots.
II. Vertical mattress sutures help in eversion of wound edges.
III. Aberdeen knot is used for continuous suturing.
IV. Silk is preferred for subcuticular suturing.
Select the answer using the code given below :
- A. I, II and IV
- B. II, III and IV
- C. I, II and III (Correct Answer)
- D. I, III and IV
Breast Surgery Explanation: ***I, II and III***
- **I. Barbed sutures** have unidirectional or bidirectional barbs that grip tissue, negating the need for traditional knots to secure the suture line. This property can significantly **reduce operating time** and the volume of foreign material left in the wound.
- **II. Vertical mattress sutures** are designed to achieve precise wound edge approximation and eversion, which are crucial for optimal healing and cosmesis, particularly in areas under tension or for thick skin.
- **III. The Aberdeen knot** is a slip knot technique specifically designed to secure the end of a **continuous suture line** efficiently and reliably. It provides a flat, secure knot that minimizes bulk and is less prone to loosening.
*I, II and IV*
- While statements I and II are correct, statement IV is incorrect. **Silk is a braided, non-absorbable multifilament suture** that can cause significant tissue reaction.
- It is generally not preferred for subcuticular suturing due to its increased risk of infection, visibility, and foreign body reaction compared to monofilament, absorbable sutures.
*II, III and IV*
- Statements II and III are correct, but statement IV is incorrect. **Silk is avoided for subcuticular closure** due to its inflammatory properties and potential for suture extrusion or sinus formation.
- Subcuticular sutures typically use **absorbable monofilament sutures** (e.g., poliglecaprone 25 or polydioxanone) to minimize tissue reaction and achieve good cosmetic results.
*I, III and IV*
- Statements I and III are correct regarding barbed sutures and the Aberdeen knot, respectively. However, statement IV is incorrect because **silk suture is a non-absorbable, braided material that is highly reactive and not suitable for subcuticular placement**, where monofilament absorbable sutures are preferred for minimal tissue reaction and good cosmesis.
Breast Surgery Indian Medical PG Question 2: Regarding breast conservative therapy and issue of post operative local recurrence, all are true except:
- A. Margins should be clear for ductal carcinoma in situ (DCIS)
- B. Margins should be clear for invasive cancer
- C. Lumpectomy can be considered in any size provided the tumour can be excised with clear margins and acceptable cosmetic results
- D. Margins should be clear for lobular carcinoma in situ (LCIS) (Correct Answer)
Breast Surgery Explanation: ***Margins should be clear for lobular carcinoma in situ (LCIS)***
- This statement is incorrect because **LCIS** is considered a **risk indicator** rather than a true malignant entity requiring clear margins. It represents an increased risk for invasive carcinoma in either breast.
- While clear margins are crucial for invasive and in-situ ductal cancers, the presence of LCIS at a margin is not typically an indication for re-excision.
*Margins should be clear for ductal carcinoma in situ (DCIS)*
- This statement is true. Achieving **negative margins** (no tumor cells at the inked surgical margin) is critical for **DCIS** to minimize local recurrence risk.
- Positive or close margins for DCIS often necessitate re-excision or a boost in radiation therapy to improve local control.
*Margins should be clear for invasive cancer*
- This statement is true. For **invasive breast cancer**, a **negative margin** (no tumor on ink) is a standard of care to reduce the risk of **local recurrence**.
- Consensus guidelines recommend that "no ink on tumor" is an adequate negative margin for invasive cancer treated with breast-conserving therapy.
*Lumpectomy can be considered in any size provided the tumour can be excised with clear margins and acceptable cosmetic results*
- This statement is true. The **absolute size** of the tumor is less important than the **ratio** of tumor size to breast size that allows for **clear margins** and an **acceptable cosmetic outcome**.
- Large tumors in large breasts or smaller tumors in very small breasts can both be candidates for lumpectomy if these criteria are met.
Breast Surgery Indian Medical PG Question 3: Milan trial, NSABP trial and EORTC trial in breast cancer compared:
- A. Neoadjuvant chemotherapy vs Adjuvant chemotherapy
- B. Hormonal vs Chemotherapy
- C. Chemotherapy vs Radiotherapy in breast cancer
- D. Breast conservative therapy vs Mastectomy (Correct Answer)
Breast Surgery Explanation: **Breast conservative therapy vs Mastectomy**
* The **Milan trial**, **NSABP trial (B-04 and B-06)**, and **EORTC trial** were pivotal studies that compared the efficacy and outcomes of **breast conservative therapy (BCT)** followed by radiation therapy against **mastectomy** for early-stage breast cancer.
* These trials established that BCT with radiation offers comparable survival rates to mastectomy, transforming the surgical management of breast cancer.
*Neo adjuvant chemotherapy vs Adjuvant chemotherapy*
* While these are important questions in breast cancer management, the specific trials mentioned (**Milan, NSABP B-04/B-06, EORTC**) did not primarily focus on comparing neo-adjuvant versus adjuvant chemotherapy strategies.
* Their main objective was to evaluate surgical approaches: lumpectomy plus radiation versus mastectomy.
*Hormonal vs Chemotherapy*
* The trials mentioned did not directly compare hormonal therapy against chemotherapy. These are distinct systemic treatment modalities used in different contexts.
* The focus was on the extent of surgical intervention, with systemic therapies often applied in addition to surgery based on tumor characteristics.
*Chemotherapy vs Radiotherapy in breast cancer*
* These trials did not compare chemotherapy directly against radiotherapy. Radiotherapy was an integral component of the **breast-conserving therapy** arm, used to reduce local recurrence after lumpectomy.
* Chemotherapy is a systemic treatment, while radiotherapy is a local treatment, and their roles are generally complementary rather than mutually exclusive or directly competitive in these study designs.
Breast Surgery Indian Medical PG Question 4: The most important prognostic factor in carcinoma of the breast is
- A. Size of tumour
- B. Skin involvement
- C. Axillary gland involvement (Correct Answer)
- D. Involvement of muscles
Breast Surgery Explanation: ***Axillary gland involvement***
- The presence and number of involved **axillary lymph nodes** are the single most significant factor in determining prognosis and guiding adjuvant therapy in breast cancer.
- Lymphatic spread to the axillary nodes indicates a higher likelihood of distant metastasis, directly impacting survival rates.
*Size of tumour*
- While **tumor size** is an important prognostic factor and is part of the TNM staging system (T for tumor size), it is less significant than nodal status.
- A small tumor with nodal involvement has a worse prognosis than a larger tumor without nodal involvement.
*Skin involvement*
- **Skin involvement** (T4b in TNM staging) indicates locally advanced disease and is a poor prognostic sign, but it is not as universally important as axillary nodal status in predicting overall survival.
- It often reflects aggressive local tumor growth rather than systemic spread as directly as nodal metastasis.
*Involvement of muscles*
- **Muscle involvement** (specifically the pectoralis major muscle, T4a in TNM staging) signifies locally advanced disease and is associated with a poor prognosis.
- Similar to skin involvement, it suggests extensive local spread but is not as strong a predictor of distant metastasis and overall survival as axillary nodal involvement.
Breast Surgery Indian Medical PG Question 5: Which anatomical structure is most commonly the target of incisions during major gynecological surgical procedures?
- A. Ovary
- B. Cervix
- C. Fallopian tube
- D. Uterus (Correct Answer)
Breast Surgery Explanation: ***Uterus***
- The **uterus** is the primary anatomical target for many major gynecological procedures, such as **hysterectomy** (removal of the uterus) and **myomectomy** (removal of fibroids from the uterus).
- These are among the most commonly performed major gynecological surgeries, making the uterus the most frequent target for incisions in gynecological practice.
- In obstetric procedures, the uterus is also incised during **cesarean sections**, highlighting its central role in both obstetric and gynecologic surgery.
*Ovary*
- While ovaries are involved in gynecological surgery (e.g., **oophorectomy**, cystectomy), they are not as frequently the *primary* target for incisions as the uterus in the context of major procedures.
- Ovarian surgeries are often performed for **cysts**, **tumors**, or in conjunction with hysterectomy, but are less common than uterine procedures.
- Many ovarian procedures can be managed laparoscopically without major incisions.
*Cervix*
- The **cervix** is incised in procedures like **trachelectomy** for cervical cancer or during specific cervical cerclage procedures, but these are less frequent compared to surgeries involving the uterine body itself.
- Many cervical procedures are considered minor (e.g., LEEP, cone biopsy) or are part of a larger uterine surgery.
*Fallopian tube*
- The **fallopian tubes** are primarily targeted for procedures like **salpingectomy** (removal of the tube, often for ectopic pregnancy or sterilization) or salpingostomy.
- While significant, these procedures are generally less common than those involving the uterus and overall less frequently associated with major incisions compared to uterine procedures.
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