Breast Surgery Practice Questions

Question 1

A 33-year-old woman comes to the physician 1 week after noticing a lump in her right breast. Fifteen years ago, she was diagnosed with osteosarcoma of her left distal femur. Her father died of an adrenocortical carcinoma at the age of 41 years. Examination shows a 2-cm, firm, immobile mass in the lower outer quadrant of the right breast. A core needle biopsy of the mass shows adenocarcinoma. Genetic analysis in this patient is most likely to show a defect in which of the following genes?

Accepted Answer

TP53

Answer

BRCA1

Answer

KRAS

Answer

Rb

Answer

PTEN

Question 2

The patient undergoes a mammogram, which shows a 6.5mm sized mass with an irregular border and spiculated margins. A subsequent core needle biopsy of the mass shows infiltrating ductal carcinoma with HER2-positive, estrogen-negative, and progesterone-negative immunohistochemistry staining. Blood counts and liver function tests are normal. Laboratory studies show:
Hemoglobin 12.5 g/dL
Serum
Na+ 140 mEq/L
Cl- 103 mEq/L
K+ 4.2 mEq/L
HCO3- 26 mEq/L
Ca2+ 8.9 mg/dL
Urea Nitrogen 12 mg/dL
Glucose 110 mg/dL
Alkaline Phosphatase 25 U/L
Alanine aminotransferase (ALT) 15 U/L
Aspartate aminotransferase (AST) 13 U/L
Which of the following is the most appropriate next step in management?

Accepted Answer

Breast-conserving therapy and sentinel lymph node biopsy

Answer

Bilateral mastectomy with lymph node dissection

Answer

Trastuzumab therapy

Answer

Bone scan

Answer

Whole-body PET/CT

Question 3

A 23-year-old woman, gravida 1 para 0, at 16 weeks’ gestation presents to the physician because of swelling of her right breast for 1 month. She has no personal or family history of any serious illnesses. She has taken contraceptive pills over the past few years. Vital signs are within normal limits. Physical examination shows asymmetric breasts with the right breast being enlarged. The palpation of the breast shows a 4 x 5 cm (1.5 x 1.9 in) mass under the skin in the upper outer quadrant. It is nontender and mobile with a rubbery consistency and regular borders. A breast ultrasound shows a round and solid homogeneous mass with well-defined borders and low echogenicity, measuring 5 cm (1.9 in) in diameter. Which of the following is the most likely diagnosis?

Accepted Answer

Fibroadenoma

Answer

Invasive ductal carcinoma

Answer

Lobular carcinoma

Answer

Medullary carcinoma

Answer

Fibrocystic changes

Question 4

A 52-year-old woman visits your office complaining about discharge from her left nipple for the past 3 months. The discharge looks like gray greenish and its amount is progressively increasing. She appears to be anxious and extremely uncomfortable with this situation as it is embarrassing for her when it occurs outdoors. Past medical history is insignificant. Her family history is negative for breast and ovarian disorders. She tries to stay active by running for 30 minutes every day on a treadmill, staying away from smoking, and by eating a balanced diet. She drinks alcohol occasionally. During physical examination you find a firm, stable mass under an inverted nipple in her left breast; while on the right breast, dilated subareolar ducts can be noted. There is no lymphadenopathy and remaining of the physical exam is normal. A mammogram is performed which reveals tubular calcifications. Which of the following is the most likely diagnosis?

Accepted Answer

Duct ectasia

Answer

Periareolar fistula

Answer

Intraductal papilloma

Answer

Periductal mastitis

Answer

Phyllodes tumor

Question 5

Patient 1 – A 26-year-old woman presents to her primary care physician for an annual exam. She currently does not have any acute concerns and says her health has been generally well. Medical history is significant for asthma, which is managed with an albuterol inhaler. Her last pap smear was unremarkable. She is currently sexually active with one male and consistently uses condoms. She occasionally smokes marijuana and drinks wine once per week. Her mother recently passed away from advanced ovarian cancer. Her sister is 37-years-old and was recently diagnosed with breast cancer and ovarian cancer. Physical examination is remarkable for a mildly anxious woman.

Patient 2 – A 27-year-old woman presents to her primary care physician for an annual exam. She says that she would like to be screened for breast cancer since two of her close friends were recently diagnosed. She noticed she has a small and mobile mass on her left breast, which increases in size and becomes tender around her time of menses. Family history is remarkable for hypertension in the father. The physical exam is significant for a small, well-defined, and mobile mass on her left breast that is not tender to palpation.

Which of the following is the best next step in management for patient 1 and 2?

Accepted Answer

Patient 1 – BRCA testing. Patient 2 – Breast ultrasound

Answer

Patient 1 – Breast ultrasound. Patient 2 – Return in 3 months for a clinical breast exam

Answer

Patient 1 – Reassurance. Patient 2 – Breast ultrasound

Answer

Patient 1 – CA-125 testing. Patient 2 – BRCA testing

Answer

Patient 1 – Breast and ovarian ultrasound. Patient 2 – Mammography

Question 6

A 65-year-old woman returns to the outpatient oncology clinic to follow up on her recently diagnosed breast cancer. A few months ago, she noticed a lump during a breast self-exam that was shown to be breast cancer. A lumpectomy revealed invasive ductal carcinoma that was estrogen- and progesterone receptor-positive with nodal metastases. She is following up to discuss treatment options. She had her last menstrual period 10 years ago and has not had any spotting since that time. Her mother had breast cancer and she remembered her taking chemotherapy and had a poor quality of life, thus she asks not to be treated similarly. Which of the following is the mechanism of action of the best treatment option for this patient?

Accepted Answer

Inhibit peripheral conversion of androgens to estrogen

Answer

Cell cycle arrest

Answer

Estrogen receptors downregulation in the breast

Answer

Antagonist for estrogen receptors in the breast

Answer

Antagonist for estrogen receptors in the hypothalamus

Question 7

An obese 34-year-old primigravid woman at 20 weeks' gestation comes to the physician for a follow-up examination for a mass she found in her left breast 2 weeks ago. Until pregnancy, menses had occurred at 30- to 40-day intervals since the age of 11 years. Vital signs are within normal limits. Examination shows a 3.0-cm, non-mobile, firm, and nontender mass in the upper outer quadrant of the left breast. There is no palpable axillary lymphadenopathy. Pelvic examination shows a uterus consistent in size with a 20-week gestation. Mammography and core needle biopsy confirm an infiltrating lobular carcinoma. The pathological specimen is positive for estrogen and human epidermal growth factor receptor 2 (HER2) receptors and negative for progesterone receptors. Staging shows no distant metastatic disease. Which of the following is the most appropriate management?

Accepted Answer

Surgical resection and chemotherapy

Answer

Surgical resection

Answer

Radiotherapy and chemotherapy

Answer

Radiotherapy only

Answer

Surgical resection and radiotherapy

Question 8

A 32-year-old woman presented for her annual physical examination. She mentioned that her family history had changed since her last visit: her mother was recently diagnosed with breast cancer and her sister tested positive for the BRCA2 mutation. The patient, therefore, requested testing as well. If the patient tests positive for the BRCA1 or BRCA2 mutation, which of the following is the best screening approach?

Accepted Answer

Twice-yearly clinical breast exams, annual mammography, annual breast MRI, and breast self-exams

Answer

Order magnetic resonance imaging of the breast

Answer

Annual ultrasound, annual mammography, and monthly self-breast exams

Answer

Annual clinical breast exams, annual mammography, and monthly self-breast exams

Answer

Refer to radiation therapy

Question 9

A 39-year-old man presents with painless swelling of the right testis and a sensation of heaviness. The physical examination revealed an intra-testicular solid mass that could not be felt separately from the testis. After a thorough evaluation, he was diagnosed with testicular seminoma. Which of the following group of lymph nodes are most likely involved?

Accepted Answer

Para-aortic lymph nodes

Answer

Superficial inguinal lymph nodes (lateral group)

Answer

Deep inguinal lymph nodes

Answer

Superficial inguinal lymph nodes (medial group)

Answer

Para-rectal lymph nodes

Question 10

A 64-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer. She has a medical history of type 2 diabetes mellitus for which she takes metformin. Her surgical history is a total knee arthroplasty 7 years ago. Her family history is insignificant. Physical examination is notable for an irregular nodule near the surface of her right breast. Her primary concern today is which surgical approach will be chosen to remove her breast cancer. Which of the following procedures involves the removal of a portion of a breast?

Accepted Answer

Lumpectomy

Answer

Arthroplasty

Answer

Vasectomy

Answer

Mastectomy

Answer

Laminectomy

Breast Surgery

Study Resources

Lessons

Questions

Flashcards

Lessons

Axillary lymph node dissection

Benign breast disease management

Breast biopsy techniques

Breast cancer staging and surgical management

Breast conservation therapy

Breast reconstruction options

Hereditary breast cancer syndromes

Inflammatory breast cancer

Male breast cancer

Mastectomy techniques and indications

Nipple discharge evaluation

Post-mastectomy complications

Sentinel lymph node biopsy

Practice Questions

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About Breast Surgery for USMLE

Lessons in Breast Surgery

Master Breast Surgery