Breast
3. A 51-year-old woman presents with an ill-defined, slightly firm area in the upper outer quadrant of her right breast. The clinician thinks this area is consistent with fibrocystic change, but a biopsy from this area has a focus of lobular carcinoma in situ. Which of the following histologic features is most characteristic of this lesion?
Expansion of lobules by monotonous proliferation of small cells
Large cells with clear cytoplasm within the epidermis
Large syncytium-like sheets of pleomorphic cells surrounded by aggregates of lymphocytes
Small individual malignant cells dispersed within extracellular pools of mucin
Small tumor cells with little cytoplasm infiltrating in a single-file pattern
1. A 62-year-old woman presents with invasive ductal carcinoma of the right breast. Which of the following findings would still allow her to receive breast conservation surgery (partial mastectomy)?
Previous treatment of a breast cancer with lumpectomy and radiation
Large tumor relative to breast size
Persistently positive margins after multiple reexcisions of the breast cancer
Multifocal disease
Diffuse suspicious microcalcifications throughout the breast
1. A 47-year old woman comes to the clinic because of worsening left breast swelling and pain. She had mastitis when she nursed her first child 20 years ago. She has not seen a doctor since that time. She is afebrile. Breast examination shows the left breast is enlarged with a 7 x 6 cm area of edema and erythema. A poorly localized mass without fluctuation is palpated in that area. Scant non-bloody discharge is noted on the nipple, and several large axillary nodes are palpated. Which of the following is the most appropriate next step in management?
Antibiotic active against Streptococci and Staphylococci
Culture of the discharge and treatment depending on the findings of the culture
Drainage, culture of the drained exudate and treatment depending on the findings of the culture
Biopsy for culture and treatment depending on the findings of the culture
Biopsy for histology and treatment depending on the findings of the histology
A 62-year-old woman has a 4-cm, hard mass under the nipple and areola of her rather small left breast. The mass occupies most of the breast, but the breast is freely movable from the chest wall. There is no dimpling or ulceration of the skin over the mass, and careful palpation of the axilla is completely negative. A core biopsy of the breast mass has established a diagnosis of infiltrating ductal carcinoma, and the mammogram showed no other lesions in that breast or the other one. A chest x-ray film and liver fun
Lumpectomy only
Lumpectomy with axillary sampling and post-op radiation
Total mastectomy only
Modified radical mastectomy (including axillary sampling)
Radical mastectomy (including complete axillary dissection)
1. A 35-year-old woman presents with a right breast mass. You perform a thorough history and physical examination as well as a core biopsy of the right breast mass. In which of the following circumstances would a sentinel lymph node biopsy be indicated?
The core biopsy is consistent with ductal carcinoma in situ without comedo necrosis for which the patient desires partial mastectomy only.
The core biopsy is consistent with ductal carcinoma and the patient has a positive pregnancy test.
The core biopsy is consistent with ductal carcinoma and the patient desires partial mastectomy.
The core biopsy is consistent with ductal carcinoma and the patient has palpable axillary lymph nodes.
The core biopsy is consistent with ductal carcinoma and the patient has a bone scan suspicious for metastasis.
4. A 44-year-old woman has a 2-cm firm palpable mass in the upper outer quadrant of her right breast. The mass is freely movable, and her breast is of normal, rather generous size. There are no palpable axillary nodes. Mammogram shows no other lesions. A core biopsy establishes a diagnosis of infiltrating ductal carcinoma. She has no neurologic or skeletal symptoms, and a chest x-ray film and liver enzymes are normal. She understands that systemic therapy may eventually be needed once the full extent of her disease is known. Although she wants the best chance for cure, she is very concerned about cosmetic deformity and wants to know what can be done about the breast itself. Which of the following is the most appropriate management?
Radiation and chemotherapy without breast surgery
Lumpectomy, axillary sampling, and postoperative radiation
Simple total subcutaneous mastectomy with implants
Modified radical mastectomy with immediate rectus abdominis flap reconstruction
Radical mastectomy and postoperative radiation, with delayed reconstruction
5. A 35-year-old woman presents with a lump in the left breast. Her family history is negative for breast cancer. On examination the mass is rubbery, mobile, and nontender to palpation. There are no overlying skin changes and the axilla is negative for lymphadenopathy. An ultrasound demonstrates a simple 1-cm cyst in the area of the palpable mass in the left breast. Which of the following represents the most appropriate management of this patient?
Reassurance and re-examination
Immediate excisional biopsy
Aspiration of the cyst with cytologic analysis
Fluoroscopically guided needle localization biopsy
Mammography and reevaluation of options with new information
6. A 35-year-old woman presents to the clinic for a discussion on breast cancer risk. Her family history is pertinent for a grandmother who died of breast cancer at age 53, a mother who died of premenopausal breast cancer, and one of three sisters with breast cancer diagnosed at age 42. The sister with breast cancer underwent genetic testing and was found to have a BRCA1 mutation. Subsequently, the 35-year-old woman underwent genetic testing and was found to be a carrier of the same deleterious BRCA1 mutation.For this patient, which of the following strategies represents an accepted management option for her high-risk status?
Yearly self-breast examinations
Semiannual mammography
Bilateral breast irradiation
Prophylactic unilateral mastectomy
Chemoprevention with tamoxifen
7. A 33-year-old pregnant woman notices a persistent, painless lump in the left breast. On examination the left breast has a single mobile mass without evidence of skin changes or lymphadenopathy in the neck or axilla. An ultrasound demonstrates a solid, 1-cm mass in the upper outer quadrant of the breast. A core-needle biopsy shows invasive ductal carcinoma. The patient is in her first trimester of pregnancy. Which of the following is the most appropriate management of this patient?
Termination of the pregnancy followed by modified radical mastectomy
Immediate administration of chemotherapy followed by modified radical mastectomy after delivery of the baby
Administration of radiation in the third trimester followed by modified radical mastectomy after delivery of the baby
Total mastectomy with sentinel lymph node biopsy
Modified radical mastectomy
8. A 40-year-old woman presents with a rash involving the nipple-areola complex for the last month with associated itching. On physical examination there is crusting and ulceration of the nipple with surrounding erythema involving the areola and surrounding skin, no palpable breast masses, and no cervical or axillary lymphadenopathy. Which of the following is the most appropriate next step in the management of this patient?
Reexamine the patient in 1 month
Corticosteroid cream to the affected area
Administration of oral antibiotics
Mammogram and biopsy of the affected area
Modified radical mastectomy
9. A 44-year-old homeless woman presents to the emergency department because she is "bleeding from the breast." Physical examination shows a huge, fungating, ulcerated mass that occupies the entire right breast and is firmly attached to the chest wall. The right axilla is full of hard masses that are not movable either. Core biopsies of the breast are read as highly undifferentiated infiltrating ductal carcinoma, and assay for estrogen and progesterone receptors are negative. Which of the following is the most appropriate next step in management?
Local wound care, but no specific antineoplastic therapy
Tamoxifen therapy
Radiation and chemotherapy
Palliative mastectomy
Radical mastectomy with extended lymph node dissection
13. A 43-year-old woman comes in because of a breast mass. Two days ago, she noticed a lump on self- examination. She has a 2-cm, firm, nontender mass in the left breast, which is movable from the chest wall, but not movable within the breast. She has no prior history of breast disease, but she is well read and well informed, and she specifically requests that a biopsy be done with a mammotome. Before proceeding, which of the following is the most appropriate initial step?
Discuss the surgical options in case cancer is found
Do a mammogram to ascertain whether biopsy is needed
Do a mammogram to find any other lesions that might also need to be addressed
First wait for two menstrual cycles to see whether there is spontaneous resolution
Obtain a fine-needle aspirate and go no further if no malignant cells are found
14. A 45-year-old woman is found to have suspicious appearing calcifications in the right breast on a screening mammogram. Stereotactic biopsy of the calcifications shows lobular carcinoma in situ (LCIS). On examination both breasts are dense without palpable masses. The neck and bilateral axilla are negative for lymphadenopathy. Which of the following is the most appropriate management of this patient?
Frequent self-breast examinations and yearly screening mammograms
Chemotherapy
Radiation
Right total mastectomy with sentinel lymph node biopsy
Bilateral modified radical mastectomy
1. A 41-year-old woman has noted bilateral thin serous discharge from her breasts. There seems to be no mass associated with it. Which of the following statements would be appropriate to tell the patient?
Intermittent thin or milky discharge can be physiologic.
Expressible nipple discharge is an indication for open biopsy.
Absence of a mass on mammogram rules out malignancy.
Galactorrhea is indicative of an underlying malignancy.
Pathologic discharge is usually bilateral.
15. Incisional biopsy of a breast mass in a 35-year-old woman demonstrates cystosarcoma phyllodes at the time of frozen section. Which of the following is the most appropriate management strategy for this lesion?
Wide local excision with a rim of normal tissue
Lumpectomy and axillary lymphadenectomy
Modified radical mastectomy
Excision and postoperative radiotherapy
Excision, postoperative radiotherapy, and systemic chemotherapy
17. A 49-year-old woman has a firm, 2-cm mass in the right breast that has been present for 3 months. Mammogram has been read as "cannot rule out cancer," but it cannot diagnose cancer either. A fine- needle aspiration of the mass (FNA) and cytology do not identify any malignant cells. Which of the following is the most appropriate next step in management?
Reassurance and reappointment in a year
Repeat mammogram and FNA in 1 month
Core or incisional biopsies
Lumpectomy and axillary dissection
Modified radical mastectomy
18. A 42-year-old woman returns to the clinic following an uneventful biopsy for a well-defined, mobile mass. The pathology report describes the mass as a fibro adenoma, but LCIS is identified in the breast parenchyma adjacent to the fibro adenoma and extending to the margin of resection. She has no current illnesses, is on no medications, and her family history is negative for breast cancer. Breast imaging studies show fatty breasts with no abnormal findings except for the fibro adenoma. Which of the following is the most appropriate management option?
Re-excision of the biopsy cavity to gain negative margins of resection
Ipsilateral mastectomy
Contralateral breast biopsy
Observation including examinations and mammography
Bilateral total mastectomies
19. A 65-year-old woman presents to the physician’s office for a second opinion on the management options for recently diagnosed breast cancer. She presents with a 2.5-cm mass in the upper outer quadrant of the left breast associated with a palpable axillary node suspicious for metastatic disease. The remainder of her examination is normal. Mammography demonstrates the cancer and shows no other suspicious lesions in either breast. Chest x-ray, bone scan, and blood test panel, including liver fun
Radical mastectomy
Lumpectomy, irradiation, and axillary node dissection
Lumpectomy and axillary node dissection
Irradiation of the breast and axilla
Quadrantectomy, irradiation, and axillary node dissection
16. An otherwise healthy, 65-year-old woman comes to the physician because of bloody discharge from the right nipple for 2 weeks. On examination, no retraction, erosion, or other abnormal change is present. Palpation reveals an ill-defined, 1-cm nodule located deep in the right areola. Which of the following is the most appropriate next step in diagnosis?
Cytologic examination of nipple discharge
Mammography alone
Ultrasonography
Biopsy under mammographic localization
Mammography followed by fine-needle cytology
17. A premenopausal, 48-year-old woman undergoes a routine mammographic screening. Physical examination is normal. Mammography identifies a suspicious focus with clustered micro- calcifications located deeply in the lateral upper quadrant of the right breast. No abnormality can be detected in this area on breast examination. Which of the following is the most appropriate next step in diagnosis?
Mammographic reexamination in 1 year
Ultrasonography
Biopsy guided by mammographic localization
Fine-needle aspiration cytology
Large needle (core needle) biopsy
16. During a routine breast self-examination, a 35-year-old woman is concerned because her breasts feel “lumpy.” She consults you as her primary care physician. After performing an examination, you reassure her that no masses are present and that the “lumpiness” is due to fibrocystic changes. Which of the following pathologic findings is a type of nonproliferative fibrocystic change?
A radial scar
A blue-domed cyst
Atypical ductal hyperplasia
Papillomatosis
Sclerosing adenosis
18. A 23-year-old woman presents with a rubbery, freely movable 2-cm mass in the upper outer quadrant of the left breast. Which of the following histologic features is most likely to be seen when examining a biopsy specimen from this mass?
Large numbers of neutrophils
Large numbers of plasma cells
Duct ectasia with inspissation of breast secretions
Necrotic fat surrounded by lipid-laden macrophages
A mixture of fibrous tissue and ducts
19. A 51-year-old man presents with bilateral enlargement of his breasts. Physical examination is otherwise unremarkable, and the diagnosis of gynecomastia is made. Which of the following histologic features is most likely to be seen when examining a biopsy specimen from this man’s breast tissue?
Atrophic ductal structures with increased numbers of lipocytes
Dilated ducts filled with granular, necrotic, acidophilic debris
Expansion of lobules by monotonous proliferation of epithelial cells
Granulomatous inflammation surrounding ducts with numerous plasma cells
Proliferation of ducts in hyalinized fibrous tissue with periductal edema
20. A 51-year-old woman returns to clinic for a follow-up visit. You recently sent her for a routine mammogram, which shows a small, calcified mass that the radiologist labels as “probably benign finding—short-interval follow-up suggested.” The patient is extremely concerned because, although no one in her family has breast cancer, a close friend recently died of it. Breast examination reveals no abnormalities, and her physical examination is normal. Which of the following is the most appropriate course of action?
Excisional biopsy
Diagnostic mammogram
Screening ultrasound in 1 to 2 years
Serial breast exams
Ultrasound of breast
21. A 35-year-old woman comes to the clinic because of a left breast “thickness.” She noted this 5months ago and it has not receded. She has no family history of breast cancer. There is no drainage. She denies any pain. She has no other medical issues. She takes no birth control pills or any other medication. Examination shows a palpable mass in the left breast at 9 o’clock. A mammogram is nondiagnostic. Which of the following is the appropriate course of action?
Observe and repeat mammogram in 1 month
Prescribe hormone replacement therapy
Schedule breast ultrasound
Schedule a lumpectomy
Schedule a mastectomy
22. A 29-year-old woman comes to the physician for follow-up of a right breast lump. The patient first noticed the lump 4 months ago. It was aspirated at that time, and cytology was negative, but the cyst recurred about 1 month later. The cyst was re-aspirated 2 months ago and, again, the cytology was negative. The lump has recurred. Examination reveals a mass at 10 o'clock, approximately 4 cm from the areola. Ultrasound demonstrates a cystic lesion. Which of the following is the most appropriate next step in management?
Mammography in 1 year
Ultrasound in 1 year
Tamoxifen therapy
Open biopsy
Mastectomy
24. Which feature of fibrocystic disease of the breast is associated with the greatest risk of developing breast cancer?
Number of nodules
Serous nipple discharge
Size of the dominant mass
Presence of epithelial hyperplasia
Presence of a palpable axillary node
1. A 32-year-old woman in the 2nd month of pregnancy is found to have a 5-cm mass in the upper outer quadrant of her left breast. Mammogram shows no other lesions, and core biopsy reveals infiltrating ductal carcinoma. Which of the following would be the best course of action at this time?
Chemotherapy now, deferring surgery until after delivery
Radiation therapy now, deferring surgery until after delivery
Lumpectomy and axillary sampling, followed in 6 weeks by radiotherapy
Modified radical mastectomy now, deferring systemic therapy until later
Immediate therapeutic abortion and palliative breast surgery
2. A 37-year-old woman undergoes a lumpectomy and axillary dissection for a 3-cm infiltrating ductal carcinoma, diagnosed by core biopsies, located on the upper outer quadrant of her left breast. The pathology report of the surgical specimen is received 3 days after the operation. It indicates that all margins around the tumor are clear, and that 4 of 17 axillary lymph nodes have metastatic tumor. The tumor is reported to be estrogen and progesterone receptor negative. Which of the following should further therapy most likely include?
Antiestrogen medication (tamoxifen)
Conversion to modified radical mastectomy
Radiation to the remaining left breast
Radiation to the remaining left breast and systemic chemotherapy
Radiation to both breasts and tamoxifen
3. A 35-year-old woman is being evaluated after having a screening mammography. A 3 x 3 cm speculated mass with coarse calcifications is seen in the upper outer quadrant of her right breast. She has no complaints. She has a history of bilateral reduction mammoplasty for mammary hyperplasia 12 years ago. She has no family history of medical problems. Breast examination shows her right nipple is slightly retracted. A fixed mass is palpated in the upper outer quadrant of the right breast. Ultrasonography of the breast shows a hypo-echoic mass. Multiple core biopsy samples show foamy macrophages and fat globules. Which of the following is the most appropriate course of action?
Instruction for regular clinical breast examination and follow-up mammography
Radiation therapy of the right breast
MRI of the breast
Simple mastectomy
Segmental excision and axillary node dissection followed by radiation therapy
5. A 37-year-old woman comes to the physician's office because of left breast discomfort. The discomfort has been there for several months, and she recently started having breast pain before menses. Yesterday she noticed a lump in her breast. She has no family history of breast cancer. She smokes one pack of cigarettes every day. She had a baseline mammogram at age 35, which showed no abnormalities. Examination shows a smooth, soft, mobile mass palpable in the upper outer quadrant of the left breast; some diffuse nodularity is present bilaterally. Vital signs are normal. Physical examination otherwise shows no abnormalities. Fine needle aspiration of the mass shows thin greenish, non-bloody fluid; the mass disappears completely after the aspiration. Which of the following is the most appropriate next step in management?
Recommend mammogram to be done as soon as possible
Prescribe oral contraceptives and reassure her
Reassure and reexamine her in six weeks
Send the aspirated fluid for cytologic analysis
Recommend ultrasound evaluation of the aspirated cyst
1. A 22-year-old woman comes to the office for the evaluation of a breast mass which she discovered while taking a shower 2 months ago. She experiences severe pain in this mass during her menses. She looks very anxious because her 45-year-old friend was diagnosed with breast cancer last year, and who "now has all sorts of medicines that have made her lose her hair." She has no other problems. She has never been pregnant. She is an occasional smoker, and drinks 3-4 beers a week. There is no family history of breast cancer. Her vital signs are stable. Physical examination reveals a 4 x 5 x 6 cm firm, moveable, rubbery mass in her left breast. Ultrasound shows a cystic mass. Needle aspiration yields clear fluid, after which the mass disappears. What is the best approach in the management of this patient?
Send the fluid for cytology
Perform a core biopsy
Observe for 4 weeks
Order a mammogram to look for other lesions
Breath CT scan
A 55-year-old woman has a palpable 2 cm mass in her left breast. She had found the mass on self-examination, but she says that she had not done self-breast exam for at least six months before she did this one. Physical examination confirms the presence of the lesion, which is hard, movable, and not painful. A mammogram confirms the presence of an opacity in that area, but it does not have any of the radiological characteristics of a breast cancer. The radiologist also does a sonogram, and comes up with the same opinion, I.e., that neither study is suggestive for cancer. Fine needle aspirate is read as negative. Which of the following is the most appropriate next step in management?
Core biopsies of the mass
MRI of the breast
Reassurance
Repeat both imaging studies in six months
Repeat physical exam in six months
A 24-year-old woman presents to your office with a self-palpated breast lump. She discovered the mass 2 days ago while taking a shower and noted that it is mildly tender. Her menstrual periods are regular, occurring every 26 days. Her last menstrual period (LMP) was 3 weeks ago. Her past medical history is insignificant. She has no family history of breast cancer. Physical examination reveals a lump in the superior outer quadrant of the right breast without palpable lymphadenopathy. Which of the following is the most reasonable next step in the management of this patient?
Ask her to return shortly after the menstrual period
Order mammography
Proceed with fine needle aspiration biopsy
Suggest excisional biopsy
Reassure that the mass is benign and no follow-up is necessary
1. On a routine annual examination, a 43-yearold woman is found to have a 2-cm mass in the lateral aspect of her right breast. Which of the following is the most appropriate next step in management?
Repeat the breast examination after her next menses
Mammography
Fine-needle aspiration
Open biopsy
Segmental resection
2. A 35-year-old woman at 30 weeks’ gestation discovers a lump in her left breast. Examination reveals a 2–3 cm, firm nodule in the upper outer quadrant. Which of the following is the most appropriate next step in the management of this patient?
Observation until after delivery
Thermography
Application of hot packs
Breast ultrasound
Fine-needle aspiration
3. A 1-cm carcinoma of the breast is diagnosed by an excisional biopsy in a 36-year-old woman at 14 weeks’ gestation. The axillary nodes are negative. Which of the following is the best management of this patient?
Terminate the pregnancy immediately and treat the breast cancer
Monitor the mass throughout pregnancy with serial breast ultrasounds
Induce labor at 34 weeks’ gestation, then give chemotherapy
Perform a cesarean delivery at 36 weeks and treat the breast cancer
Modified radical mastectomy at the time of diagnosis
1. A 62-year-old woman has an eczematoid lesion in the areola of her right breast that has been present for 3 months. She has self-medicated with skin lotions and over-the-counter steroid ointments, but the area has not improved. On physical examination, the nipple is inverted, the skin of the areola is reddish and desquamated, and the entire area feels firm, with no discrete mass demarcated from the rest of the breast. Which of the following is the most appropriate next step in management?
Estrogen cream and systemic estrogen replacement
Mammogram and galactogram
Mammogram and punch biopsies
Serum levels of glucagon and CT of the pancreas
Skin scrapings, culture, and appropriate topical antibiotic
50. A 56-year-old woman presents to the physician’s office with complaints of a new left breast mass. She denies any pain, nipple discharge, or skin dimpling. She has a prior history of breast cysts 5 years ago, treated by aspiration at that time. Her last mammogram was at age 53. Past history is pertinent for a 30 pack-year smoking history, prior total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH-BSO) at age 54 for leiomyomas, and current use of hormone replacement therapy (HRT). Family history is negative for breast disease. Examination reveals a firm, well defined, mobile,1.5-cm nodule in the upper outer quadrant of the left breast without any regional lymphadenopathy. Which of the following is the most appropriate next step in management?
Fine-needle aspiration (FNA) biopsy
Discontinuation of HRT and reexamination in 4–6 weeks
Breast imaging
Open surgical biopsy
Core needle biopsy
51. A 42-year-old woman hit her breast with a broom handle while doing housework. She noticed a lump in that area at the time, and 1 week later the lump was still present. She then sought medical advice. On physical examination, she has a 3-cm, hard mass deep inside the affected breast and some superficial ecchymosis over the area. Which of the following is the most appropriate next step, or steps, in management?
Reassess in about 2 months, with no specific therapy
Hot packs, analgesics, and surgical evacuation of the hematoma
Mammogram, and no further therapy if the report does not identify cancer
Mammogram and biopsy of the mass
Mastectomy
52. A 47-year old woman comes to the clinic because of worsening left breast swelling and pain. She had mastitis when she nursed her first child 20 years ago. She has not seen a doctor since that time. She is afebrile. Breast examination shows the left breast is enlarged with a 7 x 6 cm area of edema and erythema. A poorly localized mass without fluctuation is palpated in that area. Scant non-bloody discharge is noted on the nipple, and several large axillary nodes are palpated. Which of the following is the most appropriate next step in management?
Antibiotic active against Streptococci and Staphylococci
Culture of the discharge and treatment depending on the indings of the culture
Drainage, culture of the drained exudate and treatment depending on the indings of the culture
Biopsy for culture and treatment depending on the indings of the culture
Biopsy for histology and treatment depending on the findings of the histology
50. A 35-year-old woman presents to the physician's office after she palpated a lump in her right breast. She has no other complaints. She has not seen a doctor for 10 years. She regularly performs breast self-exams after menses. She has no signifficant past medical history. Her mother died of breast cancer at the age of 40. Breast examination shows a 1 x 1 cm, rubbery, firm, freely mobile round mass in the upper, outer quadrant of the right breast; no axillary lymph nodes are palpable. Which of the following is the most appropriate next step in management?
Observation
Ultrasonography
Excisional biopsy
Fine needle aspiration
Mammography
53. A 36-year-old woman presents to the physician's office after she palpated a lump in her right breast. She has no other complaints. She has not seen a doctor for 10 years. She regularly performs breast self-exams after menses. She has no significant past medical history. Her mother died of breast cancer at the age of 40. Breast examination shows a 1 x 1 cm rubbery, firm, freely mobile, round mass in the upper, outer quadrant of the right breast. No axillary lymph nodes are palpable. Which of the following is the most appropriate next step in management?
Reassurance
Repeat physical exam in 6 months
Excisional biopsy
Core needle biopsy
Mammography and ultrasound
A 48-year-old perimenopausal woman presents with a 2-month history of a painful lump in her right breast. On examination you find a 2.5 cm tense, fluctuant, mobile lump in the outer lower quadrant of the right breast. The most appropriate next course of action is?
Computed tomography scan
Mammography and ultrasound
Fine needle aspiration
Core biopsy
Mammography and core biopsy
A 34-year-old premenopausal woman presents to your clinic with a lump in her right breast. On examination you find a 2.5 cm fluctuant, mobile, tender lump in the inner lower quadrant of the right breast. The ultrasound report suggests a benign fluid-filled cyst. The most appropriate course of action is?
Breast magnetic resonance imaging
Ultrasound guided fine needle aspiration
Ultrasound guided core biopsy
Reassure and discharge
Mammography
A 59-year-old woman is undergoing triple assessment for a suspicious lump in the upper outer quadrant of the breast. Which one of the following correctly describes the components of this clinical investigation?
Physical examination, lump excision, ultrasonography, computed tomography
Physical examination, fine needle aspiration cytology, core biopsy, ultrasonography
Physical examination, fine needle aspiration cytology, core biopsy and mammography
Physical examination, lump excision, mammography, core biopsy
Ultrasonography, fine needle aspiration cytology, mammography
A 25-year-old woman presents to your clinic after discovering, for the first time, two lumps in the inner lower quadrant of her left breast. On examination you find these lumps to be 2 cm in size, solid, discrete, mobile and non-tender. The right breast is normal and there is no lymphadenopathy. The most appropriate course of management is?
Request a mammogram
Reassure the patient and discharge her
Request an ultrasound of the left breast
Request fine needle aspiration
Request a core biopsy
1. A 29-year-old African-American woman comes to the physician after discovering a mass on breast self-examination. Her last menstrual period was 2 weeks ago. She reports occasional bilateral gray nipple discharge that has not changed since menarche. She has no significant past medical history and does not take any medications. Examination reveals a 1.5-cm fluctuant mass in the upper and outer quadrant of the left breast. Which of the following is the best next step in management?
Cytological examination of the nipple discharge
Fine-needle aspiration
Incisional biopsy
Mammography
Reassurance and continued breast self-examination
. After a triple assessment, including core biopsy, a 28-year-old woman is diagnosed with a fibroadenoma of the left breast. The patient has a significant family history of breast carcinoma. The non-tender lump is situated in the inner lower quadrant of the left breast. The lump is approximately 1.5 cm x 1.5 cm. What is the most appropriate course of management?
Excision of the lump
Reassure and follow-up after 3 months
The patient should be given the choice of excision or not and if not she could be discharged
Fine needle aspiration
Perform triple assessment again in 6 weeks
A 38-year-old woman, and mother of two healthy children, is diagnosed with a fluid-filled simple cyst after triple assessment. On ultrasound the inner surface of the cyst looks entirely smooth. The woman does not have any significant family history of carcinoma and the cyst is located in the outer-lower quadrant of the right breast. What would be the most appropriate course of action?
Wide local excision
Follow-up appointment in 3 months
Annual follow- up
Reassure and discharge
Core biopsy
A 25-year-old woman is diagnosed with a 1.5 cm palpable area of fat necrosis of the left breast by core biopsy following a traumatic injury 14 days earlier. She has slight bruising of the lower outer quadrant of the left breast with moderate tenderness. What would be the most appropriate course of management?
Reassurance and discharge
Follow-up appointment for ultrasound in 3 months
Wide local excision
Left mastectomy
Follow-up appointment for ultrasound in 6 months
A 45-year-old perimenopausal woman is diagnosed with mammary duct ectasia of the right breast after having had small and infrequent amounts of milky green discharge from multiple ducts of the right nipple for over 2 months. The patient has no significant family history and mammography findings are normal. What is the most appropriate course of management?
Reassure and discharge
Surgical resection of the duct system of the right breast (Hadfield's operation)
Cormnence antibiotic therapy
Perform mammography of the right breast in 3 months
Mastectomy of the light breast
A 60-year-old woman was found to have one focal area of microcalcification (approximately 20 mm in diameter) in the left breast. A stereotactic core biopsy of this area was taken for histological assessment, which revealed low-grade ductal carcinoma in situ. In light of this, what would be the most appropriate treatment modality for this patient?
Mastectomy
Mastectomy + postoperative radiotherapy
Wide local excision + postoperative radiotherapy
Mastectomy+ axillary clearance + postoperative radiotherapy
Wide local excision + axillary clearance + postoperative radiotherapy
A 47-year-old woman is diagnosed with an unofficial 2.5 cm Grade 3 invasive ductal carcinoma of the right breast. Following MDT discussion the consultant sees the patient in clinic to convey management options. Which of the following would be the most appropriate management plan for this patient?
Wide local excision
Wide local excision and axillary clearance
Mastectomy and sentinel node biopsy
Wide local excision and sentinel node biopsy
Mastectomy and axillary clearance
A 46-year-old man is diagnosed with an oestrogen receptor positive invasive ductal carcinoma of the right breast after having discovered a lump 3 months before. The patient is found to have multiple involved axillary lymph nodes and the tumour is of an aggressive phenotype. The most appropriate treatment option for this patient is?
Cytotoxic chen1oth.erapy and Tamoxifen but no surgery
Mastectomy + axillary clearance + systemic chemotherapy + radiotherapy and tamoxifen
Wide local excision and Tamoxifen only
Mastectomy + postoperative radiotherapy only
Palliative care programme
A 58-year-old postmenopausal woman has been seen in clinic following discovery of a 3 cm, nontender, irregular, firm lump in the upper outer quadrant of the left breast. Mammography and ultrasound imaging respectively reveal that the lump has areas of calcification and is a solid mass. The most appropriate course of action is?
Repeat mammography and ultrasound scans in 6 months
Reassure and discharge
Repeat mammography and ultrasound scans in 3 months
Fine needle aspiration to ensure that the lump is not really fluid filled
Core biopsy
You are the radiologist reviewing the mammograms of a 56-year-old woman. When compared with her previous mammograms, areas of calcification previously seen within the left upper outer quadrant have now disappeared. Which of the following is not a possible explanation?
Breast surgery
Chemotherapy
Postmenopausal changes
Radiotherapy
Spontaneous resolution
Actuellement, la thérapeutique généralement conseillée en France dans un cancer du sein survenant chez une femme de 45 ans, porteuse d’un cancer inférieur à 1 cm du quadrant supéroexterne sans ganglion axillaire palpable:
Mastectomie radicale et irradiation post-opératoire
Mastectomie simple seule
Mastectomie radicale seule
Tumorectomie seule
Tumorectomie, vérification axillaire et radiothérapie loco-régionale
A 33-year-old nulliparous woman is 29 weeks pregnant. She was referred to the rapid access breast clinic for investigation of a solitary breast lump. Sadly, a biopsy of this lump revealed a carcinoma. After much counselling from the oncologists and her obstetricians a decision is reached on her further treatment. What option below may be available to her?
Tamoxifen
Computed tomography (CT) of the abdomen-pelvis
Radiotherapy
Chemotherapy
Bone isoptope scan to look for metastases in order to stage the disease
A 39-year-old woman has undergone a wide local excision for a 0.5 cm ductal carcinoma of her right breast. Sentinal node biopsy, histology and staging scans have confirmed the disease as TlNOMO. Histology has confirmed the cancer as oestrogen and progesterone receptor positive. Which of the following statements is most accurate regarding this female's treatment options?
She should receive radiotherapy
She is not suitable for tamoxifen therapy
She is not suitable for radiotherapy
She requires no further treatment
She should be considered for cetuximab therapy
1. A 29-year-old woman presents with a 6-month history of erythema and edema of the right breast with palpable axillary lymphadenopathy. A punch biopsy of the skin reveals neoplastic cells in the dermal lymphatics. Which of the following is the best next step in her management?
A course of nafcillin to treat the overlying cellulitis and then neoadjuvant chemotherapy for breast cancer
Modified radical mastectomy followed by adjuvant chemotherapy
Modified radical mastectomy followed by hormonal therapy
Combined modality chemotherapy and radiation therapy to the right breast with surgery reserved for residual disease
Combined modality therapy with chemotherapy, surgery, and radiation
{"name":"Breast", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"1. A 62-year-old woman presents with invasive ductal carcinoma of the right breast. Which of the following findings would still allow her to receive breast conservation surgery (partial mastectomy)?, 3. A 51-year-old woman presents with an ill-defined, slightly firm area in the upper outer quadrant of her right breast. The clinician thinks this area is consistent with fibrocystic change, but a biopsy from this area has a focus of lobular carcinoma in situ. Which of the following histologic features is most characteristic of this lesion?, 1. A 47-year old woman comes to the clinic because of worsening left breast swelling and pain. She had mastitis when she nursed her first child 20 years ago. She has not seen a doctor since that time. She is afebrile. Breast examination shows the left breast is enlarged with a 7 x 6 cm area of edema and erythema. A poorly localized mass without fluctuation is palpated in that area. Scant non-bloody discharge is noted on the nipple, and several large axillary nodes are palpated. Which of the following is the most appropriate next step in management?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
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