Breast MCQs — Past Paper OmpathStudy

Breast mcqs — Questions and Answers Complete review bank: 27 questions recovered from all 17 source pages. 1. A 52-year-old woman has felt a lump in her breast for the past 2 months. On physical examination a firm 2 to 3 cm mass is palpable in the upper outer quadrant of her right breast. There are no palpable axillary nodes. A lumpectomy with axillary node dissection is performed. The breast lesion is found to have positive immunohistochemical staining for HER2/neu (c-erb B2). Staining for estrogen and progesterone receptors is negative. Which of the following treatment options is most likely to be efficacious in this woman? A. Letrozole B. Tamoxifen C. Trastuzumab D. Prednisone E. Doxorubicin Answer: C. This is most likely an invasive breast carcinoma of no special type (NST), formerly calledinfiltrating ductal carcinoma. The lack of ER staining suggests a poor response to hormonal therapy with tamoxifen or letrozole. The positive C-erb B2 (HER2/neu, an epithelial growth factor receptor) staining suggests that the monoclonal antibody traztuzumab may be effective. Radical mastectomies are rarely performed. 2. A 47-year-old woman undergoes routine mammographic screening and there are multiple small areas of increased density, though a single distinctive mass lesion is not detectable either by palpation or by mammography. A fine needle aspiration biopsy of an abnormal density reveals cells suspicious for a malignancy. An excisional breast biopsy yields a diagnosis of lobular carcinoma in situ of the breast. Which of the following is the most likely finding associated with this woman's carcinoma? A. No residual carcinoma B. Opposite breast involvement C. Absent family history of breast cancer D. Concomitant Paget disease of the nipple E. Negative estrogen receptor assay Answer: B. Bilaterality is a frequent characteristic of lobular carcinoma in situ (LCIS). The prognosis is still good, but more surgery may be needed. 3. A 15-year-old healthy girl of normal height and weight for age is concerned because her right breast has developed to twice the size of her left breast since the onset of puberty at age 12. On physical examination both breasts have a similar consistency on palpation, with no lumps, and there is no tenderness. The nipples and areolae appear normally formed. Which of the following is the most likely cause for these findings? A. Cystosarcoma phyllodes B. Adrenogenital syndrome C. Virginal hypertrophy D. Fibrocystic changes E. Ductal carcinoma in situ Answer: C. Virginal hypertrophy, or rapid enlargement of one or both breasts following puberty, is a problem that can be easily remedied with plastic surgery, and tamoxifen therapy may reduce recurrence. As breasts are enlarging following puberty, there is often some unequal growth, but eventually an equal size is reached by the end of puberty. 4. A 20-year-old woman notes a mass in her left breast after following the directions for breast self-examination provided by her health clinic. Her physician palpates a firm, 1 to 2 cm mass. There is no nipple discharge and no pain. No axillary adenopathy is present. The overlying skin of the breast appears normal. Her left breast is slightly larger than the right, a condition she says has been present since puberty. Her urine pregnancy test is negative. Mammography confirms the presence of a rounded density, which has no microcalcifications, and reveals no lesions of the opposite breast. Which of the following is the most likely diagnosis? A. Focus of fat necrosis B. Fibroadenoma C. Intraductal papilloma D. Invasive breast carcinoma, NST E. Phyllodes tumor Answer: B. At her age, such a firm small movable mass is most likely to be a benign lesion, and a fibroadenoma is the most likely cause for this small 'lump' in the breast. Cancers are not common at this age. 5. A 19-year-old woman gave birth to a healthy male infant at term following an uncomplicated pregnancy. She has now been breast feeding the baby for a month, but notes that her left breast has gradually become swollen and painful to touch over the past week. On physical examination her temperature is 38.2°C. Which of the following is the most likely diagnosis? A. Acute mastitis B. Fibrocystic disease C. Fat necrosis D. Intraductal papilloma E. Galactocele Answer: A. The causative organism is most often Staphylococcus aureus or Streptococcus. Antibiotic therapy is usually successful. 6. A 35-year-old woman has noted a palpably firm, irregular mass in her right breast for the past 3 months. On physical examination there is no tenderness or swelling. By mammography there is an irregular 2 cm density that contains scattered microcalcifications. Biopsy of this mass reveals extensive fat necrosis. Which of the following is the most likely cause for this breast lesion? A. Pregnancy B. Prolactinoma C. Trauma D. Fibrocystic changes E. Lobular carcinoma in situ F. Mastitis Answer: C. Trauma leads to fat necrosis. This lesion can sometimes mimic a carcinoma on