Lecture 10 practice

Question 1

Transection of __________ leads to winged-scapula deformity
a) Long thoracic nerve of Bell
b) Thoracodorsal nerve
c) Medial pectoral nerve
d) Lateral pectoral nerve

Answer 1

a) Long thoracic nerve of Bell

Question 2

The USPSTF recommends biennial screening mammography for women aged ____ to 74 years.

Answer 2

40

Question 3

What is the diagnostic procedure of choice for palpable and image-detected abnormalities of the breast?
a) Fine needle aspiration
b) Core needle biopsy (CNB)
c) MRI
d) CT scan

Answer 3

b) Core needle biopsy (CNB)

Question 4

A 37 y/o woman presents with a firm, mobile mass on her breast that fluctuates with her menstrual cycle. Which of the following should you do next?
a) FNA
b) CNB
c) Cytologic evaluation

Answer 4

a) FNA
(pt has simple cyst)

Question 5

The most common breast lesion <30 y/o is what?

Answer 5

Fibroadenoma

Question 6

Presumed fibroadenomas > 3-4 cm are excised to r/o what?
a) Phyllodes tumor
b) Mondor Disease
c) Hamartoma
d) Breast cancer

Answer 6

a) Phyllodes tumor

Question 7

Which is more often painless?
a) Mondor Disease
b) Hamartoma

Answer 7

b) Hamartoma

Question 8

A 75 y/o postmenopausal smoker presents with green nipple discharge. Based on her age, which is more likely?
a) Mammary duct ectasia
b) Periductal mastitis

Answer 8

a) Mammary duct ectasia

Question 9

What is the most common cause of bloody nipple discharge?
a) Periductal mastitis
b) Intraductal papillomas
c) Subareolar papillomas
d) Sclerosing lesions

Answer 9

c) Subareolar papillomas

Question 10

What is the most significant risk for breast cancer?
a) Family history
b) COCPs
c) Nulliparity
d) Age

Answer 10

d) Age

Question 11

___________is associated with ovarian cancer, and __________ is associated with breast cancer in males
a) BRCA1; BRCA2
b) BRCA2; BRCA1

Answer 11

a) BRCA1; BRCA2

Question 12

Which does not form a palpable lesion, is 50-70% bilateral, and is not considered pre-invasive lesion?
a) Ductal Carcinoma in Situ (DCIS)
b) Lobular carcinoma in Situ (LCIS)

Answer 12

b) Lobular carcinoma in Situ (LCIS)

(Ductal is pre-invasive and usually unilateral)

Question 13

What is the most common invasive breast cancer?
a) Invasive tubular carcinoma
b) Invasive metaplastic carcinoma
c) Invasive (infiltrating) ductal carcinoma (IDC)
d) Invasive lobular carcinoma (ILC)

Answer 13

c) Invasive (infiltrating) ductal carcinoma (IDC)

Question 14

Which breast cancer patients should definitely be treated with palliative intent? Select all that apply
a) Stage 3
b) Stage 4
c) Locally advanced (T3 & T4)
d) Inflammatory tumors
e) Unresectable local cancers

Answer 14

b) Stage 4
e) Unresectable local cancers

Question 15

What is the standard surgical option for invasive breast cancer?
a) Partial mastectomy (lumpectomy) with radiation therapy
b) Total or simple mastectomy
c) Modified radical mastectomy (MRM)
d) Radical mastectomy with pectoralis muscle removal

Answer 15

c) Modified radical mastectomy (MRM)

Question 16

Most common complication of mastectomy and axillary lymph node dissection is what?
a) Adenoma
b) Cystadenoma
c) Seroma
d) Mastitis

Answer 16

c) Seroma

Question 17

What is spared in a Modified radical mastectomy (MRM)? Select all that apply
a) Pectoralis muscle
b) Breast tissue
c) Axillary nodes
d) All of the above

Answer 17

a) Pectoralis muscle

Question 18

What is spared in a total or simple mastectomy? Select all that apply
a) Pectoralis muscle
b) Breast tissue
c) Axillary nodes
d) All of the above

Answer 18

a) Pectoralis muscle
c) Axillary nodes

Question 19

Which form(s) of autologous breast reconstruction do not require harvest of muscle & have a lower incidence of lower abdominal wall complications? Select all that apply
a) Pedicled TRAM (transverse rectus abdominus myocutaneous) flap
b) Free TRAM flap
c) DIEP (deep inferior epigastric perforator) flap
d) SIEP (superficial epigastric perforator) flap

Answer 19

c) DIEP (deep inferior epigastric perforator) flap
d) SIEP (superficial epigastric perforator) flap

Question 20

Which procedure has a risk of residual ductal tissue and requires screening?
a) Skin-sparing Mastectomy
b) Nipple-sparing mastectomy (NSM)
c) TRAM (transverse rectus abdominus myocutaneous) flap
d) DIEP (deep inferior epigastric perforator) flap

Answer 20

b) Nipple-sparing mastectomy (NSM)

Question 21

A mastectomy pt has had Jackson-Pratt (JP) drains in place for the past 12 days, and their drainage is now ~20cc/day. Can they be removed?
a) Yes, drainage and timeframe are appropriate
b) No, still draining too much
c) No, it hasn’t been long enough

Answer 21

a) Yes, drainage and timeframe are appropriate

Question 22

The current recommendation is 10 years of treatment with ____________ or __________ after surgery for ER-positive breast cancers or ductal carcinoma in situ. Select two.
a) Radiation
b) Chemotherapy
c) Tamoxifen
d) Raloxifene

Answer 22

c) Tamoxifen
d) Raloxifene

(Tamoxifen doesn’t work for ER- cancers)

Question 23

If a BC pt has negative nodes (low risk) and is ER+, what should you do besides surgery?
a) No adjuvant Tx
b) Tamoxifen only
c) Tamoxifen and/or chemotherapy

Answer 23

b) Tamoxifen only

Question 24

What is the strongest risk factor for male breast cancer?
a) FHx breast or ovarian CA
b) H/o undescended testes
c) Chronic liver disorders (ie, cirrhosis)
d) Klinefelter syndrome (47,XXY)
e) BRCA2 mutation

Answer 24

d) Klinefelter syndrome (47,XXY)

Question 25

A solitary hard thyroid nodule generally ________ worrisome than multiple nodules More Less

Answer 25

More

Question 26

Which of the following is suggestive of a more benign cause of a thyroid nodule? New onset hoarseness Horner syndrome Palpable adenopathy Painless nodule Elevated Sr TSH Cervical lymphadenopathy

Answer 26

Painless nodule

Question 27

A 22 y/o pt presents with a slow-growing solitary thyroid nodule that has spread to nearby lymph nodes. Biopsy shows Psammoma bodies, so you realize this is indicative of the most common form of thyroid carcinoma, which is what? Papillary Follicular Anaplastic Medullary Hurthle cell Insular

Answer 27

Papillary

Question 28

Thyroid cancer: __________ has an 85% 10 yr survival rate, whereas __________ is one of the most aggressive and lethal malignancies a) Hurthle cell carcinoma; Insular carcinoma b) Medullary carcinoma; Insular carcinoma c) Hurthle cell carcinoma; Anaplastic cancer d) Anaplastic cancer; Hurthle cell carcinoma

Answer 28

c) Hurthle cell carcinoma; Anaplastic cancer (Hurthle cell is a variant of follicular carcinoma, medullary is assoc with MEN2A/2B)

Question 29

A 20 y/o pt has a large toxic adenoma. Labs show hyperthyroidism, low TSH, so you do a RAI scan which shows it’s hyperfunctioning. What does this tell you? Bonus: Tx? a) Benign w <1% chance of malignancy b) Benign w 20% chance of malignant transformation c) Malignant

Answer 29

a) Benign w <1% chance of malignancy (hypofunctioning = 20% chance) -If younger and with large nodule like this pt, surgery recommended -If smaller, may be managed with antithyroid meds and RAI -If larger, may require higher doses (which may lead to hypothyroidism)

Question 30

If a pt has a parathyroid adenoma causing hyperparathyroidism, you’d expect which lab values? Select all that apply High serum phosphate High serum calcium High PTH High ADH

Answer 30

High serum calcium High PTH

Question 31

T/F: Surgical intervention (parathyroidectomy) is recommended in patients with primary hyperparathyroidism and clinical symptoms

Answer 31

True (four gland parathyroid exploration is gold standard, subtotal parathyroidectomy also an option for parathyroid hyperplasia (secondary))

Question 32

If ACTH or renin level is low, but excretion of cortisone, aldosterone, etc. is excessive, a _________ cause is confirmed

Answer 32

adrenal

Question 33

T/F: Almost all adrenal tumors can be removed laparoscopically

Answer 33

True (except when >8/10cm)

Question 34

HTN is the most common feature in 90% of patients with what? Bonus: Tx? a) Pheochromocytoma b) Adrenal cortex tumors c) MEN Type 1 d) MEN Type 2A

Answer 34

a) Pheochromocytoma (pheochromocytoma is a type of adrenal medulla tumor that can be caused by MEN2A) Tx with Phenoxybenzamine (alpha blocker) + beta blocker (if tachy) + metyrosine right after Dx, then excision after imaging

Question 35

Which are correct abt the types of MEN? Select all that apply a) MEN 1 is associated with ZES b) Prophylactic total thyroidectomy should be offered to all pts with MEN 2A and MEN 3, but never MEN 1 c) Both MEN 2A and MEN 3 have a 90% chance of developing MTC d) MEN 2A and MEN 3 are caused by the RET proto-oncogene on chromosome 10

Answer 35

a) MEN 1 is associated with ZES c) Both MEN 2A and MEN 3 have a 90% chance of developing MTC d) MEN 2A and MEN 3 are caused by the RET proto-oncogene on chromosome 10

Question 36

A pt with a type of MEN (they forget what kind) presents for an annual physical. You note mucosal neuromas w bumpy, enlarge lips and tongue. Which conditions are they at risk for? Select all that apply a) MTC b) Pheochromocytoma c) Hyperparathyroidism d) All of the above

Answer 36

a) MTC b) Pheochromocytoma (pt has MEN 3)