Extra Questions

1. Breast lymphatics drain into:

a- Axillary nodes.
b- Internal mammary nodes.
c- Pectoral and subscapular nodes.
d- All of the above.

Answer: D
Explanation: All are correct

2. The axillary lymph nodes receive what percentage of lymph from breast:
a- 50%.
b- 75%.
c- 90%.
d- 100%.

Answer: B
Explanation: The axillary lymph nodes receive the majority of lymph drainage from the breast, The
remaining percentage of lymph from the breast, approximately 25%, drains into other nearby lymph
nodes, such as the internal mammary lymph nodes located along the sternum (breastbone) and the
infraclavicular lymph nodes located below the collarbone.

3. Which of the following statements about milk lines is False:

a- They are common to all mammals.
b- Between 2% and 6% of human females have an accessory nipple or extramammary breast tissue.
c- Milk lines are derived from endoderm.
d- They extend from the axilla to the inguinal region.
e- None of the above.

Answer: C
Explanation: Milk lines, or mammary ridges, are derived from the ectoderm during embryonic
development.

4. Which of the following advantages breast ultrasound enjoys:

a. Can localize impalpable breast lumps
b. Can distinguish solid from cystic lesion.
c. Better yield in young dense breast than mammogram.
d. All of the above.

Answer: D
Explanation: All are correct

5. Mammographic findings suggestive of breast cancer include:

a- Solid lesion with stellate configuration.
b- Microcalcification.
c- Asymmetry or distortion of breast outline.
d- Increased skin thickness.
e- All of the above.
Answer: E
Explanation: All are correct

6. Mammographic lesions that are strongly associated with malignancy include all of the following
EXCEPT:
a- Large and coarse calcifications.
b- Thickened epidermis.
c- Poorly defined mass lesions.
d- Fine stapled calcifications.
e- Increased density.

Answer: A
Explanation: Larger calcifications are more commonly benign and may be related to conditions such
as fibroadenomas or benign breast calcifications.

7. Which of the following about MRI breast imaging is True:

a- Distinguishes scar from recurrence.
b- Gold standard for imaging with breast implants.
c- Management of axilla in breast cancer and recurrent disease.
d- All of the above.

Answer: D
Explanation: All are correct

8. All are True of breast FNAC EXCEPT:

a- Safe and reliable.
b- Least invasive for cell diagnosis.
c- Very accurate.
d- Invasive cancer can be diagnosed from in situ disease.

Answer: D
Explanation: FNAC can help determine if cancer is present, it cannot differentiate between in situ
breast cancer and invasive, A definitive diagnosis and determination of whether cancer is in situ or
invasive require a biopsy,

9.Acute mastitis MOST commonly occurs at or during:

a. Birth.
b. Puberty.
c. Pregnancy.
d. Lactation.
e. Blunt trauma to the breast.

Answer:D
Explanation: Due to A) Breast problems such as: Milk engorgement due to blockage of the ducts
thickened milk and epithelial debris, Nipple cracks and fissures, Retracted nipple.
B) General Problems (Bad hygiene, Bad general condition as diabetes, steroid therapy).

10. What is True about breast abscess:

 a- Rare during lactation.
b- Usually, unilocular.
c- Best treated with antibiotics.
d- Requires incision and break up of all trabeculae.

Answer: D
Explanation: Acute breast abscess should not be Treated by antibiotics to avoid formation of chronic
breast abscess that can be mistaken for cancer (because it will form granulation tissue thus retracting
nipple and dimpling of breast. Surgical drainage is done.

11. What is common consensus about breast abscess:

a- Fluctuation is late sign.
b- Area of induration is sector shaped.
c- Must be drained if no resolution within 48 hours of antibiotics.
d- Counter incision is made in most dependent part.
e- All the above

Answer: E
Explanation All are True.

12. Organism causing breast abscess is:

a- Bacillus.
b- Neisseria ganorrhea.
c- Proteus.
d- Staphylococcus.

Answer: D
Explanation: Staphylococcus aureus is frequently found on the skin, including the nipple and areola
area. It can enter the breast tissue through cracks or openings in the skin, such as through a cracked or
sore nipple during breastfeeding or through a skin infection.

13. Breast mouse refers to:

a. Fibroadenosis.
b. Fibrocystic disease.
c. Hard fibroadenoma.
d. All the above

Answer: C
Explanation: Because it is freely mobile and never attached to surroundings and well encapsulated
between cleavage, firm to hard consistency and well circumscribed

14-The acronym ANDI stands for:

-a Abnormal development and involution.
-b Aberration of normal development and involution.
c- Accelerated normal development and involution.
d- None of the above.

Answer: B
Explanation: The breast undergo changes throughout the woman’s productive life with cyclic changes
during menstrual cycle ( Adenosis, Fibrosis, Epitheliosis ,Cyst formation , etc )
15- Regarding benign breast disease all are true EXCEPT:
a. Cyclical mastalgia is the commonest reason for referral to the breast clinic
b. Fibroadenomas are derived from the breast lobule
c. Lactational breast abscesses are usually due to Staph aureus.
d. Duct ectasia is more common in smokers
e. Atypical lobular hyperplasia is not associated with an increased risk of breast cancer

Answer: E
Explanation:. Atypical lobular hyperplasia is 5 times precancerous, It is characterized by
fibroadenosis, Fibrocystic dysplasia and sector mastitis.

16. Regarding fibroadenomas all are true EXCEPT:

a- Are benign monoclonal neoplasms (arise from one cell type)
b- Most commonly present in late adolescence or the early 20s
c- Should be diagnosed by triple assessment
d- At least 30% reduce in size over a 2 year period
e. Can be safely managed conservatively in young females

Answer: A
Explanation: fibroadenoma is a benign neoplasm of breast affects both fibrous and glandular but
fibrous eliment predominates ( Diclonal or Polyclonal )

17. Most common cause of blood discharge from nipple is:

a- Fibroadenoma
b- Fibro-adenosis.
c- Ductal papilloma.
e- Ductal carcinoma.

Answer: C

Note: (( The blood stained discharge is most commonly caused by duct papilloma, and less
commonly duct carcinoma or duct ectasia.))

18. Greenish discharge from nipple indicates:

a- Carcinoma
b- Duct papilloma.
c- Duct carcinoma.
e- Fibroadenosis.

Answer: D

Note : (( A green discharge is more frequently associated with ductal changes and the secondary
retention cysts of fibroadenosis. ))

19. Massive swellings of the breast include the following EXCEPT:

a. Cystosarcoma phyllodes
b. Atrophic scirrhous carcinoma.
c. Diffuse hypertrophy.
d. Giant fibroadenoma.

Answer: B
Explanation: In general, atrophic scirrhous carcinoma often presents as a palpable mass or lump in
the breast

20. The treatment of choice for cystosarcoma phyllodes is:

a. Radical mastectomy.
b. Simple mastectomy.
c. Radiation therapy.
d. Hormonal ablation.

Answer: B
Explanation: It is rarely malignant so no need for radical mastectomy
Note: Probe test is used to differentiate between benign and malignant , if probe can pass+benign if
not it is malignant .

21. Mondor's disease is:

a. An obscure type of thrombophlebitis particularly affecting veins of the breast.
b. Lymphoedema of the arm.
c. Chondritis of a costal cartilage.
d. Pectus excavatum.

Answer: A
Note: It is Thrombophlebitis of the superficial veins of the breast and anterior chest wall, it occurs
either spontaneously or secondary to infection or injury.

22. Non-malignant conditions of the breast include all the following EXCEPT:
a. Cystosarcoma phyllodes.
b. Duct ectasia.
c. Giant fibroadenoma.
d. Paget's disease of the nipple.

Answer: D
Explanation: It is a specific form of intraductal carcinoma that involves the main lactiferous ducts, but
it extends to infiltrate nipple and areola , it is a superficial manifestation of underlying carcinoma.

23. Protective factors for breast cancer include all EXCEPT:

a. Nulliparity.
b. Breast feeding.
c. Late menarche
d. Early menopause.

Answer: A
Explanation: Nulliparity is one of the major risk factor of breast cancer due to the associated
hormonal and structural changes that occur during pregnancy and childbirth, which play a role in
reducing the risk of breast cancer. (Breast cancer is commoner in single and nulliparous women)
24. Factors associated with increased relative risk of breast cancer include all EXCEPT:
a. Nulliparity.
b. Menopause before 40
c. Fibrocystic disease with epithelial proliferation.
d. Early menarche.

Answer: B
Explanation: Age of menarche and menopause is intermediate risk factor not major

25. Common site of breast cancer is:

a. Upper inner quadrant.
b. Upper outer quadrant.
c. Lower inner quadrant.
d. Lower outer quadrant.

Answer: B
Explanation: The upper outer quadrant of the breast is a common site for breast cancer due to the
higher concentration of glandular tissue in that area, the lymphatic drainage pathways leading to the
nearby axillary lymph nodes, and the ease of detection during screening.

26. The MOST frequent histologic type of breast carcinoma is:

a- Infiltrating papillary carcinoma.
b- Infiltrating ductal carcinoma.
c- Infiltrating lobular carcinoma.
d- Colloid carcinoma.
e- Medullary carcinoma.

Answer: B
Explanation: The most frequent histologic type of breast carcinoma is infiltrating ductal carcinoma.
This type of breast cancer originates in the ductal cells of the breast and can invade and spread to
other tissues. It accounts for approximately 70-80% of all diagnosed breast cancer cases.

27. The risk of bilateral breast cancer is HIGHEST if the first breast shows:
a. Inflammatory carcinoma.
b. Lobular carcinoma.
c. Medullary carcinoma.
d. Infiltrating ductal carcinoma.
e. Paget's disease.

Answer: B
Note: The exact reasons for this increased risk are not fully understood, but it may be related to
genetic factors and a higher tendency for lobular carcinoma to affect both breasts simultaneously or
sequentially, women diagnosed with lobular carcinoma may undergo additional screening and
surveillance measures to monitor both breasts closely for any signs of cancer.

28. Regarding Ductal carcinoma is situ (DCIS) of the breast all the following are true EXCEPT:
a- Can be distinguished from invasive carcinoma on fine-needle aspiration Cytology (FNAC).
 b- Accounts for around 15-20% of screen-detected breast cancers. c
c- Is associated with axillary node metastases in 1% of cases.
d- Can be treated by mastectomy or lumpectomy with or without radiotherapy

Answer: A
Explanation: FNAC cannot differentiate insitu and invasive breast cancer, therefor biopsy is needed.

29. Regarding Lobular carcinoma is situ (LCIS) all are true EXCEPT:
a- Multifocal, multicentric and affects both breasts
b- Is a marker of an increased risk for developing invasive breast cancer
c- Has a characteristic mammographic appearance.
d- LCIS found incidentally in breast biopsy taken for another indication.
f- Some patients receive tamoxifen. for up to 5 years, those with positive family history of breast
carcinoma may under go prophylactic mastectomy ..
Answer: C
Explanation: Mammographic imaging typically does not show any distinctive features specific to LCIS.
In fact, LCIS is generally not detectable by mammography alone as it does not usually result in a visible
mass or calcifications. It is usually detected in biopsy specimens of other unrelated conditions.

30. The size of a stage IIIa breast tumour is:

a. 2 cm.
b. 2-5 cm.
c. > 5 cm.
d. All of the above.

Answer: C
Note:
31. In the management of early breast cancer all the following are true EXCEPT ::
a- Mastectomy is associated with significantly higher survival rates than conservative surgery.
b- Postoperative radiotherapy reduces the incidence of local recurrence.
c- Adjuvant tamoxifen improves survival in both pre- and postmenopausal patients for ER +ve
tumours.
d- Adjuvant Systemic chemotherapy has reduced mortality by 30%.

Answer: A
Explanation : Breast conservative surgery local recurrence is high 20% but the overall survival rate is
same
32. Absolute Contraindications of Breast-Conserving Therapy include all the following EXCEPT:
a- Pregnancy in the first and second trimester.
b- Multicentric disease with two or more gross tumors in separate quadrants.
c- Diffuse microcalcifications that are malignant-appearing .
d- History of prior irradiation to the breast region.
e- Large tumor-to-breast ratio with anticipation of poor cosmetic result.
f- DCIS discovered by mammography.

Answer: F
Explanation: DCIS can be treated with Breast conservative surgery.

33. The acronym QUART stands for:

a. Quadrantectomy and radiotherapy.
b. Quadrantectomy, axillary dissection and radiotherapy.
c. Quadrant resection and chemotherapy.
d. None of the above.

Answer: B
Note : QUART is type of Breast conservative surgery

34. When stage I breast cancer is treated by partial mastectomy and axillary dissection, further
therapy should include:
a. Nothing.
b. Chemotherapy.
c. Antioestrogen agents.
d. Radiation of the affected breast.
e. Oophorectomy if premenopausal.

Answer: D.
Explanation: This procedure is called breast conservative surgery where surgery( wide local excision
with safety margin by lumpectomy or quadrantectomy + Post operative radical does of radiotherapy
+ local control of axilla is done

35. What is not True about role of axillary surgery in carcinoma of breast:
a. Axillary lymph node metastasis is best marker for prognosis.
b. Treatment of axillary lymph nodes positively influences survival.
c. Axillary surgery should not be combined with radiotherapy to axilla.
d. All are true.

Answer: B
Explanation: Either surgical clearance of the axilla or radiotherapy both give the same oncologic
outcome.

36. Five Benefits of Tamoxifen in breast carcinoma include all the following EXCEPT:
a. Tamoxifen can reduce recurrence.
b. Tamoxifen can halt the progression of metastatic breast cancer.
c. Tamoxifen can reduce the risk of cancer in the other breast.
d. Tamoxifen can help prevent osteoporosis.
e. Tamoxifen can lower cholesterol levels and decrease incidence of myocardial infarction
f. Decrease incidence of endometrial carcinoma

Answer: F
Explanation: tamoxifen acts as an estrogen antagonist in breast tissue, but as an estrogen agonist in
the uterus. it can stimulate the growth of the endometrial lining, leading to an increased risk of
endometrial cancer.

37. Regarding radiotherapy for breast cancer all are true EXCEPT:
a- Has been clearly shown to imporove overall survival.
b- Has been clearly shown to reduce local recurrence rates following conservative breast surgery.
c- Should not be applied to the axilla, if axillary clearance is performed.
d- Is the treatment of choice for the palliation of painful bone metastases.
 Answer: A
Explanation: Radiotherapy does not improve the survival rates but it reduces the incidence of local
recurrence.

38. The drugs used for primary chemotherapy of breast cancer include all EXCEPT:
a. Cyclophosphamide.
b. Methotrexate.
c. Cisplatin.
d. Fluorouracil.

Answer: C
Explanation: Cisplatin is more commonly used in the treatment of other types of cancer, such as
testicular, ovarian, and bladder cancer.

39. Adjuvant chemotherapy for breast cancer:

a- Single-agent chemotheraphy has a significantly greater beneficial effect on survival than
combination chemotherapy.
b- Is the treatment of choice for metastases.
c- Has little role in the treatment of inflammatory cancers.
d- Has a clinical response limited to premenopausal women

Answer: B
Explanation: Adjuvant systemic therapy such as chemotherapy is indicated if the tumour has poor
prognostic factors such as tumour size, site, invasive and metastatic, grade, etc

40. Lymphatic obstruction of advanced breast cancer leads to:

a. Peau d'orange.
b. Oedema of arm.
c. Lymphangiosarcoma.
d. All of the above .

Answer: D
Explanation: All are correct

41. What is not True of inflammatory carcinoma:

a. Highly aggressive.
b. Very common.
c. Breast is painful, warm and edematous.
d. Mistaken for mastitis.

Answer: B
It represents 1-2% of breast cancer in western literature, in Egypt and north America 10%
Note: The prognosis is very bad

42. In carcinoma of breast, a secondaries deposit is most common in:

a. Bone
b. Brain.
c. Liver
d.Lung
Answer: A
Explanation: Bone secondaries are mainly osteolytic lesions, the metastases are due to free
(valveless) communication between posterior intercostal veins (to hemiazygous vein) and
paravertebral venous plexus (to azygous vein) ((((batson venous plexus))))

43. In carcinoma of the breast, most common site of bony metastasis is:
a- Sacral vertebra.
b- Lumbar vertebra.
c- Thoracic vertebra
d- Cervical vertebra.

Answer: B
Explanation: factors such as proximity to breast tissue, rich blood supply, mechanical stress, higher
concentration of hormone receptors, and lymphatic drainage from the breast to the lumbar lymph
nodes.

44. Which of the following genes predispodes to breast cancer:

a- BRCA1
b- BRCA2
c- TP53
d- All of the above

Answer: D
Explanation: All are correct

45. Which is not true regarding BRCA mutations in breast cancer?

a. BRCA 1 tumors are high grade as compared to BRCA 2
b. BRCA 1 breast cancer are hormone receptor positive
c. BRCA 1 breast tumor are aneuploid
d. BRCA 1 breast cancer have an increased S phase fraction

Answer: f ( None of the above )

Notes :
(( BRCA1- associated breast tumors have a worse prognosis than BRCA2- associated breast cancers.
They are high grade, associated with negative ER- PR receptors, increased S phase fraction and
aneuploid))

46. Causes of gynaecomastia include:

a- Idiopathic
b- Liver failure
c- Leprosy
d- Hormonal e.g. teratoma of the testis, ectopic hormonal production in bronchial carcinoma
e- Klinefelter's syndrome
f- All of the above
Answer: F
Explanation: All are correct leading to imbalance of oestrogen and testosterone leading to increased
glandular elements leading to generalized enlargement of male breast.

47. Regarding male breast cancer spot the wrong statement

 a- It is about 1% of all cases of breast cancer.
b- Predisposing causes include gynecomastia.
c- Caused by excess endogenous and exogenous estrogen.
d- It has a better prognosis than the female breast cancer.

Answer: D
1. Explanation: Late diagnosis, Male breast cancer is rare and often goes undetected until it has
advanced to a later stage, making treatment more challenging and reducing the chances of a
successful outcome + Male breast cancer is typically hormone receptor-positive, which means it
may be more aggressive and less responsive to hormone therapies compared to female breast
cancer.

———————-
Options:
a- Wide local excision.
b- Wide local excision + breast radiotherapy.
c- Wide local excision + breast radiotherapy + axillary clearance.
d- Mastectomy.
e- Mastectomy + axillary clearance.
f- Tamoxifen.
g- Cytotoxic chemotherapy.
h- Tamoxifen + cytotoxic chemotherapy.
i- Bilateral oophorectomy.
j- Local radiotherapy.

For each of the cases scenarios listed below, select the single most likely therapy from the options listed
above. Each option may be used once, more than once or not at all.

48. Investigation of a 35-year-old woman presented with 2cm carcinoma of the upper outer quadrant of
her right breast with no palpable axillary lymph nodes. She has expressed concern regarding disfiguring
surgery.

Answer : C
Explanation: She is a candidate for breast conservative surgery

49. A 50 year-old postmenopausal woman undergoes a simple mastectomy with lymph node sampling
following a diagnosis of breast carcinoma. Histology reveals carcinoma in three of the four sampled
nodes. The tumour is oestrogen receptor negative.

Answer: G
Explanation: Chemotherapy is indicated because it is hormonal receptor -ve

CHOOSE THE CORRECT ANSWER

50. A patient with early breast cancer who has received appropriate treatment asks, "When can I be
considered cancer-free?"
A. After 2 years.
B. After 5 years.
C. After 10 years.
D. After 20 years.
E. Never.

Answer: E
Explanation:: Though the incidences of local and distant recurrences diminish with the passage of years,
escaping cancer cells may remain dormant. For unknown reasons these cells may be activated after many
years and cause recurrence.

51. One of the following associations between tumour markers and cancers is not correct.
A. AFP and breast cancer.
B. AFP and hepatocellular carcinoma.
C. AFP and malignant teratoma of the testis.
D. CA 19-9 and pancreatic cancer.
E. Thyrocalcitonin and medullary carcinoma of thyroid.

Answer: A.
Explanation: CA 15-3, CA 27.29 and CEA may be elevated in breast cancer patients, particularly with
metastatic disease. They are used to monitor success of treatment.

52.The axillary lymph nodes are divided into three levels I, II and III by:
F. The axillary artery.
G. The axillary vein.
H. The pectoralis minor muscle.
I. The clavicle.
J. The nerve to latissmus dorsi.

Answer : C
Explanation: The axillary lymph nodes make the main station for lymphatic spread of breast cancer.
These lymph nodes are divided into three levels by the pectoralis minor muscle. Level I nodes is below
the muscle, level II behind it and level III is above it. Lymph node deposits affect level I, then moves to
level Il and later on to level III. The higher the level of involvement, the worse is the prognosis.

53. About acute lactational breast abscess, one statement only is true:
A. Is commonly multilocular.
B. Weaning the baby is mandatory.
C. Aspirating pus by a wide bore needle is superior to incisional drainage as it avoids injury to lactiferous
ducts
D. Mammography is indicated if an abscess is suspected
E. Treatment is essentially conservative by antibiotics

Answer: A
Explanation: The breast parenchyma is divided by fascial septa. These septa cause
multiloculation of a breast abscess. For this reason needle aspiration is usually
inadequate and a breast abscess should ideally be incised to break through the
septa and to convert the abscess into one cavity, thus allowing complete drainage.
The golden rule for abscess treatment is "pus drainage". The use of antibiotics only is likely to convert an
acute abscess into a chronic one. This is frequently
referred to as "antibioma". In the breast a chronic abscess is difficult to distinguish from cancer.
Weaning the baby is not necessary, particularly if the infant is a few months old. The patient can nurse it
from the healthy breast. When the abscess is drained the patient evacuates milk from the affected side by
a breast pump until it is convenient to her to nurse the baby from this side as well.
An acute abscess is very tender. The patient cannot withstand the breast
compression that is required to take a mammogram. If in doubt of the diagnosis,
ultrasound imaging is the best choice. It shows thick fluid collection within the breast.

54. The following statements about fibrocystic breast are all true, except:
A. May be asymptomatic
B. May cause nipple retraction.
C. Is a cause of breast pain
D. Produces breast nodularity.
E. May cause discharge per nipple

Answer: B
Explanation: Fibrocystic breast changes are very common. The condition may be asymptomatic. Itm a y
cause mastalgia (usually cyclic) or nipple discharge. Breast nodularity is commonly felt. Large cysts are
felt as discrete lumps. When these lumps are surrounded by fibrosis, they are easily confused with breast
cancer. Nipple retraction may be developmental and dates to menarche, or may be recently developed in
an adult female. The latter condition is almost always diagnostic of breast cancer.

55. Treatment of cyclic mastalgia may include all the following, except:
A. Exclusion of malignancy and reassurance
B. Avoidance of breast support
C. Giving up caffeine consumption
D. Bromocriptine 2.5 mg bid E. Danazol 100-200 mg bid.

Answer: B
Explanation: Cyclic mastalgia is a common disorder. The patient is usually apprehensive about the
possibility of malignancy. Once excluded and the patient is reassured, most patients will be relieved both
psychologically and physically. Addition of simple analgesics will usually be enough for management.
Other simple
measures as breast support (particularly with heavy breasts) and stopping the intake of caffeine-
containing beverages will further reduce pain.
Medications as bromocriptine (anti-prolactin) and Danazol (modified testosterone) are occasionally used
for the treatment of resistant cases.

56. The following statements about fibroadenoma of the breast are all true, except:
A. Usually affects females in the second and third decades of life.
B. May be multiple.
C. Freely mobile.
D. The lesion is easily excised as it is well encapsulated.
E. If left untreated it turns malignant in 9% of cases within 15 years.

Answer: E
Explanation: A fibroadenoma is a mixed epithelial and mesenchymal benign tumour. The peak age of
appearance is late teens and early twenties. Multiple tumours may be discovered in the same time
(snchronous) or appear months or years after the discovery of the first fibroadenoma (metachronous).
A very characteristic feature is its free mobility, so much so that it is called the "breast mouse". As a
benign tumour it is well-encapsulated, a feature that makes its enucleation at surgery an easy task.
A fibroadenoma is not known to be precancerous or to be a risk factor for the development of malignancy.

57. Regarding breast cysts, one statement is true:

A. The commonest is galactocele.
B. Malignancy is suspected if the cyst is tense.
C. Malignancy is suspected if the lump does not totally disappear after complete aspiration of fluid.
D. Multiplicity of cysts raises suspicion of malignancy.
E. In the majority of cases cyst excision is necessary.

Answer. : C
Explanation: The criteria of malignant cyst is irregular wall, hemorrhagic fluid, rapid refilling,
residual mass after aspiration, malignant cells in the aspirate by the cytological examination.

58. The following statements about mammary duct ectasia are all true, except:
A. May produce a mass like carcinoma in the axillary tail of the breast.
B. May produce non-lactational mastitis and abscess.
C. May produce a mamillary fistula.
D. Anaerobic bacteria are commonly implicated.
E. May present by nipple discharge.

Answer :A
Explanation: Swelling is subareolar

59. The commonest histological type of breast cancer is:

A. Duct carcinoma in situ.
B. Lobular carcinoma in situ.
C. Invasive duct carcinoma.
D. Invasive lobular carcinoma.
E. Paget's disease of nipple.

Answer: C
Explanation: The most frequent histologic type of breast carcinoma is infiltrating ductal carcinoma. This
type of breast cancer originates in the ductal cells of the breast and can invade and spread to other tissues.
It accounts for 70-80% of all diagnosed breast cancer cases.

60. A woman has a 3 cm breast mass. There are neither palpable axillary lymph nodes nor clinical
evidence of metastasis. FNAC proves the presence of invasive duct carcinoma. TNM clinical staging is:
A. T1 N1 M1
B. T1 NO MO
C. T2 N2 M0
D. T2 N1 M0
E. T2 NO MO
Answer: E
Explanation: T stands for tumour size. A tumour between 2-5 em is T2.
N stands for lymph node status. Impalpable axillary nodes is NO. M stands for metastases. MO means no
metastases.

61. Breast self-examination:

A. Is recommended for all women above the age of twenty.
B. Is recommended for women above the age of 40 only.
C. Is recommended to be done monthly in the immediate premenstrual period.
D. Is recommended to be done twice yearly.
E. Should be conducted in the presence of a specialist surgeon.

Answer: A
1. Explanation: Understanding normal breast tissue: Starting breast self-examination at a younger
age allows women to establish a baseline understanding of what is normal for their breasts. This
familiarity enables them to detect any changes more easily, such as new lumps, thickening, or
other abnormalities.

62. The following statements about mammography are all true, except:
A. Indicated for the diagnosis of a breast lump.
B. Indicated for regular screening of women who are at high-risk of development of breast cancer.
C. Indicated for follow-up of contralateral breast after mastectomy for breast cancer.
D. More informative in young women below the age of 35 years.
E. Addition of ultrasound improves the diagnosis of breast cancer.

Answer : D
Explanation: Mammography is not Good in showing lesiosn in dense breast, thus not suitable under age
of 35years instead U/S is Good in examination of dense breast but cant detect microcalcifations.

63. The following statements about breast cancer prognosis are all true, except:
A. Is worsened by the detection of axillary node deposits.
B. Is better in estrogen receptor +ve cases.
C. Is better for tumours in the medial than in the lateral half of the breast.
D. Is worse for invasive duct carcinoma than for cystosarcoma phylloides.
E. Is affected by the tumour grade.

Answer: C

Explanation: Tumours in lateral have better prognosis than medial, most of lymphatic drainage of the
whole breast is directed to the axillary nodes, a medially placed tumour may also spread to internal
mammary nodes

64. The following statements about Paget's disease of the nipple are all true, except:
A. Is lobular carcinoma arising at the opening of a lactiferous duct on the nipple.
B. Should be differentiated from eczema of the nipple.
C. Sometimes there is no palpable mass.
D. Mastectomy is indicated.
E. The disease is not related to Paget's disease of bones.
Answer: A
Explanation: : It is a specific form of intraductal carcinoma that involves the main lactiferous ducts, but it
extends to infiltrate nipple and areola , it is a superficial manifestation of underlying carcinoma.

65. Regarding axillary node involvement in cancer of the breast, all the following statements are true,
except:
A. Clinical assessment of the axilla is commonly inaccurate.
B. Prognosis is affected by the number of affected nodes.
C. Is an indication for adjuvant chemotherapy in early cases.
D. Is an indication for adding irradiation of the axilla after its surgical evacuation.
E. Raises suspicion of distant microscopic spread.

Answer: D
Explanation: The treatment of the axilla that is positive for metastasis is either surgical clearance of the
axilaa or radiotherapy not both . when the axillary lymph nodes are removed irradiation of the axilla is
containdicated as it raises the possibiltity of arm edema

66. The following statements about pulmonary metastases of breast cancer are all true, except:
A. May be asymptomatic.
B. May produce persistent cough.
C. May produce dyspnoea.
D. May cause pleural effusion.
E. If localized to one lung while the other lung shows good function, pneumonectomy is indicated.

Answer: E
 Explanation: Pulmonary metastases indicate the cancer has spread systemically through the
bloodstream. Even if the visible tumors are isolated to one lung, micrometastases from the
primary breast cancer are likely present throughout the body,pneumonectomy would not be
curative and exposes the patient to high surgical risk without clear survival benefits. Non-surgical
palliative options are preferred., this policy is useful only in cases of colorectal cancer with
localized liver metastasis

67. Haematogenous spread of breast cancer may produce any of the following, except:
A. Brain metastases
B. Fracture of the spine
C. Pleural effusion
D. Jaundice
E. Hypocalcaemia

Answer: E
Explanation: Due to osteolytic lesions the serum calcium is elevated in fact one of the oncologic
emergencies that may occur with advanced breast cancer is acute hypercalcemia

68. Concerning sampling of a breast lump, all the following statements are true, except:
A. The most accurate is excision biopsy.
B. Fine needle aspiration cytology does not require general anaesthesia.
C. Fine needle aspiration cytology shows tissue architecture.
D. Frozen section biopsy is sometimes inconclusive.
E. Tru-cut biopsy obtains a core of tissue.

Answer: C
Explanation: FNAC only shows the presence of malignant criterio in cell morphology.

69. The following statements about lymphatic drainage of the breast are all true, except:
A. Lymph from medial half of the breast may drain in internal mammary nodes.
B. From anywhere in the breast lymphatics drain mostly to axillary nodes.
C. Division of axillary nodes into levels I, II, and III depends upon the anatomical relationship with the
pectoralis minor muscle.
D. Level one axillary nodes is the highest in the axilla.
E. The sentinel node is the earliest axillary node to be involved with cancer spread.

Answer: D
Explanation: Level I is the lowest while Level III is the highest in the axilla
Note ( Level II is under pectoralis minor )

70. Regarding duct carcinoma in situ of the breast, one statement only is true:
A. May be discovered on screening mammography for asymptomatic women.
B. Is not a true malignancy.
C. It does not progress to invasive cancer but is a powerful marker of increased cancer risk.
D. Close observation is all that is needed.
E. Is always bilateral.

Answer: A
Explanation: Duct carcinoma in situ is usually detected in screening programs as visible
microcalcifications , It accounts for 20% of cancers detected by screenig.

71. Early breast cancer

A. Means a T1 N1 MO tumour or less.
B. Means that cure is impossible.
C. Means that microscopic metastases are not present.
D. Primary treatment is by surgery + radiotherapy.
E. Adjuvant chemotherapy is not indicated.

Answer; D
Explanation: Early breast cancer is T2N1M0 or less , it is curable disease, N1 means enlarged mobile
axillary lymph nodes which is indicator of distant micrometastasis, this requires adjuvant chenotherapy to
get rid of this possibilty

72. For modified radical mastectomy all the following statements are true, except:
A. The areola and nipple are removed.
B. The whole breast tissue is removed.
C. Block dissection of the axillary nodes requires excision of axillary vein.
D. Nerve to serratus anterior should be spared.
E. The pectoralis major muscle is spared.
Answer: C
Explanation: Axillary vein is spared, or postoperative complications occur in the form of arm
lymphedema which predispose to arm infections and rarely lymphangiosarcoma as well as venous
insufficiency
NB other structures like nerve to latissimus, nerve to serratus, axillary plexus should also be spared

73. The following statements about post-mastectomy arm oedema are all true, except:
A. Is always transient.
B. Adding radiotherapy to the axilla after clearance of lymph nodes increases the risk of oedema.
C. Rough dissection of the axillary vein at surgery is one of the causes.
D. Insertion of an IV line in the ipsilateral upper limb is a predisposing factor.
E. May be caused by recurrence in the axilla.

Answer: A
Explanation: post-mastectomy arm oedema is usually troublesome chronic problem.

74. Acute hypercalcaemia in a patient with advanced breast cancer:

A. Is caused by parathyroid hyperplasia.
B. Is better treated at home.
C. Bilateral lower limb oedema is a constant feature.
D. IV fluid administration is an important line of treatment.
E. Chemotherapy is the main method of reducing serum calcium.

Answer: D
Explanation: Acute hypercalcaemia is life threatening problem oncologic emergency. It occurs when there
are heavy bone metastasis. The main line of ttt is IV hydration and diuretics.

75. Neo-adjuvant therapy for malignancy means:

A. Treatment with modern methods.
B. Giving chemo and/or radiotherapy before surgery.
C. Giving chemotherapy after radical excision.
D. Giving radiotherapy after palliative excision.
E. Giving chemotherapy after palliative excision.

Answer: B
Explanation: Neoadjuvant means giving radio or chemotherapy before the surgery to reduce the size of
locally advanced tumour aimimg for radical surgical excision (Down staging)

76. When screening females for breast carcinoma what is the most significant risk?
A. Three previous breast biopsies in premenopausal females.
B. More than 2 first degree relatives with ovarian or breast carcinoma.
C. Hyperplasia in breast biopsy.
D. None of the above.

Answer: B
Explanation: Hereditary breast cancer is caused by inherited gene mutation, the mode of inheritance is
autosomal dominant (BRCA-1 and BRCA-2) The patients with more than 2 first degree relatives have
about 7% increased risk of developing breast cancer .
77. What is the hereditary factor percentage in female breast cancers?
A. 20-30%.
B. 45-50%.
C. 6-10%.
D. 75-80%.
E. None of the above.

Answer: C
EXPLANATION: about 5-10% of cancers of the breasts are hereditary, Hereditary breast cancer is
characterized by occurring in younger age group, higher incidence of synchronous and metachronous
tumours and higher incidence of other tumours elsewhere in the body.

78.Investigations in Breast Cancer ..

Q- Which of the following statements are true?
a) Five per cent of breast cancers are missed by population-based mammographic screening.
b) Ultrasound can also be used as a screening tool.
c) Magnetic resonance imaging (MRI) can be a useful imaging tool.
d) Fine-needle aspiration cytology (FNAC) and core biopsy are equally useful diagnostically.

Answer: A,C
Explanation: Mammogram does not exclude the presence of a carcinoma as 5% of breast cancer are
missed on population screening , while U/S is not useful as a screening tool and is highly operator
dependent, MRI is extremely useful imaging modality, it can also distinguish scar tissue from recurrence
in a patient who had breast conservative surgery + best imaging for breast which had implant inserted.
—————
79.Benign breast disease…
Q. Which of the following statements are false?
A) Benign breast disease is the most common cause of breast problems.
B) Lipoma is a common condition of the breast.
C) Traumatic fat necrosis can be mistaken for a carcinoma.
D) 30 per cent of breast cysts recur after aspiration.
E) Non-cyclical mastalgia is more common in postmenopausal women.

Answer: B, E
Explanation:
————-
80.Breast cancer …
Which of the following conditions have an increased risk of breast carcinoma?
A) Breast cyst
B) Duct ectasia
C) Florid hyperplasia
D) Atypical ductal or lobular hyperplasia
E) Fibroadenoma.

Answer: C,D
———
81. In a patient with nipple discharge which of the following statements are true?
A) Clear, serous discharge may be physiological.
B) Bloodstained discharge occurs in carcinoma, duct ectasia and duct papilloma.
C) Mammography is an important investigation.
D) Microdochectomy is the treatment once cancer has been excluded.
 E) Paget's disease causes discharge from the surface.

Answer: A,B,D,E
_______

82. In breast carcinoma, which one of the following statements is false?

A) Ductal carcinoma is the most common variant.
B) Lobular carcinoma occurs in 15 per cent.
C) There may be a combination of lobular and ductal features.
D) Colloid, medullary and tubular carcinomas carry a poor prognosis.
E) Paget's disease is a superficial manifestation of an underlying breast carcinoma.

Answer : D
______

83. In the treatment of breast cancer, which of the following statements are false?
A) There is a higher rate of local recurrence after conservative surgery and radiotherapy.
B) After mastectomy, radiotherapy to the chest wall is not indicated.
C) Sentinel lymph node biopsy should be done in clinically node-negative disease.
D) Besides treating the patient, the role of axillary surgery is to stage the patient accurately.
E) Lymph node-positive women and higher- risk node-negative women should have adjuvant
chemotherapy.
F) There is no role for preoperative chemotherapy

Answer: B, F
———-

84. Extended matching questions..

Benign breast disease
A) Fat necrosis
B) Breast abscess
C) Tuberculosis
D) Mondor's disease
E) Duct ectasia
F) Aberrations of normal development and involution (ANDI)
G) Breast cyst
H) Galactocele
I) Fibroadenoma
J) Phyllodes tumour

Choose and match the correct diagnosis with each of the scenarios given below:
1) A 42-year-old woman presents with a large irregular lump, about 12 cm in diameter, in her right
breast, of 4 months' duration. The lump is very mobile and is stretching the skin and about to
ulcerate.
Answer: J
Explanation: This lady has phylloid tumour, large irregular stretching the skin, about to ulcerate

2) A 25-year-old woman presents with a discrete lump in the left breast. She found it accidentally 3
weeks ago. She can move the lump about within the breast tissue.
Ans: I
Explanation :Fibroadenoma, an incidental mobile lump mainly hard type (Breast mouse)

3) A 40-year-old Asian woman, recently arrived in the UK, complains of a lump in her right breast of
several months' duration. There is no pain. In her ipsilateral axilla she also has a discharging abscess,
which tends to clear up and recur again .

Ans: C
Explanation: The discharging sinus in her axilla is from TB lymphadenitis. The diagnosis is
confirmed by triple assessment.

4) A 45-year-old woman complains of pain in her left breast of 2 weeks' duration. On examination she
has a tender string-like band with overlying prominent veins.
Ans: D
Explanation: Patient suffers from thrombophlebitis of the superficial veins of the chest (Mondor’s
disease )

5) A 28-year-old lactating woman noticed a tender lump deep to her areola. The lump is cystic.
Ans: H
Explanation: Galactocele is a subareolar cystic lump which dates from the start of her lactation,
confirmation by aspiration of milk.

6) A 40-year-old woman complains of a lump in her right breast that she noticed accidentally 3 weeks
ago. This has not changed since her period a week ago. It is mobile and tender.
Ans: G
Explanation: Breast cyst, it is essential to exclude malignancy by triple assessment , aspiration of the cyst
following which is completely disappears will give both physical and psychological relief.

7) A 50-year-old woman noticed a lump in her left breast 4 weeks ago. She has a firm, slightly tender
lump which is not mobile. On questioning about trauma, she recalls having been hit on her breast by
her grandchild at about the same time.
Ans: A
Explanation: Traumatic fat necrosis, usually after blunt trauma, painless lump and can’t exclude
malignancy, firm mass which is not mobile, The full triple assessment should be done , Fine or true cut
biopsy shows foamy fat laden macrophages with characteristic chalky white appearance.
NB: Mammography is not conclusive as it gives features similar to those of cancer.

8) A 30-year-old woman complains of a tender, painful right breast with fever. She gave birth to her
third child 2 weeks ago. On examination she feels hot with a red, tender, indurated and diffuse lump
underlying the areola.
Ans: B
Explanation: Breast Abscess, associated with lactation usually caused by staph aureus, a segment of
breast is inflamed, red, very painful, tender and indurated.
 9) A 44-year-old woman complains of greenish nipple discharge on and off for 4 months. On
examination she has an irregular, firm lump deep to the areola which looks indrawn.
Ans: E
Explanation: Mammary duct ectasia, nipple discharge (not blood stained), deformed nipple with
retraction, and a subareolar indurated mass which may mimic carcinoma. (Must be excluded by triple
assessment)
The condition is caused by dilatation and inflammation of the ducts leading to periductal mastitis. TTT is
by surgical removal of all terminal ducts.

10) A 38-year-old woman complains of painful breasts of some 6 months' duration. She noticed a lump
in her right breast 6 weeks ago and feels that the size of the lump waxes and wanes with her periods,
which are regular.
Ans: F
Explanation: ANDI (Aberrations of normal development and involution), the symptoms are generalized
lumpiness of breasts, less often confined to one quadrant, changes being cyclical with the periods and
sometimes discrete lump, which may be a cyst or fibroadenoma. (If lump do triple assessment and if
discharge do cytological examination and benzidine test )
Examination at a different time of menstrual cycle followed by reassurance supplemented by
conservative measures is the overall management.

Answers:
1-J
2-I
3-C
4-D
5-H
6-G
7-A
8-B
9-E
10-F