1.A 64 yo woman has been treated for breast cancer with tamoxifen. What other drug should be
added to her tx regime?
a. Bisphosphonates
b. Calcium
c. Vit D
d. Calcitonin
e. Phosphate binders
answer: A
2.A 65yo female pt was given tamoxifen, which of the following side effect caused by it will
concern you?
a. Fluid retention
b. Vaginal bleeding
c. Loss of apetite
d. Headache and dizziness
e. Anorgasm
answer: B
DVT, Pulmonary Embolism
Stroke
Cataracts
Endometrial and uterine cancers
Bone loss in premenopausal women.
Mood swings, depression, and loss of libido.
In men: headaches, nausea, vomiting, skin rash, impotence, and decreased sexual interest.
3.A 50 yo woman who was treated for breast cancer 3 yrs ago now presents with increase thirst
and confusion. She has become drowsy now. What is the most likely metabolic abnormality?
a. Hypercalcemia
b. Hyperkalemia
c. Hypoglycemia
d. Hyperglycemia
e. Hypocalcemia
4.A 48yo lady presents with itching, excoriations, redness, bloody discharge and ulceration around her nipple. What is the most likely dx?
a. Paget’s disease of the breast
b. Fibrocystic dysplasia
c. Breast abscess
d. Duct papilloma
e. Eczema
answer: A
Paget’s disease (1-3%)
Ductal carcinoma that invades nipple with scaling, eczematoid lesion. Malignant epithelial (Paget) cells infiltrate and proliferate in the epidermis, causing thickening of the nipple and the areolar skin. These tumorous glandular epithelial cells are derived from luminal lactiferous ductal epithelium of the breast tissue.
Erythema(sharply demarcated unlike eczema)
Scaling
Itching
Burning sensation
Ulceration
Oozing with serosanguineous discharge
Bleeding
Some combination of the above symptoms
Early symptoms and signs of mammary PD include the following:
Excoriation from itching
Resolution and recurrence of small vesicles within the skin lesion
5.A 67yo female who had undergone a radical mastectomy now comes with the complaint of
swelling and redness in her right upper limb. Involvement of which of the following structures
explain these symptoms?
a. Epitrochlear LN
b. Cephalic vein
c. Subclavian artery
d. Axillary group of LN
e. Long thoracic nerve
answer: D lymphedema following LN clearance
• mastectomy
modified radical mastectomy (MRM): removes all breast tissue, skin, and axillary nodes
simple mastectomy: removes all breast tissue and skin
6.A 67yo woman has presented with hard, irregular, poorly defined 5cm lump in her right breast.
She has a bruise on the surface and there is no discharge. What is the most likely dx?
a. Fibroadenosis
b. Fat necrosis
c. Fibroadenoma
d. Duct ectasia
e. Ca breast
answer: B
Fat Necrosis
• uncommon, result of trauma (may be minor, positive history in only 50%), after breast surgery
• firm, ill-defined mass with skin or nipple retraction, ± tenderness
• regress spontaneously, but complete imaging ± biopsy to rule out carcinoma
7.A 45yo woman comes with red, swollen and exudating ulcer on the nipple and areola of right
breast with palpable lump under the ulcer. What do you think is causing this skin condition?
a. Inflammatory cells releasing cytokines
b. Infiltration of the lymphatics by the carcinomatous cells
c. Infiltration of the malignant skin cells to the breast tissue
answer: B
Inflammatory carcinoma
Š ductal carcinoma that invades dermal lymphatics
Š most aggressive form of breast cancer
Š clinical features: erythema, skin edema, warm, swollen and tender breast ± lump
Š peau d’orange indicates advanced disease (IIIb-IV)
8.A lady presents with itching around the breast and greenish foul smelling discharge from the
nipple. She had a similar episode before. What is the most likely dx?
a. Duct papilloma
b. Duct ectasia
c. Breast abscess
d. Periductal mastitis
e. Mammary duct fistula
ANSWER: b
Discharge from the nipple
1 Blood - stained :
a duct papilloma, when blood arises from a
single duct;
b intraduct carcinoma;
c Paget ’s disease;
d invasive carcinoma (rare).
2 Clear : intraduct papilloma.
3 Multicoloured (often multiduct) : duct ectasia
(discharge commonly yellow, brown or green).
4 Milky : galactorrhoea: may follow lactation but
can also be drug - induced or a manifestation of
hyperprolactinaemia (or, occasionally,
hypothyroidism).
5 Purulent : breast abscess.
9.A clinical picture of breast cancer originated from the mammary duct. Biopsy was done and there were neoplastic cells found. Choose the histological picture of the cancer.
a. Neoplastic cells are arranged in small clusters occupying a space between collagen bundles (Seirrhous carcinoma)
b. Spindle cell neoplasms with margins, which infiltrate adjacent structure, fat invaded (Breast sarcoma)
c. Small cells with round nucleus and scant indistinct cytoplasm (Lobular carcinoma)
ANSWER: A
invasive ductal carcinoma (most common 80%)
originates from ductal epithelium and infiltrates supporting stroma
characteristics: hard, scirrhous, infiltrating tentacles, gritty on cross-section
10.A lady with breast cancer has undergone axillary LN clearance. She develops arm swelling
after being stung by a bee. What is the most likely mechanism responsible for the swelling?
a. Lymphedema
b. Cellulitis
c. Hypersensitivity reaction
d. DVT
e. Fluid retention
A…insect bites/ needles/ cuts predispose to to bacteria entering the skin, in a pt like this, fluid trapped in the tissues makes it very easy to get an infection…so the mechanism of her swelling is lymphedema(which is much more likely than a bee sting causing an arm swelling due to hypersensitivity and it asks u for the most likely)