Breast MCQ - Part II - Surgery - with answers

01. 60yrs old lady presented with 2cm painless lump in the left breast for 2 weeks duration. In clinical examination it suggested malignancy which of the following are T/F

a) Tethering with skin indicate poor prognosis 

b) Mammography is done of the triple assessment 

c) FNAC negative no need to go for further investigation 

d) Hormonal treatment compare with CT is best in this patient than young patient with same features 

e) If decided to do breast conservation surgery, radiotherapy should not given

02. Regarding breast carcinoma;

a) Detected by self breast examination is free of metastatic disease 

b) In 80 year old woman can effectively treat with tamoxifen only. 

c) Her-2-neu receptor represents poor prognosis 

d) Micro metastases can be excluded if the isotope bone scan is normal 

e) Treated with mastectomy has better overall survival rather than breast conservative surgery combined with radiotherapy

03. Features of metastatic breast CA

a) Bone pain 

b) High ALP level 

c) Hypocalcaemia 

d) Pathological fractures 

e) Pleural effusions

04. Regarding breast CA

a) Fibro adenoma is an AND! arising from a single terminal duct lobule 

b) Typical hyperplasia of fibrocystic disease has a high risk for developing malignancies c) USS is a method of screening 

d) Hormonal therapy is the first line therapy for elderly patients

05. A 40 year old female presented with pain in both breasts & upper limbs for 6 months. Features favoring the diagnosis of fibrocystic disease are,

a) Cyclical pain 

b) Nodules like feeling in the respective area c) Presence in upper medial quadrant 

d) Bilateral involvement

06. What is the most common complication following simple mastectomy and axillary clearance

a) Bleeding 

b) Thoracodorsal never damage 

c) Seroma formation 

d) Surgical site infection 

e) Flap necrosis mastectomy

07. Risk factors for breast carcinoma 

a) Hormone replacement therapy 

b) Menopause at 35y of age

c) Oral contraceptive pills for 5 years 

d) Null parity 

e) Breast feeding

08. Regarding breast disorders, 

a) Acute mastitis needs incision and drainage. 

b) Female with malignant lump without any metastasis can be treated with lumpectomy. c) Cyclical mastalgia can be treated with cyst aspiration. 

d) 2cm fibro adenoma need wide local excision. 

e) Mastalgia is common at perimenopause age.

09. Breast carcinoma, 

a) Characterized by macro calcifications on mammogram. 

b) Detected on self breast examination stands the best chance of cure. 

c) When locally advanced, best treated with neo adjuvant chemotherapy. 

d) Micro metastasis cannot be excluded if the isotope bone scan is normal. 

e) Survival is superior when treated by modified radical mastectomy comparing with breast conservation surgery combine with radiotherapy.

10. Regarding breast carcinoma 

a) Tumor situated in sub areolar area is the best situation for breast conservative surgery

b) Estrogen receptor positive breast carcinoma has good prognosis

c) Estrogen ,progesterone and HER2 receptors can be identified

d) Usually sensitive to chemotherapy

11. True or False regarding benign breast disease

a) Fibro adenoma has irregular margins

b) Usually grows up to 2-3cm in size

c) Giant fibro adenoma can be seen in pregnancy

d) Well lobulated

12. WOF are true or false

a) Middle thyroid vein drains to the internal jugular vein

b) Clinical features of L5/S1 disc prolapse affecting the S1 root includes parasthesia of the lateral aspect of the foot

c) 80% of blood supply to the liver is from the portal vein

d) Iliohypogastric nerve passes through the external inguinal ring along with the spermatic cord

e) Abductor pollicis brevis muscle is supplied by the ulnar nerve

Answers 

01. a) T b) T c) F d) F e) F

02. a) F b) F c) T d) F e) F

03. a) T b) T c) F d) T e) T

04. a) T b) F c) T d) F

05. a) T b) T c) F d) T

06. a

07. a) T b) F c) T d) T e) F

08. a) F b) F c) F d) F e) F

09. a) F b) F c) T d) T e) F

10. a) F b) T c) T d) T

11. a) F b) T c) F d) F

12. a) T b) T c) T d) F e) F

Global Medcast - Health and Wellness Website

Breast MCQ - Part I - Surgery - with answers

1. A 50 years old mother of two breast fed children presents with a lump in her right breast. There is no
personal or family history of breast cancer. The report on ultrasound and mammogram reads 'suggestive of malignancy. FNAC report reads C4. What is the next appropriate step in the management?

a. Perform a core biopsy
b. Excisional biopsy
c. Lumpectomy
d. Wide local excision
e. incisional biopsy


2. 30year old female ,4days after the delivery of her first baby, presented with pain and swelling of upper outer quadrant of the left breast. On examination the area is reddish. Which of the following is/are true

a) commonly caused by lactobacillus
b) diagnosed by USS
c) treat with cloxacillin
d) need to rest the breast until the pain subsidies
e) IM pethidine can be given for pain


3. 23 year old married women came to take an advice for nipple retraction since childhood. There are no palpable lumps. She wish to Breast feed her children. What is the most appropriate initial management option.

a) refer her to a surgeon for surgery
b) perform biopsy of nipple
c) request USS of breast
d) prescribe her a suction device
e) reassure her that this will resolve during pregnancy


4. 25-year-old woman complained of painless lump in l/breast for 2/52 her grandmother had breast CA @60uears.on examination well defined mobile lump 2cm in size @ the upper outer quadrant/breast is normal and lymphadenopathy. The next step of management

a) Perform FANC
b) Reassure and review in 6/12
c) Arrange mammogram
d) Arrange USS breast
e) Schedule her for excision of the lump


5. Risk factors for breast cancer includes

a) Hx of Breast CA on contralateral side of the breast
b) family history
c) breast feeding
d) null parity
e) OCP


6. 25yr female present with lump in right breast on EX lump was mobile, well demarcated non tender and 3*5cm in size. Mother Rx for breast CA .appropriate step in Mx

a) mammogram
b) USS
c) FANC
d) incision biopsy
e) reassurance and review in 6months


7. A 35 yr old female T4N1Mx breast carcinoma. What is the most appropriate initial treatment ?

a) Breast conservative surgery
b) salvage mastectomy
c) neo adjuvant chemotherapy
d) total mastectomy
e) tamoxifen therapy


8. A 35yr old came female came with blood stained nipple discharge from the R breast. On examination there is no lump. She has no past hx or family hx of breast carcinoma. On examination there was no palpable lump in the breast. What is the most likely diagnosis?

a) Duct ectasia
b) Intraductal papilloma
c) Phylloid tumor
d) Atypical duct hyperplasia
e) Fibrocystic disease


9. Regarding the Breast carcinoma

a) BRCA tumour suppressor genes
b) Due to mutation of BRACA gene.
c) Most of the breast carcinoma has family inheritance
d) Women with mutated gene can undergo prophylactic mastectomy
e) Patient with Breast carcinoma need to refer to genetic service


10. 56yr old patient undergone wide local excision and axillary clearance. Resu its came as stage 1 invasive ductal CA. Two core biopsies were taken, but came as normal. What is the next management?

a. Tamoxifen
b. Radiotherapy to axilla
c. Radiation to the breast
d. Reassure and follow up the patient
e. 6 cycles of chemotherapy


11. 28yr old female R quadrant Breast lump. USS done, no significant finding. 2 core biopsies also done and they are normal. What is the next step of management?

a) Repeat core biopsy
b) Breast MRJ
c) Excision biopsy
d) PET scan
e) Wide local excision


12. 50yr old lady had undergone wide local excision and sentinel nod biopsy. Hist report revealed complete excision of invasive ductal carcinoma and sentinel node contained to metastatic features.ER receptor negative. What is the most appropriate next step of Mx

a) Aromatase inhibitor
b) Chemotherapy
c) Radiotherapy for whole Breast
d) Systemic therapy
e) Mastectomy

Answers 

1. d

2. a) F b) T c) T d) T e) F

3. d

4. d

5. a) T b) T c) F d) T e) T

6. b

7. c

8. b

9. a) T b) T c) T d) T e) -

10. d

11. c

12. b

Gallstones MCQ - Surgery - with answers

1. A 34 year old female presented with acute cholecystitis. She was treated with Co-amoxiclav 1.2g IV. After 48 hours of treatment, she develops swinging fever with severe right hypochondrial tenderness. Most appropriate next investigation is, 

a. CT scan 
b. ERCP 
c. MRCP 
d. FBC 
e. USS of abdomen


2. Regarding gallstones 

a. Calcium bilirubinate is the predominant constituent of the mixed stones 
b. Pigment stones are caused due to haemolytic anaemia 
c. Majority of stones are radiolucent 
d. Majority of stones are pigment stones. 
e. Majority are of mixed type


3. A 50 year old otherwise healthy male presented with recurrent, vague upper abdominal pain which was worsening after meals. He had lost 5 kg during last 2 months. USS showed multiple stones in gallbladder with mild thickening of the gallbladder wall. Extrahepatic ducts looked normal. No pericholedochal fluid. What is the next appropriate step of management? 

a. ERCP 
b. ESWL 
c. Laparoscopic cholecystectomy 
d. MRCP 
e. UGIE


4. 45 year old female in routine USS Scan found 4cm solitary stone in gall bladder; 

a. Most likely is a pigment stone 
b. Acute cholecystitis is likely to occur 
c. Requires regular USS to monitor size of the stone 
d. Is at an increased risk of malignancy 
e. Should undergo Cholecystectomy to prevent complications


5. In a 50 year old man with gall stone disease who is otherwise healthy, the indications for cholecystectomy are 

a. History of biliary colic 
b. Passage of flatus after meals 
c. History of recurrent epigastric pain 
d. Porcelain gall bladder 
e. Serum cholesterol level of 425mg/dl


6. T/F regarding ascending cholangitis 

a. Considered as DD in patient presenting with collapse 
b. Caused by stone impacted in cystic duct 
c. Common bile duct stone obstruction is relieved by endoscopy 
d. Lead to liver abscess 
e. Usually caused by gram + organisms

7. 45 year old male presented with yellowish discolouration of eyes & pruritus for 2/52 which progressed gradually. 2/52 prior to presentation he noticed stools were tarry. On examination slightly pale, deeply icteric. The abdomen slightly distended, liver palpable 4cm below the costal margin. The gall bladder is palpable & non tender. The most likely diagnosis 

a. CBD calculus 
b. CA head of the pancrease 
c. Hilar cholangio CA 
d. Duodenal CA 
e. Periampullary CA


8. 40 year old female presented with right hypochondrial pain for 3 days duration with moderate fever. What features in this history most help distinguishing acute cholangitis from acute cholecystitis?

a. Family history of haemolytic anaemia 
b. LOA 
c. Passage of tea coloured urine 
d. Past history of biliary colic 
e. Radiation of pain to back


9. 30yr old male patient presented with progressive jaundice and darkening of urine. USS revealed dilated intrahepatic and common hepatic ducts. But CBD measured 7 mm.GB is not dilated and no GB calculi.What is the most appropriate management? 

a. Pecrutaneous transhepatic cholangiogram 
b. Contrast enhanced CT 
c. MRCP 
d. ERCP 
e. HIDA


10. 60yr old male with Hx of progressive jaundice going to have a CECT, his RFT are marginally elevated. Which of the following agent/fluid is needed to use during procedure 

a. 0.9% NS 
b. NaHCO3 
c. N-AC 
d. IV hydrocortisone 
e. N/2 + 5% Dextrose


11. A 60y old male presents with loss of appetite and loss of weight for 6 months. He is deeply icteric and USS of abdomen shows dilatation of intrahepatic ducts but no dilatation of cystic duct or gall bladder, What is the most probable diagnosis? 

a. Peri-hilar cholangiocarcinoma 
b. Pancreatic head carcinoma 
c. Peri-ampullary carcinoma 
d. Cholangiocarcinoma of distal CBD 
e. Malignant stricture of CBD


12. 65 year old man presented with worsening jaundice & pruritis for 2months, also has anorexia & loss of weight for 4 months. USS gallbladder not distended & has multiple gall stones. CBD not dilated but intrahepatic duct dilated. S.Bilirubin 220umol/, S.Alkaline phosphate -- 1250. What is the diagnosis 

a. Common bile cut stone 
b. Hilar cholangio CA 
c. Mirizi syndrome 
d. Periampulary CA 
e. Sclerosing cholangitis


13. Which of the following is not a recognized cause of postoperative jaundice following laparoscopic cholecystectomy? 

a. Ascending cholangitis 
b. Ligation of the left hepatic duct 
c. Ligation of the common hepatic duct 
d. Gallstone retention in the common bile duct 
e. Thermal injury due to use of electrocautery during dissection.


14. Operations that require perioperative use of antibiotics in otherwise healthy patient include 

a. Herniotomy repair in a 3yr old baby 
b. Thyroidectomy 
c. Elective left hemicolectomy 
d. Transurethral resection of prostate 
e. Knee joint replacement


15. Which of the following is not a risk factor for gallstone formation? 

a. Smoking 
b. Pregnancy 
c. Crohn's disease 
d. Diet high in fats 
e. Contraceptive pills


16. Laparoscopic cholesystectomy is contraindicated in, 

a. Acute cholecystitis 
b. Large solitary gallstone
c. Empyema of the gallbladder. 
d. Patient with bleeding disorder 
e. Carcinoma of the gallbladder

Answers

01. e

02. a) F b) T c) T d) F e) T

03. c

04. a) F b) F c) F d) T e) F

 

05. a) T b) F c) F d) T e) F

 

06. a) T b) F c) T d) T e) F

 

07. e

 

08. c

 

09. c

 

10. a

 

11. a

 

12. c

 

13. a) F b) T c) F d) F e) F

 

14. a) F b) F c) T d) T e) T

 

15. a) T b) T c) T d) T e) T

 

16. a) F b) F c) F d) T e) T