Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

Breast Disease

12–1. Which of the following is NOT a common presentation of breast disease in women?

a. Breast pain

b. Palpable mass

c. Nipple discharge

d. Skin pigmentation abnormalities

12–2. The areola contains numerous lubricating sebaceous glands referred to as which of the following?

a. Mallory glands

b. Montgomery glands

c. Mammosebaceous units

d. Mammolactiferous glands

12–3. Which group of lymph nodes receives most of the lymphatic drainage from the breasts and are therefore most often involved by breast cancer metastases?


Reproduced, with permission, from Poggi MM, Harney K: The breast. In DeCherney AH, Nathan L (eds): CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10th ed. New York, McGraw-Hill, 2007, Figure 63-3.

a. Axillary

b. Supraclavicular

c. External mammary

d. Internal mammary

12–4. The primordial breast develops from which of the following tissues?

a. Mesoderm

b. Primitive fat lobules

c. Basal layer of the epidermis

d. Multipotent cells within the dermis

12–5. Final histologic differentiation of breast tissue is not completed until which of the following occurs?

a. Menarche

b. Onset of puberty

c. First full-term pregnancy

d. Breastfeeding for several months

12–6. Most benign and malignant breast disease occurs within the breast structures that are the most sensitive to ovarian hormones and prolactin. Which structures are these?

a. Lobular fat

b. Collecting ducts

c. Collagenous stroma

d. Terminal ducts and acini

12–7. Which of the following describes the physiology of the breast in menopause?

a. Increased estrogen-receptor expression

b. Replacement of collagenous stroma with fat

c. Conversion of adrenal androgens to estrogen by aromatase

d. All of the above

12–8. The “triple test” that best guides the management of breast abnormalities does NOT include which of the following evaluation modalities?

a. Imaging

b. Pathology

c. Genetic markers

d. Clinical examination

12–9. Frequently mistaken for a breast mass, the axillary extension of normal breast tissue is referred to as the tail of which of the following?


Reproduced, with permission, from LeBlond RF, Brown DD, DeGowin RL: The chest: chest wall, pulmonary, and cardiovascular Systems; the breasts. In DeGowin’s Diagnostic Examination, 9th ed. New York, McGraw-Hill, 2009, Figure 8-55.

a. Rahn

b. Spence

c. Pearson

d. Griffith

12–10. Which of the listed mammographic features of solid breast masses suggests malignancy?


Reproduced, with permission, from Hunt KK, Newman LA, Copeland EM III: The breast. In Brunicardi FC, Andersen DK, Billiar TR, et al (eds): Schwartz’s Principles of Surgery, 9th ed. New York, McGraw-Hill, 2010, Figure 17-28.

a. Irregular margins

b. Absent internal echoes

c. Width-to-height ratio of 3 or greater

d. None of the above

12–11. The reporting system for mammographic results in general use is referred to as which of the following acronyms?





12–12. Which of the following initial diagnostic techniques is currently favored because of its minimal invasiveness, its lower insufficient-sample rate, and its ability to provide superior diagnostic tissue samples?

a. Core-needle biopsy

b. Fine-needle aspiration

c. Open excisional biopsy

d. Intraductal washings for cytology

12–13. What is the accuracy of a concordant benign triple test for correctly predicting that a breast mass is benign?

a. 60%

b. 70%

c. 80%

d. >99%

12–14. A 40-year-old woman is evaluated for a self-discovered breast mass. Clinical examination shows a left breast mass that is smooth, mobile, 1.5 cm in greatest diameter, and located at 4 o’clock and 3 cm from the nipple. Diagnostic mammography shows the mass with smooth borders, no calcifications, presence of internal echoes, and a width-to-height ration of 1. Core needle biopsy shows benign ductal and lobular structures. Which of the following is the most appropriate clinical management of this mass?

a. Excision

b. Breast sonography

c. Repeat core biopsy in 3 months

d. Clinical examination at 6-month intervals

12–15. A 50-year-old woman without any family history of breast or related cancers is found to have a palpable, 2-cm breast cyst with complex sonographic features. The mass is asymptomatic. What is the most reasonable management of this complex mass?

a. Excision

b. Fine-needle biopsy

c. Aspiration with cytology

d. Aspiration and if sonographic abnormality persists, then excision

12–16. A 17-year-old presents with a 0.5-cm breast mass with a triple test classification of benign concordant. The diagnosis of fibroadenoma is strongly suspected. The mass is asymptomatic. Repeat examinations 6 months and 1 year later show the mass to be unchanged in size and character. What is the best option for further management of this mass?

a. Excision

b. Core needle biopsy

c. Magnetic resonance imaging

d. Continued clinical monitoring

12–17. Which statement regarding phyllodes tumors of the breast is FALSE?


Reproduced, with permission, from Hunt KK, Newman LA, Copeland EM III: The breast. In Brunicardi FC, Andersen DK, Billiar TR, et al (eds): Schwartz’s Principles of Surgery, 9th ed. New York, McGraw-Hill, 2010, Figure 17-40A.

a. Lymph node metastasis is rare.

b. The lung is the most common site of metastasis.

c. Local recurrence is common (>30%) for malignant tumors.

d. Primary treatment consists of chemotherapy and radiation.

12–18. Which of the following scenarios involving breast nipple discharge is most concerning for an underlying malignancy?

a. Spontaneous, bloody, multiduct discharge in a 36-year-old pregnant patient

b. Spontaneous, single-duct serous discharge in a 28-year-old on oral contraceptive pills

c. Greenish multiduct discharge expressed during routine clinical examination of a 50-year-old woman

d. Milky white discharge expressed from several ducts during clinical examination of a 40-year-old multi-para

12–19. Which of the following is NOT part of the therapeutic approach to puerperal mastitis?


Photograph contributed by Dr. La’Keisha Demerson.

a. Antibiotics

b. Breastfeeding cessation

c. Sonography if abscess suspected

d. Topical treatment of any nipple cracks

12–20. Which of the following is an infrequent presentation of cancer in the nonpuerperal breast?

a. Abscess

b. Mastalgia

c. Cellulitis

d. All of the above

12–21. The presence of atypical epithelial hyperplasia carries what increased relative risk of breast cancer?


Reproduced, with permission, from Euhus D: Breast disease. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 12-9.

a. 1.5

b. 2.5

c. 3.5

d. 4.5

12–22. Lobular carcinoma of the breast is a marker of increased cancer risk rather than a direct cancer precursor. Which of the following interventions is NOT a reasonable strategy for reducing that risk?

a. Chemoprevention

b. Prophylactic unilateral mastectomy

c. Twice-yearly clinical examinations

d. Alternating mammography and magnetic resonance imaging

12–23. Which histologic feature of ductal carcinoma in situ is the most predictive of the presence of invasive cancer, the extent of disease, and the recurrence risk after treatment?

a. Nuclear grade

b. Morphologic type

c. Mammographic features

d. Presence or absence of comedonecrosis

12–24. Paget disease of the nipple is a type of which of the following breast neoplasias?


Reproduced, with permission, from Neuhaus IM, Grekin RC: Mammary and extramam-mary Paget disease. In Wolff K, Goldsmith LA, Katz SI, et al (eds): Fitzpatrick’s Dermatology in General Medicine, 7th ed. New York, McGraw-Hill, 2008, Figure 121-1.

a. Fibrocystic change

b. Ductal carcinoma in situ

c. Lobular carcinoma in situ

d. Atypical epithelial hyperplasia

12–25. Which of the following has the strongest association with increased breast cancer risk?

a. Increasing parity

b. Earlier age of first live birth

c. Increasing lifetime number of menstrual cycles

d. Use of estrogen-only hormone replacement therapy

12–26. Which of the following breast cancer risk evaluation tools has been independently validated and is widely used?

a. Gail model

b. Richardson model

c. Tryer-Cuzick model

d. Bloom-Schwarz model

12–27. What percentage of breast cancers are caused by inherited gene mutations such as BRCA1 and BRCA2?

a. Fewer than 10

b. Approximately 25

c. Approximately 50

d. Greater than 75

12–28. Up to 40 percent of male breast cancers are related to which genetic syndrome?

a. BRCA1

b. BRCA2

c. p16INK4a

d. Li-Fraumeni

12–29. Carriers of BRCA gene mutations, in addition to breast cancer, are at increased risk for which of the following?

a. Melanoma

b. Ovarian cancer

c. Pancreatic cancer

d. All of the above

12–30. Approximately what percentage of abnormalities detected by screening mammography represent a malignancy?

a. 5

b. 15

c. 35

d. 55

12–31. Up to what percentage of women diagnosed with breast cancer will have had a normal mammogram during the preceding 12 to 24 months?

a. 5

b. 10

c. 15

d. 25

12–32. An advantage of breast screening with magnetic resonance imaging compared with screening using mammography includes which of the following?

a. Lower cost per procedure

b. Lower false positive rate

c. Increased ease of test performance

d. Better performance in dense breast tissue

12–33. Breast cancers positive for estrogen and progesterone receptors generally demonstrate a better prognosis and allow more treatment options. What proportion of breast cancers are estrogen- and progesterone-receptor positive?

a. One third

b. Two thirds

c. One fourth

d. Three fourths

12–34. What is the most common site of distant breast cancer metastasis?

a. Bone

b. Liver

c. Lungs

d. Ovaries

12–35. At present, what is standard treatment following lumpectomy for apparently localized breast cancer?

a. Bilateral axillary radiation

b. Ipsilateral axillary radiation

c. Whole breast radiation of affected breast

d. Whole breast radiation of both affected and contralateral breasts

12–36. Which of the following therapeutic agents used to treat breast cancer in postmenopausal women increases the risk of bone fractures?

a. Tamoxifen

b. Bisphosphonates

c. Aromatase inhibitors

d. None of the above

12–37. Which of the following characteristics is NOT typical of inflammatory breast cancer?


Reproduced, with permission, from Euhus D: Breast disease. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed., New York, McGraw-Hill, 2008, Figure 12-16B.

a. Slow onset

b. Breast induration

c. Breast enlargement

d. Erythematous skin changes

12–38. Which of the following are known to be effective breast cancer prevention strategies?

a. Regular physical activity in average risk women

b. Tamoxifen for 5 years in women at increased risk

c. Prophylactic oophorectomy in women at very high risk

d. All of the above

Chapter 12 ANSWER KEY