MRCS Breast Questions
Q1. Vessels provides the greatest contribution to the arterial supply of the breast?
A. External mammary artery
B. Thoracoacromial artery
C. Internal mammary artery
D. Lateral thoracic artery
E. Subclavian artery
Q2) 34 year old lady has had an axillary node clearance for breast malignancy. After surgery she unable to push herself forwards from a wall with the right arm and the scapula is pushed out medially from the chest wall. Where is the injury?
A. C5, C6
B. C8, T1
C. Axillary nerve
D. Long thoracic nerve
Q3. Which deep fascia is pierced in axillary dissection for breast cancer surgery
a) Sibsons fascia
B. Pre tracheal fascia
C. Waldayers fascia
D. Clavipectoral fascia
Q4. In BRCA 1 mutation, Apart from breast cancer, which of the following malignancies is she at greatest risk of developing?
Q5 Young female with breast mass, initial investigation?
d) CT chest
Q6) Management of Galactocele
a) Incision and drainage
b) Excision of abscess cavity
c) USG guided needle aspiration
d) IV antibiotics
Q7) 50 year old woman, 3 cm mass in the outer quadrant of breast. No lymph nodes. Lumpectomy and axillary dissection is done. Breast lesion is positive for Her2 neu and negative for estrogen and progesterone receptors
What must be done further
a) Chemotherapy with Tamoxifen
b) Radical mastectomy
Q8) Most likely structure seen during axillary lymph node dissection?
a) Structures of brachial plexus
b) Thoraco dorsal trunk
c) Internal mammary artery
d) Thoracoacromial artery
60% of the arterial supply to the breast is derived from the internal mammary artery. The external mammary and lateral thoracic
arteries also make a significant (but lesser) contribution. This is of importance clinically in performing reduction mammoplasty procedures.
2 ) d
The patient has a winged scapula caused by damage to the long thoracic nerve (C5,6,7) during surgery. The long thoracic nerve innervates serratus anterior.
Incision of clavipectoral fascia gives ntrance to axilla to clear the nodes
Pre tracheal - neck
Waldeyer's - colon
BRCA 1 mutation patients are 55% more likely to get ovarian cancer. Those with
BRCA 2 are 25% more likely. The risk of developing other malignancies is slightly
increased but not to the same extent
BRCA 1 and 2
Carried on chromosome 17
linked to developing breast cancer (60%) risk.
Associated risk of developing ovarian cancer (55% with BRCA 1 and 25%
Disease name and what it is
A. Mondors disease- Thrombophlebitis of superficial veins of breast and sometimes arm. Skin tethering to the breast tissue can occur
B. Duct ectasia - Smokers, with dilated breast ducts. Pathogenesis is dilatation of ducts, green discharge, discharge causes a peri ductal reaction with mastitis or even abscess formation. Fibrosis and slit like nipple retraction
C. Periductal mastitis- Same as above
D. Lactational breast abscess
F. Breast cyst
G. Intraductal papilloma
H. Atypical ductal hyperplasia
I. Radial scar
In cellulitic stage - iv antibiotics
once pus has formed
Repeated aspirations under antibiotic cover (if necessary using ultrasound for localisation) be performed. This often allows resolution without the need for an incision and will also allow the patient to continue breast-feeding
Patients whose tumours overexpress HER2 are offered treatment with the monoclonal antibody trastuzumab.
Bailey page 250