ABSITE – Breast ACTUAL Exam Questions
and CORRECT Answers
Role of estrogen in breast development/cyclic changes?
Progesterone?
Prolactin - CORRECT ANSWER - a) duct development (double layer of columnar
cells)/increase breast swelling, growth of glandular tissue
b) lobular development/ increase maturation of glandular tissue, withdrawal causes menses
c) synergizes estrogen and progesterone
Important nerves in breast? - CORRECT ANSWER - a) long thoracic nerve - innervates
serratus anterior, injury results in winged scapula (lateral thoracic artery to serratus anterior)
b) thoracodorsal nerve - innervates latissimus dorsi, injury results in weak arm pull ups and
adduction (artery to ld)
c) medial pectoral nerve - innervates pec minor/major
d) lateral pectoral nerve - pec major only
e) intercostobrachial nerve - lateral cutaenous branch of the 2nd intercostal nerve, provides
sensation to medial arm and axilla; just below axillary vein when performing axillary dissection,
ok to dissect.
Blood supply to breast? - CORRECT ANSWER - Branches of internal thoracic artery,
intercostal arteries, thoracoacromial artery and lateral thoracic artery
What is Batson's plexus? - CORRECT ANSWER - valveless vein plexus that allows direct
hemtogenous metastasis of breaast CA to spine
Lymphatic drainage of breast? - CORRECT ANSWER - 97% to axillary lymph nodes
1-2% to internal mammary nodes, any quadrant can drain here
Supraclavicular disease - considered M1 node
Primary axillary adenopathy - #1 cause is lymphoma
, What is cooper's ligaments? - CORRECT ANSWER - suspensory ligaments, divide breast
into segments, breast CA involving these strands can dimple the skin
What is etiology of breast abscess? Treatment? - CORRECT ANSWER - usually with
breast feeding, S aureus. Tx - incision and drainage, dc breast feeding, ice, heat, brest pump, abx
Infectious mastitis? Tx? - CORRECT ANSWER - associated with breast feeding. S. aureus
most common; in nonlactating women can be due to chronic inflammatory diseases
(actinomyces, TB, syphillus) or SLE/autoimmune disease. Need to rule out nectrotic cancer -
need incisional biopsy including the skin.
Periductal mastitis - - CORRECT ANSWER - dilated mammary ducts, nipple retraction,
get creamy discharge from nipple, difficulty with breast feeding. Tx if creamy dischrge with no
nipple retraction, reassurance, if not then need to rule out malignancy.
Mechanism of tamoxifen? - CORRECT ANSWER - competitive inhibitor of estrogen
activity in the breast, agonist to estrogen receptor in uterus. Increases risk of endometrial CA
Mechanism of action for herceptin? - CORRECT ANSWER - Used to treat HER-2/neu
positive breast CA. Monoclonal antibody that selectively binds to human epidermal growht
factor receptor 2 protein (HER2). Can cause CHF, decreased EF
Best management of LCIS? - CORRECT ANSWER - Qurterly physical exam and annual
mammogaphy. Not considered premalignant, usually marker of increased risk of developing
invasive carcinoma in either breast. Chemoprevention with tamixofen shows 50% decrease in
development of LCIS.
Which chromosomes are BRCA1 and BRCA2 found? - CORRECT ANSWER - BRCA1
17q21, BRCA 2 13q12
Responsible for 5-10% of all breast CA, 40-85% of developing breast CA. Tamoxifen shows
50% risk reduction, bilateral masectomy decreaess risk by 90-94%.
and CORRECT Answers
Role of estrogen in breast development/cyclic changes?
Progesterone?
Prolactin - CORRECT ANSWER - a) duct development (double layer of columnar
cells)/increase breast swelling, growth of glandular tissue
b) lobular development/ increase maturation of glandular tissue, withdrawal causes menses
c) synergizes estrogen and progesterone
Important nerves in breast? - CORRECT ANSWER - a) long thoracic nerve - innervates
serratus anterior, injury results in winged scapula (lateral thoracic artery to serratus anterior)
b) thoracodorsal nerve - innervates latissimus dorsi, injury results in weak arm pull ups and
adduction (artery to ld)
c) medial pectoral nerve - innervates pec minor/major
d) lateral pectoral nerve - pec major only
e) intercostobrachial nerve - lateral cutaenous branch of the 2nd intercostal nerve, provides
sensation to medial arm and axilla; just below axillary vein when performing axillary dissection,
ok to dissect.
Blood supply to breast? - CORRECT ANSWER - Branches of internal thoracic artery,
intercostal arteries, thoracoacromial artery and lateral thoracic artery
What is Batson's plexus? - CORRECT ANSWER - valveless vein plexus that allows direct
hemtogenous metastasis of breaast CA to spine
Lymphatic drainage of breast? - CORRECT ANSWER - 97% to axillary lymph nodes
1-2% to internal mammary nodes, any quadrant can drain here
Supraclavicular disease - considered M1 node
Primary axillary adenopathy - #1 cause is lymphoma
, What is cooper's ligaments? - CORRECT ANSWER - suspensory ligaments, divide breast
into segments, breast CA involving these strands can dimple the skin
What is etiology of breast abscess? Treatment? - CORRECT ANSWER - usually with
breast feeding, S aureus. Tx - incision and drainage, dc breast feeding, ice, heat, brest pump, abx
Infectious mastitis? Tx? - CORRECT ANSWER - associated with breast feeding. S. aureus
most common; in nonlactating women can be due to chronic inflammatory diseases
(actinomyces, TB, syphillus) or SLE/autoimmune disease. Need to rule out nectrotic cancer -
need incisional biopsy including the skin.
Periductal mastitis - - CORRECT ANSWER - dilated mammary ducts, nipple retraction,
get creamy discharge from nipple, difficulty with breast feeding. Tx if creamy dischrge with no
nipple retraction, reassurance, if not then need to rule out malignancy.
Mechanism of tamoxifen? - CORRECT ANSWER - competitive inhibitor of estrogen
activity in the breast, agonist to estrogen receptor in uterus. Increases risk of endometrial CA
Mechanism of action for herceptin? - CORRECT ANSWER - Used to treat HER-2/neu
positive breast CA. Monoclonal antibody that selectively binds to human epidermal growht
factor receptor 2 protein (HER2). Can cause CHF, decreased EF
Best management of LCIS? - CORRECT ANSWER - Qurterly physical exam and annual
mammogaphy. Not considered premalignant, usually marker of increased risk of developing
invasive carcinoma in either breast. Chemoprevention with tamixofen shows 50% decrease in
development of LCIS.
Which chromosomes are BRCA1 and BRCA2 found? - CORRECT ANSWER - BRCA1
17q21, BRCA 2 13q12
Responsible for 5-10% of all breast CA, 40-85% of developing breast CA. Tamoxifen shows
50% risk reduction, bilateral masectomy decreaess risk by 90-94%.
