SURGERY EOR EXAM PAEA BLUEPRINT
COMPREHENSIVE STUDY GUIDE WITH
SOLUTIONS
◉ What is the most common underlying pathology associated with
Paget's disease of the breast?
Answer: Ductal carcinoma in situ (DCIS) or invasive ductal
carcinoma (IDC)
◉ Which initial imaging studies must be ordered to evaluate for
multicentric disease when Paget's disease of the breast is
diagnosed?
Answer: Bilateral mammography and breast ultrasound
◉ What is the tertiary diagnostic imaging modality of choice if
mammography and ultrasound are negative in a patient with biopsy-
confirmed Paget's disease of the breast?
Answer: Breast MRI with gadolinium contrast
◉ What is the primary surgical treatment of choice for Mammary
Paget's disease with a localized, biopsy-proven breast mass?
Answer: Lumpectomy with wide excision of the nipple-areola
complex followed by adjuvant whole-breast radiation therapy
,◉ What is the secondary surgical treatment option for Mammary
Paget's disease when multicentric disease or a large tumor-to-breast
ratio is present?
Answer: Total mastectomy with sentinel lymph node biopsy
◉ What is the pathognomonic histopathological feature of a
phyllodes tumor seen on core needle biopsy?
Answer: Hypercellular stroma forming leaf-like projections into
epithelial-lined clefts
◉ Why is fine-needle aspiration (FNA) considered an inadequate
primary diagnostic tool for a suspected phyllodes tumor?
Answer: FNA cannot reliably differentiate a benign phyllodes tumor
from a standard fibroadenoma due to overlapping cellular features
◉ What is the primary surgical management for a benign,
borderline, or malignant phyllodes tumor?
Answer: Wide local excision with clear margins of at least 1 cm
without routine axillary lymph node dissection
◉ What is the secondary surgical intervention for a malignant
phyllodes tumor when clear margins cannot be achieved with
breast-conserving surgery?
,Answer: Total mastectomy without axillary lymph node dissection
◉ Which adjuvant therapy is indicated as a tertiary treatment option
for recurrent or highly aggressive malignant phyllodes tumors?
Answer: Adjuvant external beam radiation therapy to the chest wall
◉ What primary lab screening panel must be ordered in the initial
evaluation of a male presenting with rapid-onset gynecomastia?
Answer: Serum Testosterone, Luteinizing Hormone (LH), Follicle-
Stimulating Hormone (FSH), Estradiol, beta-hCG, and Thyroid-
Stimulating Hormone (TSH)
◉ What selective estrogen receptor modulator (SERM) is the first-
line pharmacological agent for patients with painful, early-stage
gynecomastia?
Answer: Tamoxifen
◉ What is the secondary surgical treatment option for persistent,
fibrotic gynecomastia that has failed medical therapy?
Answer: Subcutaneous mastectomy with liposuction
◉ Which potassium-sparing diuretic is the most common
pharmacological trigger for painful gynecomastia?
Answer: Spironolactone
, ◉ What is the primary endocrine therapy class and popular drug
name used as first-line treatment for hormone receptor-positive
(ER/PR+) breast cancer in premenopausal women?
Answer: Selective Estrogen Receptor Modulator (SERM) such as
Tamoxifen
◉ What is the primary endocrine therapy class and popular drug
name used as first-line treatment for hormone receptor-positive
(ER/PR+) breast cancer in postmenopausal women?
Answer: Aromatase inhibitor such as Anastrozole
◉ What is the first-line targeted monoclonal antibody therapy and
its specific generic name used for patients with HER2-positive
breast cancer?
Answer: Trastuzumab
◉ What is the primary systemic therapeutic regimen for patients
with Triple-Negative Breast Cancer (TNBC) prior to surgical
resection?
Answer: Neoadjuvant chemotherapy utilizing Paclitaxel,
Doxorubicin, and Cyclophosphamide combined with Pembrolizumab
COMPREHENSIVE STUDY GUIDE WITH
SOLUTIONS
◉ What is the most common underlying pathology associated with
Paget's disease of the breast?
Answer: Ductal carcinoma in situ (DCIS) or invasive ductal
carcinoma (IDC)
◉ Which initial imaging studies must be ordered to evaluate for
multicentric disease when Paget's disease of the breast is
diagnosed?
Answer: Bilateral mammography and breast ultrasound
◉ What is the tertiary diagnostic imaging modality of choice if
mammography and ultrasound are negative in a patient with biopsy-
confirmed Paget's disease of the breast?
Answer: Breast MRI with gadolinium contrast
◉ What is the primary surgical treatment of choice for Mammary
Paget's disease with a localized, biopsy-proven breast mass?
Answer: Lumpectomy with wide excision of the nipple-areola
complex followed by adjuvant whole-breast radiation therapy
,◉ What is the secondary surgical treatment option for Mammary
Paget's disease when multicentric disease or a large tumor-to-breast
ratio is present?
Answer: Total mastectomy with sentinel lymph node biopsy
◉ What is the pathognomonic histopathological feature of a
phyllodes tumor seen on core needle biopsy?
Answer: Hypercellular stroma forming leaf-like projections into
epithelial-lined clefts
◉ Why is fine-needle aspiration (FNA) considered an inadequate
primary diagnostic tool for a suspected phyllodes tumor?
Answer: FNA cannot reliably differentiate a benign phyllodes tumor
from a standard fibroadenoma due to overlapping cellular features
◉ What is the primary surgical management for a benign,
borderline, or malignant phyllodes tumor?
Answer: Wide local excision with clear margins of at least 1 cm
without routine axillary lymph node dissection
◉ What is the secondary surgical intervention for a malignant
phyllodes tumor when clear margins cannot be achieved with
breast-conserving surgery?
,Answer: Total mastectomy without axillary lymph node dissection
◉ Which adjuvant therapy is indicated as a tertiary treatment option
for recurrent or highly aggressive malignant phyllodes tumors?
Answer: Adjuvant external beam radiation therapy to the chest wall
◉ What primary lab screening panel must be ordered in the initial
evaluation of a male presenting with rapid-onset gynecomastia?
Answer: Serum Testosterone, Luteinizing Hormone (LH), Follicle-
Stimulating Hormone (FSH), Estradiol, beta-hCG, and Thyroid-
Stimulating Hormone (TSH)
◉ What selective estrogen receptor modulator (SERM) is the first-
line pharmacological agent for patients with painful, early-stage
gynecomastia?
Answer: Tamoxifen
◉ What is the secondary surgical treatment option for persistent,
fibrotic gynecomastia that has failed medical therapy?
Answer: Subcutaneous mastectomy with liposuction
◉ Which potassium-sparing diuretic is the most common
pharmacological trigger for painful gynecomastia?
Answer: Spironolactone
, ◉ What is the primary endocrine therapy class and popular drug
name used as first-line treatment for hormone receptor-positive
(ER/PR+) breast cancer in premenopausal women?
Answer: Selective Estrogen Receptor Modulator (SERM) such as
Tamoxifen
◉ What is the primary endocrine therapy class and popular drug
name used as first-line treatment for hormone receptor-positive
(ER/PR+) breast cancer in postmenopausal women?
Answer: Aromatase inhibitor such as Anastrozole
◉ What is the first-line targeted monoclonal antibody therapy and
its specific generic name used for patients with HER2-positive
breast cancer?
Answer: Trastuzumab
◉ What is the primary systemic therapeutic regimen for patients
with Triple-Negative Breast Cancer (TNBC) prior to surgical
resection?
Answer: Neoadjuvant chemotherapy utilizing Paclitaxel,
Doxorubicin, and Cyclophosphamide combined with Pembrolizumab
