High-Yield and Frequently Missed ABSITE Questions with Correct Answers Breast: What is presentation, treatment, prognosis for intraductal papilloma? - Correct Answer presents with bleeding/bloody nipple discharge (most common cause), usually benign, biopsy/resect via major duct excision Breast: What are contraindications to BCT (lumpectomy) in stage I breast cancer (and what specifically is not)? - Correct Answer 1) prior irradiation; 2) pos margins; 3) inflammatory; 4) pregnancy (unless 3rd trimester) Breast: what are the axillary node levels (1-3, and one more category)? - Correct Answer 1 - lateral to pec minor;
- - beneath pec minor;
- - medial to pec minor;
Rotter's Nodes - between pec major and pec minor Breast: when is SNLB indicated (size, nodes, tumor status, metastatic risk)>? - Correct Answer >1 cm, no positive nodes (obviously), primary tumor present, low risk of axillary mets, Breast: what do you do if you can't find radiotracer dye in SNLB? - Correct Answer have to do formal ALND Breast: what is treatment for DCIS in male/female? - Correct Answer female -- BCT + xrt OR mastectomy; male -- mastectomy Breast: what is not needed for patient with negative SLNB? - Correct Answer ALND -- just do BCT or mastectomy depending on tumor is fine Breast: what patient would get only mastectomy/BCT + tamoxifen for 5 years (4 characteristics)? - Correct Answer negative SLN, old, ER+, and tumor <2 cm 1 / 3
Breast: what patient would get mastectomy/BCT + tamoxifen for 5 years plus chemo (4 characteristics)? - Correct Answer negative SLN, young, ER+, and tumor >1cm Breast: what are 3 chemo agents used for breast CA typically? - Correct Answer 1) adriamycin; 2) cyclophosphamide; 3) taxol Breast: what patient would get mastectomy/BCT + chemo (no tamoxifen)? - Correct Answer negative
SLN, ER-
Breast: what is main SE of taxol? - Correct Answer taxol - neuropathy
Breast: what is main SE of adriamycin (doxorubacin)? - Correct Answer cardiomyopathy Breast: what is treatment for inflammatory breast cancer (in order)? - Correct Answer neoadjuvant chemo, then mastectomy (mod radical), then XRT Breast: what options are available for breast mass post neoadjuvant therapy? - Correct Answer same as de novo breast cancer -- BCT or mastectomy -- if tumor shrunk and now amenable to BCT, that's fine, even if it was big before and needed mastectomy based on size Breast: LCIS -- who primarily gets this, what is most important characteristic, what % get cancer, where, and what type? - Correct Answer - pre-menopausal
- NOT premalignant itself
- 30% lifetime risk
70% ductal CA
Breast: LCIS -- what % have synchronous cancer? - Correct Answer 5%
Breast: LCIS -- what is treatment (4 possibility, 2 things not needed ever)? - Correct Answer 1) Need to resect the lesion but do not need neg margins 2) nothing and careful F/U 3) Hormonal therapy -(pre-meno: tamoxifen; Post-meno: raloxifene) 4) bilateral subcutaneous mastectomy (no ALND) 2 / 3
Breast: What are the benign proliferative breast lesions that have increased risk of CA? (3) Tx? - Correct Answer - LCIS
- Atypical ductal hyperplasia
- atypical lobular hyperplasia
Tx: resect the lesion w/ (-) margins
Breast: for atypical ductal hyperplasia; atypical lobular hyperplasia; LCIS, how are these characterized and what treatment should be considered? - Correct Answer benign proliferative dz. Incr risk of CA.Need to resect - don't need (-) margins Can give hormone therapy
- pre-meno: tamoxifen
- post-meno: raloxifene
Bilateral total mastectomy (no ALND) Liver: amebic abscess - how does organism enter, what organism is it - Correct Answer through portal system Liver: amebic abscess - what are 3 presenting symptoms? - Correct Answer fever, RUQ pain, RUQ tenderness Liver: amebic abscess - what test may help diagnose? - Correct Answer indirect hemagglutination Liver: amebic abscess - what is first line treatment, when should surgery be done, and what other option exists? - Correct Answer first option metronidazole -- surgery or percutaneous drainage if failure Liver: what are 2 primary routes for pyogenic liver abscess, and what are 2 specific causes for each? - Correct Answer biliary infection (cholecystitis/cholangitis) - most common seeding from portal vein drainage (appendicitis, diverticulitis) Liver: pyogenic abscess - what are most common organisms (3)? - Correct Answer e. coli, klebsiella, strep
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