Term 4, CPC 4 Quiz
Questions and Answers
- 1.
A 38 year old woman presented with a 5 mm discrete mobile nodular mass in the left breast. Biopsy image is shown below. What is the most likely diagnosis?
- A.
Sclerosing adenosis
- B.
Fibroadenoma
- C.
Fibrocystic disease
- D.
Duct ectasia
- E.
Invasive duct carcinoma
Correct Answer
B. FibroadenomaExplanation
Based on the description of a 5 mm discrete mobile nodular mass in the left breast, the most likely diagnosis is a fibroadenoma. Fibroadenomas are common benign breast tumors that often present as discrete, mobile masses. They are typically painless and have a smooth, well-defined border. Biopsy is usually performed to confirm the diagnosis, and the image shown below is likely to show characteristic features of a fibroadenoma. Sclerosing adenosis, fibrocystic disease, duct ectasia, and invasive duct carcinoma are less likely based on the given description.Rate this question:
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- 2.
A 51 year old woman presents with massive enlargement of her left breast over the last 3 months. On examination there is a discrete large mass with some fixation to underlying tissue making it less mobile. The below image shows the histopathological appearance. What is the most likely diagnosis?
- A.
Sclerosing adenosis
- B.
Fibroadenoma
- C.
Cystosarcoma phyllodes
- D.
Lobular carcinoma
- E.
Invasive duct carcinoma
Correct Answer
C. Cystosarcoma phyllodesExplanation
The most likely diagnosis in this case is cystosarcoma phyllodes. This is suggested by the massive enlargement of the left breast over a short period of time, the presence of a discrete large mass, and the fixation of the mass to underlying tissue. The histopathological appearance shown in the image would further support this diagnosis. Cystosarcoma phyllodes is a rare type of breast tumor that can present with rapid growth and a well-defined mass.Rate this question:
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- 3.
A 52 year old woman presents with bloody nipple discharge and a single irregular mass below the areola. The below image shows the histopathological features. What is the most likely diagnosis?
- A.
Sclerosing adenosis
- B.
Fibroadenoma
- C.
Invasive ductal carcinoma
- D.
Papillary carcinoma
- E.
Duct papilloma
Correct Answer
E. Duct papillomaExplanation
The histopathological features shown in the image are consistent with duct papilloma. Duct papilloma is a benign breast lesion characterized by a papillary growth within the breast ducts. It often presents with bloody nipple discharge and can be associated with a single irregular mass below the areola, as described in the patient's presentation. In contrast, invasive ductal carcinoma is a malignant breast tumor, while sclerosing adenosis and fibroadenoma are benign breast conditions that do not typically present with bloody nipple discharge. Papillary carcinoma is a malignant breast tumor that may have similar histopathological features to duct papilloma, but it is less likely given the benign nature of the lesion in this case.Rate this question:
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- 4.
Which of the following changes in the breast are associated with an increased risk of developing breast cancer?
- A.
Epithelial hyperplasia
- B.
Apocrine metaplasia
- C.
Sclerosing adenosis
- D.
Fibrocystic disease
- E.
Fibroadenoma
Correct Answer
C. Sclerosing adenosisExplanation
Sclerosing adenosis is a change in the breast that is associated with an increased risk of developing breast cancer. This condition involves the overgrowth of tissues in the breast ducts and lobules, which can lead to the formation of scar-like tissue. This scarring can make it difficult to interpret mammograms and can sometimes be mistaken for cancerous changes. Therefore, individuals with sclerosing adenosis may require closer monitoring and follow-up to ensure early detection and treatment of any potential breast cancer.Rate this question:
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- 5.
A 65 year old woman underwent mastectomy for breast cancer. The image of the specimen received at pathology laboratory is shown. What is the most likely type of cancer?
- A.
Medullary carcinoma
- B.
Lobular carcinoma
- C.
Schirrous carcinoma
- D.
Inflammatory carcinoma
- E.
Lymphoma of breast
Correct Answer
C. Schirrous carcinomaExplanation
The most likely type of cancer in this case is Schirrous carcinoma. This is because the image of the specimen received at the pathology laboratory shows characteristics consistent with Schirrous carcinoma.Rate this question:
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- 6.
A 61 year old woman presented with diffuse enlargement of left breast. No mass was felt on physical examination. What is the most likely explanation for the appearance shown in the picture below?
- A.
Inflammation
- B.
Lymphatic obstruction
- C.
Carcinoma infiltration
- D.
Paget's disease
- E.
Phyllodes tumour
Correct Answer
B. Lymphatic obstructionExplanation
The most likely explanation for the diffuse enlargement of the left breast without a palpable mass is lymphatic obstruction. Lymphatic obstruction can cause fluid buildup and swelling in the breast, leading to enlargement. This can occur due to various reasons such as infection, inflammation, or tumor involvement. In this case, lymphatic obstruction is the most likely cause as there is no palpable mass, suggesting that the enlargement is not due to a carcinoma infiltration or Phyllodes tumor. Additionally, the absence of other symptoms or signs of infection or inflammation makes those possibilities less likely. Paget's disease, a rare form of breast cancer, typically presents with skin changes and nipple discharge, which are not mentioned in the given information. Therefore, lymphatic obstruction is the most plausible explanation.Rate this question:
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- 7.
A 32 year old female presented with painful swelling over upper medial quadrant of right breast, unable to feed her 1 week old baby. Below is the histopathology image from needle biopsy. What is the most likely diagnosis?
- A.
Inflammatory carcinoma
- B.
Fat necrosis
- C.
Breast trauma
- D.
Acute mastitis
- E.
Chronic mastitis
Correct Answer
D. Acute mastitisExplanation
The most likely diagnosis in this case is acute mastitis. Acute mastitis is an infection of the breast tissue that commonly occurs in lactating women. It is characterized by painful swelling, redness, and warmth in the affected area. The inability to feed the baby suggests that the infection is interfering with breastfeeding. The histopathology image from the needle biopsy would likely show inflammatory changes consistent with acute mastitis. Inflammatory carcinoma, fat necrosis, breast trauma, and chronic mastitis are less likely based on the clinical presentation.Rate this question:
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- 8.
A 36 year old woman complains of bloody discharge from her right nipple. There are no palpable lumps in her breast, no axillary lymphadenopathy. The patient is on oral contraceptive pills. What is the most likely lesion to be found on excisional biopsy?
- A.
Fibroadenoma
- B.
Fibrocystic disease
- C.
Phyllodes tumour
- D.
Intraductal papilloma
- E.
Sclerosing adenosis
Correct Answer
D. Intraductal papillomaExplanation
The most likely lesion to be found on excisional biopsy in this case is an intraductal papilloma. This is because the patient is presenting with bloody discharge from her nipple, which is a common symptom of intraductal papilloma. Additionally, the absence of palpable lumps and axillary lymphadenopathy suggests a benign lesion rather than a malignant tumor. Fibroadenoma, fibrocystic disease, phyllodes tumor, and sclerosing adenosis are less likely to cause bloody nipple discharge compared to intraductal papilloma.Rate this question:
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- 9.
A 30 year old woman suffers a traumatic blow to her right breast resulting in a 3 cm contusion. A few weeks later she notices a firm irregular lump in the same area of her breast. What is the most likely diagnosis?
- A.
Fibroadenoma
- B.
Fat necrosis
- C.
Intraductal carcinoma
- D.
Duct ectasia
- E.
Sclerosing adenosis
Correct Answer
B. Fat necrosisExplanation
Fat necrosis is the most likely diagnosis in this case because it commonly occurs after trauma to the breast. It is characterized by the formation of a firm, irregular lump in the affected area. Fibroadenoma is a benign tumor that is not typically associated with trauma. Intraductal carcinoma and duct ectasia are conditions that present with different symptoms, such as nipple discharge or changes in breast shape. Sclerosing adenosis is a benign condition that may cause breast pain or a lump, but it is not commonly associated with trauma.Rate this question:
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- 10.
A 55 year old man develops bilateral breast enlargement over the past year, which is symmetric and not painful to palpation. The patient is not obese and not taking any medication. Which of the following underlying condition accounts for this change?
- A.
Micronodular cirrhosis
- B.
Chronic glomerulonephritis
- C.
Choriocarcinoma of testis
- D.
ACTH secreting pituitary adenoma
- E.
Cushing’s syndrome
Correct Answer
A. Micronodular cirrhosisExplanation
Micronodular cirrhosis is a condition characterized by the development of small nodules in the liver due to chronic liver disease. This condition can lead to hormonal imbalances, including an increase in estrogen levels. Elevated estrogen levels can cause gynecomastia, which is the development of breast tissue in males. Therefore, micronodular cirrhosis can account for the bilateral breast enlargement observed in the 55-year-old man.Rate this question:
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- 11.
A 45 year old woman had excision biopsy done for the lump which was a firm irregular mass in the upper outer quadrant of the left breast. The gross appearance is shown. Which of the additional findings do you think would be present in this patient?
- A.
Fibrocystic change
- B.
Lobular carcinoma
- C.
Fibroadenoma
- D.
Infiltrating ductal carcinoma
- E.
Fat necrosis
Correct Answer
A. Fibrocystic changeExplanation
In this case, the correct answer is "Fibrocystic change." Fibrocystic change is a common benign condition that causes changes in the breast tissue, leading to the formation of lumps or cysts. The description of a firm irregular mass in the upper outer quadrant of the left breast is consistent with fibrocystic change. This condition is characterized by the presence of multiple cysts, fibrosis, and epithelial hyperplasia. It is important to differentiate fibrocystic change from other breast conditions, such as lobular carcinoma, fibroadenoma, and infiltrating ductal carcinoma, which are more concerning and may require further investigation or treatment. Fat necrosis is another benign condition that can cause breast lumps, but it usually presents with a history of trauma or injury to the breast.Rate this question:
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- 12.
A 27 year old woman presents with a lump in her breast. She has a strong family history of breast cancer. The lump is found to be a firm 2 cm mass in the upper outer quadrant of her left breast. The biopsy shows presence of carcinoma. Genetic analysis shows that she is a carrier of BRCA1 gene mutation, as has her mother and sister. Which of the following histologic types of cancer has the highest incidence in families like hers?
- A.
Lobular carcinoma
- B.
Papillary carcinoma
- C.
Medullary carcinoma
- D.
Metaplastic carcinoma
- E.
Ductal carcinoma in situ
Correct Answer
C. Medullary carcinomaExplanation
Medullary carcinoma has the highest incidence in families with a BRCA1 gene mutation. This type of breast cancer is often associated with a strong family history of breast cancer and is more commonly found in younger women. It is characterized by well-defined borders and a syncytial growth pattern, and is typically triple-negative (negative for estrogen receptor, progesterone receptor, and HER2/neu). The presence of the BRCA1 gene mutation in the patient, her mother, and her sister suggests a hereditary predisposition to breast cancer, making medullary carcinoma the most likely histologic type in this case.Rate this question:
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- 13.
A 24 year old woman who is breast feeding her three week old baby notices fissures in the skin around her left nipple. Later she develops fever with erythematous and tender swelling of her breast with purulent discharge from the nipple. Which of the following organisms is most likely to be cultured from the discharge?
- A.
Staphylococcus aureus
- B.
Streptococcus pyogenes
- C.
Lactobacillus
- D.
Candida albicans
- E.
Streptococcus viridans
Correct Answer
A. Staphylococcus aureusExplanation
The presence of fissures in the skin around the nipple, along with fever, erythematous and tender swelling of the breast, and purulent discharge from the nipple, suggests an infection known as mastitis. Staphylococcus aureus is the most common organism cultured from mastitis, making it the most likely answer choice.Rate this question:
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- 14.
The below breast excision biopsy specimen was taken from a 44 year old female patient. What diagnosis can you make from the gross specimen?
- A.
Fibroadenoma
- B.
Breast carcinoma
- C.
Fibrocystic disease
- D.
Lobular carcinoma
- E.
Intraductal carcinoma
Correct Answer
A. FibroadenomaExplanation
Based on the given gross specimen, the diagnosis that can be made is fibroadenoma. Fibroadenoma is a benign breast tumor that is commonly found in young women. It is characterized by a well-defined, firm, and rubbery mass in the breast tissue. The specimen taken from the 44-year-old female patient matches the characteristics of a fibroadenoma rather than breast carcinoma, fibrocystic disease, lobular carcinoma, or intraductal carcinoma, which are usually associated with different clinical and pathological features.Rate this question:
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-CPC4-Term 4.jpg "The below breast excision biopsy specimen was taken from a 44 year old female patient. What diagnosis can you make from the gross specimen?")
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