Breast Cancer Quiz

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Breast Cancer Quiz

Created by Chris Galbraith and Connor Bohlken
Edited by Dr. Paris Ingledew

You are a newly minted Family Physician working in a group practice with some of your colleagues from medical school. Today you are seeing Mrs. Lump, a 54 year old female here for an incidental finding of a breast mass. It’s your lunch break and your thoughts harken back to your time in medical school with Dr. Notazebra, a preceptor of yours who was a big fan of the phrase “common is common”. Following your own train of thought you try to remember how common breast cancer is. Your memory is jogged and you recall:

1 point

Breast cancer is the most common cancer in women, with a lifetime incidence of 1 in 8 in women.

Breast cancer is the third most common cancer, with a lifetime incidence of 1 in 8 in women.

Breast cancer is a relatively rare form of cancer, with a lifetime incidence of about 1 in 200 in women.

Breast cancer is the most common cancer in men, with a lifetime incidence of 1 in 8 men.

Breast cancer is the third most common cancer in women, with a lifetime incidence of 1 in 24 women.

Clear selection

You are working as a GPO and have just been referred a new patient for a suspicious breast lesion. She is a 64 nulliparous lawyer named Brea Strong. After talking to her you find out she has a history of left-sided breast cancer. At the time she elected to have a lumpectomy and radiation therapy. Additionally, she endorses early menarche at 10, late menopause at 56, but denies any excessive alcohol consumption. She undergoes regular mammography and has a documented breast density of 80%. Which of her risk factors for breast cancer is considered a strong risk factor?

1 point

Nulliparity

Age

High Socioeconomic Status

History of Breast Cancer

Breast Density > 75% on Mammogram

Clear selection

Today you are meeting a new patient. Mrs. Friedman is a 54 year old female who is coming in for a “meet and greet” appointment. During the interview you learn the following: She is recently widowed, her and her late husband had 2 children who are now very successful in their fields. She was born in Canada and is of Ashkenazi Jew descent. She has never had any significant surgeries, and her past medical history is significant for hypertension which she is managing with lifestyle and diet. She takes no medications. She worked as a professor at the local college, teaching english. You finish up chatting and feel that you have made a connection with the patient. On her way out the door she states, “Oh yeah, I’m not sure if it’s important or not but my sister has this thing they found in her genes that increases her risk for some cancers, breast and ovarian I think”. What germline mutation is she most likely talking about?

1 point

APC

BRCA 2

PTEN

NOTME 3

BRCA 1

Clear selection

You are a student working in an outpatient clinic, and your next patient is Mrs. Ilike Toscreen. Coincedently, she is a family physician whose biggest passion is staying up to date on screening recommendations. Additionally, she firmly believes in knowledge translation and wants to make sure you know them as well. She asks “Which of the following is a proper screening protocol for an average risk female”? You answer:

1 point

Self Breast Examination (SBE) q3 months from 50-74

Clinical Breast Examination (CBE) q6 months from 50-74

Ultrasound q1 years from 50-74

Mammography q2 years from 50-74

MRI q5 years from 50-74

Clear selection

Mrs. Ilike Toscreen is impressed with your knowledge of breast cancer screening for the general population. However, she would like to know if you know the appropriate screening for women at high risk of breast cancer, such as a 40 year female with BRCA 1. You answer:

1 point

CEA q6 Months Starting at 40

Annual Mammography Starting at 40

MRI q2 Years Starting at 40

Bone Scan q3 Years Starting at 40

Core Needle Biopsy q5 Years Starting at 40

Clear selection

Today you are seeing Mrs. Whatnext, a 66 year old female, who recently had a core needle biopsy done following the detection of a suspicious solid lesion on routine screening mammography and subsequent ultrasound. She is here for the results of the biopsy, she is quite nervous. The report states: “Classic Lobular Carcinoma In-situ (LCIS)”. She wants to know what that is and what the next steps are. You answer:

1 point

Classic LCIS is a pre-malignant lesion, meaning it is not cancer but could become cancer, management will be based on multidisciplinary input and patient preference.

Classic LCIS is a form of cancer of the breast, treatment options will depend on the stage of breast cancer which will require further work up.

Classic LCIS is a pre-malignant lesion, meaning it is not cancer but could become cancer, it must be surgically removed.

Classic LCIS is a form of cancer of the breast, treatment is chemoradiation.

Classic LCIS is a pre-malignant lesion, meaning it is not cancer but could become cancer, there is no need for concern and you can return to the regular breast cancer screening protocol.

Clear selection

You are on an oncology rotation and have just seen a patient with known breast cancer. You report back to your favourite attending Dr. Montgomery, who is impressed with your history and physical. “Ok great” they say, “If all you knew was this patient has invasive breast cancer, what type do you think it would be”? You answer:

1 point

Invasive Ductal Carcinoma

Invasive Lobular Carcinoma

Inflammatory Breast Carcinoma

Paget’s Disease of the Breast

Phylloides Tumor

Clear selection

You are a third year medical student who has just started their 3rd year Oncology rotation. You are working with Dr. Ryceptor, an oncologist who primarily treats breast cancer. To test you knowledge of breast cancer management, Dr. Ryceptor asks: What is the significance of the following statement: “The patient’s breast cancer is Estrogen Receptor positive (ER+), Human epidermal growth receptor negative (HER-)”. You answer:

1 point

ER+ means that the cancer grows in response to estrogen and cannot be treated with anti-estrogen therapy, HER - means it is more aggressive.

ER+ means that the cancer does not grow in response to estrogen and cannot be treated with anti-estrogen therapy, HER - means it is less aggressive.

ER+ means that the cancer grows in response to estrogen and can be treated with anti-estrogen therapy, HER- means it is less aggressive.

ER+ means that the cancer grows in response to estrogen and cannot be treated with anti-estrogen therapy, HER- means it is less aggressive.

ER+ means that the cancer does not grow in response to estrogen and cannot be treated with anti-estrogen therapy, HER- means it is more aggressive.

Clear selection

Which of the following signs or symptoms is typically NOT associated with breast cancer.

1 point

Asymptomatic presentation.

Firm, Hard, Irregular, Non-tender Lump.

Bilateral Nipple Discharge.

Peau d'Orange

Metastatic Disease.

Clear selection

You are on a surgical rotation, and spending the day in an outpatient breast clinic. Your next patient is 61 year female with known stage 1 breast cancer that is hormone receptor positive. She has no other high risk features. Today she is coming in to discuss possible treatment modalities. Notably, she wants to achieve a good cosmetic result, but also wants to make sure she is getting the best treatment possible. You recommend:

1 point

Modified Radical Mastectomy + Hormone Therapy

Hormone Therapy Alone

Multiagent Chemotherapy + Hormone Therapy

Lumpectomy + Adjuvant Radiation + Hormone Therapy

Total Bilateral Mastectomy + Hormone Therapy

Clear selection

What are the components of the triple assessment classically used in the diagnostic approach for breast cancer:

1 point

History, Laboratory testing, and Imaging.

Physical exam, Biopsy, and Imaging.

Physical exam, Laboratory testing, and Imaging.

History, Biopsy, and Imaging.

Physical exam, Biopsy, and Laboratory testing.

Clear selection

Ms. Bump is a 28 year old female with a lump in her right breast. Which of the following imaging modalities is the recommended initial imaging modality to further evaluate her lump?

1 point

Diagnostic Mammogram

MRI

Bone scan

Chest CT

Clear selection

You are a third year medical student who has just started their third year clinical rotation in Oncology. Today you will be working with Dr. Stajh, who primarily treats breast cancers. You begin the day with a quick review of TNM staging. To gauge your knowledge he asks the following: If you have a patient with a known breast cancer that was TNM stage: T2, N1, M0, what would it’s overall stage be?

1 point

Stage 1B

Stage IIA

Stage IIIA

Stage IIB

Stage IV

Clear selection

You have just finished seeing Mrs. Smile, a wonderful 82 year female with stage 2 breast cancer. As you may have guessed, she has a delightful smile, and you feel all the better after meeting her. Just as you are about to leave, she asks you what her prognosis might be. You don’t normally divulge this to patients, but you know her outcome is good and further you would like to see that smile one last time. The 5-year prognosis for stage 2 breast cancer is:

1 point

100%

93%

72%

22%

Clear selection

You are a fourth year medical student doing an elective in Oncology. You are seeing Mrs. Gemmethedeets, a 60 year old female with ER+, HER- DCIS. Her Oncologist would like to start her on Tamoxifen, a drug used in Hormonal therapy, but she has some questions about its side effects first. Which of the following is NOT a side effect of Tamoxifen?

1 point

Hot flashes.

Increased risk of Endometrial Cancer.

Constipation / Diarrhea.

Fatigue.

Argyria

Clear selection

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