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Test yourself: MCQ and Extended Matching
MULTIPLE CHOICE QUESTIONS
Test yourself
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne; Honorary Reader, Newcastle University; Clinical Editor, Surgery; Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
lence (NICE) overview on early and locally advanced breast cancer (July 2012) has recommendations on margins for all breast cancer.
1 Imaging techniques in breast cancer When considering imaging techniques in breast cancer A
The performance of radiologists with computer-aided diagnosis is equivalent to double reading by two radiologists.
B
CT is the most important diagnostic imaging tool after mammography.
C
MRI has become the method of choice for investigating implants in the augmented breast.
D
Radical surgery is preferable to isotope-guided sentinel node biopsy for occult axillary disease in breast cancer patients.
E
MCQ and extended matching
C
The use of breast conserving therapy in the management of multifocal and multi-centric tumours is now well established.
D
The ideal candidate for a nipple sparing mastectomy has a multi-centric pre-invasive tumour, located >10 mm from the edge of the areola margin, in a relatively small to medium sized breast.
E
The most common autologous-implant reconstruction is a musculocutaneous rectus abdominis flap with or without an implant or expander.
4 The genetics of breast cancer When considering the genetics of breast cancer
Sentinel node surgery in the axilla is enhanced by the use of scintimammography.
A
Female carriers of BRCA gene pathogenic variants have a high lifetime risk of developing breast cancer only.
2 Breast pathology
B
BRCA1 and BRCA2 genes are tumour suppressor genes.
When considering breast pathology
C
Breast cancer screening for women with a family history should be offered in accordance with the NICE guidelines on Familial Breast Cancer.
A
Cytology cannot differentiate between in situ and invasive carcinoma.
B
The technical processing steps required for core biopsies preclude their use in a one-stop setting.
D
The main cancers associated with the LKB1 causative gene are breast, pancreatic, gastrointestinal and lung.
C
Ductal carcinoma in situ may present as a breast mass, nipple discharge, or Paget’s disease of the nipple.
E
All women with a family history of breast cancer will have an increased risk of developing the disease.
D
Microinvasive carcinoma is a term used to describe a focus of invasive carcinoma usually less than 1 mm in maximum extent.
E
Neoadjuvant therapy is drug treatment administered before formal surgical excision with the aim of treating and down-staging a breast cancer.
5 Adjuvant treatment for breast cancer Theme: Adjuvant treatment for breast cancer
3 Surgical techniques in breast cancer When considering surgical techniques in breast cancer A
B
Wide local excision involves complete tumour excision down to the level of the pectoral muscle with a surrounding rim of normal breast tissue. The National Institute for Health and Clinical Excel-
A
Reduces the risk of local recurrence following breast conservation surgery by two-thirds.
B
Should be used as first line hormonal therapy for male breast cancer.
C
Is offered to all patients who have oestrogen receptor (ER) positive invasive breast cancer.
D
Is associated with an increased risk of cardiac complications compared with other agents in its class.
E
The goal is to eliminate occult microscopic metastatic disease and so prevent future distant relapse, which is incurable.
see next page
SURGERY 31:1
46
MULTIPLE CHOICE QUESTIONS
Questions cont. F
Answers to incorrect statements
Should be considered for all women with early stage HER2 positive breast cancer following surgery and chemotherapy (neoadjuvant or adjuvant).
G
Should be considered as primary hormonal therapy in postmenopausal patients at intermediate or high risk of recurrence or low risk patients intolerant of tamoxifen.
H
The short-term side effects include alopecia, nausea and vomiting, myelosuppression, mucositis and fatigue.
Question 1
B Ultrasound is the most important diagnostic imaging tool after mammography. D Isotope guided sentinel node biopsy is preferable to radical surgery for occult axillary disease in breast cancer patients. Question 3
B The National Institute for Health and Clinical Excellence (NICE) overview on early and locally advanced breast cancer (July 2012) only has recommendations on margins for non-invasive cancer. C The use of breast conserving therapy in the management of multifocal and multi-centric tumours is controversial. D The ideal candidate for a nipple sparing mastectomy has a multi-centric pre-invasive tumour, located >20 mm from the edge of the areola margin, in a relatively small to medium sized breast. E The most common autologous-implant reconstruction is a musculocutaneous latissimus dorsi flap from the ipsilateral dorsum with or without an implant or expander.
When considering the adjuvant therapies listed below, select the single most likely true statement from the list above. Each option may be used only once, more than once or not at all. 1 2 3 4 5 6 7 8
Whole breast radiotherapy Systemic therapy Chemotherapy Hormonal therapy Trastuzumab Tamoxifen Aromatase inhibitors Exemestane
Answers 1 2 3 4 5
Question 4
A Female carriers of BRCA gene pathogenic variants have a high lifetime risk of developing breast and ovarian cancer. E Not everyone with a family history of breast cancer will have an increased risk of developing the disease.
A, C, E All A B, C, D 1A, 2E, 3H, 4C, 5F, 6B, 7G, 8D
SURGERY 31:1
47
Test yourself
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne; Honorary Reader, Newcastle University; Clinical Editor, Surgery; Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
lence (NICE) overview on early and locally advanced breast cancer (July 2012) has recommendations on margins for all breast cancer.
1 Imaging techniques in breast cancer When considering imaging techniques in breast cancer A
The performance of radiologists with computer-aided diagnosis is equivalent to double reading by two radiologists.
B
CT is the most important diagnostic imaging tool after mammography.
C
MRI has become the method of choice for investigating implants in the augmented breast.
D
Radical surgery is preferable to isotope-guided sentinel node biopsy for occult axillary disease in breast cancer patients.
E
MCQ and extended matching
C
The use of breast conserving therapy in the management of multifocal and multi-centric tumours is now well established.
D
The ideal candidate for a nipple sparing mastectomy has a multi-centric pre-invasive tumour, located >10 mm from the edge of the areola margin, in a relatively small to medium sized breast.
E
The most common autologous-implant reconstruction is a musculocutaneous rectus abdominis flap with or without an implant or expander.
4 The genetics of breast cancer When considering the genetics of breast cancer
Sentinel node surgery in the axilla is enhanced by the use of scintimammography.
A
Female carriers of BRCA gene pathogenic variants have a high lifetime risk of developing breast cancer only.
2 Breast pathology
B
BRCA1 and BRCA2 genes are tumour suppressor genes.
When considering breast pathology
C
Breast cancer screening for women with a family history should be offered in accordance with the NICE guidelines on Familial Breast Cancer.
A
Cytology cannot differentiate between in situ and invasive carcinoma.
B
The technical processing steps required for core biopsies preclude their use in a one-stop setting.
D
The main cancers associated with the LKB1 causative gene are breast, pancreatic, gastrointestinal and lung.
C
Ductal carcinoma in situ may present as a breast mass, nipple discharge, or Paget’s disease of the nipple.
E
All women with a family history of breast cancer will have an increased risk of developing the disease.
D
Microinvasive carcinoma is a term used to describe a focus of invasive carcinoma usually less than 1 mm in maximum extent.
E
Neoadjuvant therapy is drug treatment administered before formal surgical excision with the aim of treating and down-staging a breast cancer.
5 Adjuvant treatment for breast cancer Theme: Adjuvant treatment for breast cancer
3 Surgical techniques in breast cancer When considering surgical techniques in breast cancer A
B
Wide local excision involves complete tumour excision down to the level of the pectoral muscle with a surrounding rim of normal breast tissue. The National Institute for Health and Clinical Excel-
A
Reduces the risk of local recurrence following breast conservation surgery by two-thirds.
B
Should be used as first line hormonal therapy for male breast cancer.
C
Is offered to all patients who have oestrogen receptor (ER) positive invasive breast cancer.
D
Is associated with an increased risk of cardiac complications compared with other agents in its class.
E
The goal is to eliminate occult microscopic metastatic disease and so prevent future distant relapse, which is incurable.
see next page
SURGERY 31:1
46
MULTIPLE CHOICE QUESTIONS
Questions cont. F
Answers to incorrect statements
Should be considered for all women with early stage HER2 positive breast cancer following surgery and chemotherapy (neoadjuvant or adjuvant).
G
Should be considered as primary hormonal therapy in postmenopausal patients at intermediate or high risk of recurrence or low risk patients intolerant of tamoxifen.
H
The short-term side effects include alopecia, nausea and vomiting, myelosuppression, mucositis and fatigue.
Question 1
B Ultrasound is the most important diagnostic imaging tool after mammography. D Isotope guided sentinel node biopsy is preferable to radical surgery for occult axillary disease in breast cancer patients. Question 3
B The National Institute for Health and Clinical Excellence (NICE) overview on early and locally advanced breast cancer (July 2012) only has recommendations on margins for non-invasive cancer. C The use of breast conserving therapy in the management of multifocal and multi-centric tumours is controversial. D The ideal candidate for a nipple sparing mastectomy has a multi-centric pre-invasive tumour, located >20 mm from the edge of the areola margin, in a relatively small to medium sized breast. E The most common autologous-implant reconstruction is a musculocutaneous latissimus dorsi flap from the ipsilateral dorsum with or without an implant or expander.
When considering the adjuvant therapies listed below, select the single most likely true statement from the list above. Each option may be used only once, more than once or not at all. 1 2 3 4 5 6 7 8
Whole breast radiotherapy Systemic therapy Chemotherapy Hormonal therapy Trastuzumab Tamoxifen Aromatase inhibitors Exemestane
Answers 1 2 3 4 5
Question 4
A Female carriers of BRCA gene pathogenic variants have a high lifetime risk of developing breast and ovarian cancer. E Not everyone with a family history of breast cancer will have an increased risk of developing the disease.
A, C, E All A B, C, D 1A, 2E, 3H, 4C, 5F, 6B, 7G, 8D
SURGERY 31:1
47