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Breast Cancer & Related Breast Conditions_2: MSRA MCQs

Updated: Jul 15

  1. A 35-year-old woman’s mother had breast cancer diagnosed at 42, and her maternal grandmother had ovarian cancer at 54.

Choose the correct answer

  • A. Reassure

  • B. Offer routine NHS screening at 50

  • C. Refer to breast clinic

  • D. Refer to genetics

✅ Answer: D. Refer to genetics

 🧠 Breast + ovarian cancer in same family → red flag



  1. A 52-year-old woman reports thick, green discharge from her left nipple. No lump or systemic symptoms.

Choose the correct answer

  • A. Ductal carcinoma

  • B. Intraductal papilloma

  • C. Mammary duct ectasia

  • D. Galactorrhoea

✅ Answer: C. Mammary duct ectasia

 🧠 Green = duct ectasia. Common, benign, post-menopausal


  1. A woman presents with blood-stained discharge from a single duct, no mass.

    Likely diagnosis?

Choose the correct answer

  • A) Fibroadenoma

  • B. Intraductal papilloma

  • C. DCIS

  • D) Mastitis

✅ Answer: B. Intraductal papilloma

 🧠 Single-duct bloody discharge = papilloma



  1. A 59-year-old woman presents with red, swollen breast and peau d’orange. No fever.

    Most likely diagnosis?

Choose the correct answer

  • A. Cellulitis

  • B. Inflammatory breast cancer

  • C. Duct ectasia

  • D. Mastitis

✅ Answer: B. Inflammatory breast cancer

 🧠 Rapid onset, erythema, peau d’orange = poor prognosis



  1. Unilateral eczematous rash on nipple, persistent despite steroids.

    Next step?

Choose the correct answer

  • A. Emollients

  • B. Refer dermatology

  • C. Core biopsy

  • D. Punch biopsy + imaging

✅ Answer: D. Punch biopsy + imaging

 🧠 Unilateral eczematous rash = Paget's = cancer until proven otherwise



  1. Which of the following is not part of the breast triple assessment?

Choose the correct answer

  • A. Mammogram

  • B. Core biopsy

  • C. MRI

  • D. Clinical exam

✅ Answer: C. MRI

 🧠 Triple assessment = Clinical + Imaging (US/Mammo) + Biopsy



  1. A woman is diagnosed with ER+, PR+ breast cancer. She is post-menopausal.

    Best first-line hormonal therapy?

Choose the correct answer

  • A. Tamoxifen

  • B. Trastuzumab

  • C. Letrozole

  • D. Methotrexate

✅ Answer: C. Letrozole

 🧠 Post-menopausal ER+ = Aromatase inhibitor



  1. Which of the following is a known risk of tamoxifen therapy?

Choose the correct answer

  • A. Osteoporosis

  • B. Hyperthyroidism

  • C. Endometrial cancer

  • D. Infertility

✅ Answer: C. Endometrial cancer

 🧠 Tamoxifen = breast antagonist, uterine agonist



  1. Which mutation is most associated with male breast cancer?

Choose the correct answer

  • A. BRCA1

  • B. BRCA2

  • C. p53

  • D. APC

✅ Answer: B. BRCA2

 🧠 Male breast cancer = BRCA2 + Klinefelter



  1. A woman presents with painless, unilateral arm swelling 6 months post axillary clearance.

    Most likely cause?

Choose the correct answer

  • A. DVT

  • B. Lymphoedema

  • C. Cancer recurrence

  • D. Infection

✅ Answer: B. Lymphoedema

 🧠 Post-surgery + unilateral swelling = lymphoedema



  1. A woman has milky nipple discharge. Pregnancy test negative. No mass or trauma.

    Next best investigation?

Choose the correct answer

  • A. Prolactin level

  • B. Mammogram

  • C. Core biopsy

  • D. MRI breast

✅ Answer: A. Prolactin level

 🧠 Milky discharge = check prolactin



  1. A 23-year-old presents with a mobile, firm, rubbery lump. No red flags.

    Best management?

Choose the correct answer

  • A. Mastectomy

  • B. Core biopsy

  • D. Chemotherapy

  • E. Tamoxifen

✅ Answer: C. Reassure and observe

 🧠 Mobile, rubbery = breast mouse (fibroadenoma)



  1. Which imaging feature is most suggestive of DCIS?

Choose the correct answer

  • A. Spiculated mass

  • B) Lymphatic obstruction

  • C. Microcalcifications

  • D. Oil cysts

✅ Answer: C. Microcalcifications

 🧠 DCIS = ducts + microcalcifications



  1. Where is breast cancer most commonly located?

Choose the correct answer

  • A. Lower inner

  • B. Lower outer

  • C. Upper inner

  • D. Upper outer

✅ Answer: D. Upper outer

 🧠 “UOQ is the HQ” – Tail of Spence region



  1. What is the main difference between radical and modified radical mastectomy?

Choose the correct answer

  • A. Axillary clearance

  • B. Removal of pectoral muscles

  • C. Radiation use

  • D. Lymph node biopsy

✅ Answer: B. Removal of pectoral muscles

 🧠 Radical = removes pectoralis major + minor



  1. What is the role of sentinel node biopsy?

Choose the correct answer

  • A. Confirm breast cancer diagnosis

  • B. Remove all cancerous nodes

  • C. Identify lymph node involvement

  • D. Excise tumour margins

✅ Answer: C. Identify lymph node involvement

 🧠 Guides need for full axillary clearance



  1. A breast cancer patient reports back pain worse lying flat, leg weakness, and urinary retention.

    First investigation?

Choose the correct answer

  • A. CT spine

  • B. Lumbar puncture

  • C. MRI spine

  • D. X-ray

✅ Answer: C. MRI spine

 🧠 Red flag: Spinal cord compression = MRI + steroids



  1. A 45-year-old has a rapidly enlarging breast lump. Biopsy shows “leaf-like architecture.”

    Likely diagnosis?

Choose the correct answer

  • A. Fibroadenoma

  • B. Phyllodes tumour

  • C. Ductal carcinoma

  • D. Sarcoma

✅ Answer: B. Phyllodes tumour

 🧠 Rapid growth + leaf pattern = Phyllodes



  1. A woman’s sister had soft-tissue sarcoma at age 38. What should you do?

Choose the correct answer

  • A. Reassure

  • B. Offer mammogram at 40

  • C. Refer to genetics

  • D. Refer to dermatology

✅ Answer: C. Refer to genetics

 🧠 Sarcoma <45 y = red flag family history



  1. Which is removed in modified radical mastectomy?

Choose the correct answer

  • A. Breast only

  • B. Breast + axilla + pectoral muscles

  • C. Breast + axilla (pectorals preserved)

  • D. Axilla only

✅ Answer: C. Breast + axilla (pectorals preserved)

 🧠 Modified = keeps pectoral muscles intact



  1. A 52-year-old woman presents with a thick, green nipple discharge from her left breast. She denies pain, fever, or trauma. On examination, there is a peri-areolar lump and some nipple inversion. No axillary lymphadenopathy is noted.

    What is the most likely diagnosis?

Choose the correct answer

  • A. Ductal carcinoma in situ

  • B. Mammary duct ectasia

  • C. Intraductal papilloma

  • D. Inflammatory breast cancer

✅ Answer: B. Mammary duct ectasia

 🧠 Clue: Green, thick discharge + peri-areolar lump + older age



  1. A 70-year-old man presents with a painless firm lump under his left nipple. Examination reveals a hard, irregular, immobile mass. There is no nipple discharge. He has a history of cirrhosis.

    Which risk factor is most associated with this condition?

Choose the correct answer

  • A. BRCA1 mutation

  • B. Klinefelter’s syndrome

  • C. Alcohol use

  • D. Obesity

✅ Answer: B. Klinefelter’s syndrome

 🧠 Clue: Male breast cancer → BRCA2 and Klinefelter’s are key risks



  1. A 34-year-old woman asks about her breast cancer risk. Her mother was diagnosed with unilateral breast cancer at age 65. Her maternal aunt had ovarian cancer at 50.

    What is the appropriate next step?

Choose the correct answer

  • A. Reassure and discharge

  • B. Offer annual mammograms from age 40

  • C. Refer to breast surgeon

  • D. Refer to genetics clinic

✅ Answer: D. Refer to genetics clinic

 🧠 Clue: Breast + ovarian cancer in same family = refer



  1. A 47-year-old woman presents with unilateral, blood-stained nipple discharge. No palpable lump is found. Triple assessment is initiated.

    What is the most likely diagnosis?

Choose the correct answer

  • A. Mammary duct ectasia

  • B. Intraductal papilloma

  • C. Ductal carcinoma in situ

  • D. Phyllodes tumour

✅ Answer: B. Intraductal papilloma

 🧠 Clue: Bloody discharge, no mass, benign cause



  1. A 22-year-old woman presents with a mobile, firm, rubbery, painless breast lump that "slips under the fingers." No axillary nodes are felt. Ultrasound is benign.

    What is the most appropriate management?

Choose the correct answer

  • A. Core biopsy

  • B. Reassurance and observe

  • C. Wide local excision

  • D. Mammogram

✅ Answer: B. Reassurance and observe

 🧠 Clue: Classic fibroadenoma <3 cm in young woman



  1. A 58-year-old woman presents with painless swelling of her left arm, 6 months after axillary clearance for breast cancer. Examination reveals non-pitting oedema of the entire arm.

    What is the most likely cause?

Choose the correct answer

  • A. Deep vein thrombosis

  • B. Breast cancer recurrence

  • C. Cellulitis

  • D. Lymphoedema

✅ Answer: D. Lymphoedema

 🧠 Clue: Unilateral, painless, non-pitting swelling post-surgery



  1. A 64-year-old woman has a 4-month history of persistent, itchy, red, scaly rash on one nipple. It has not improved with topical steroids. No mass is felt.

    What is the next best step?

Choose the correct answer

  • A. Prescribe antifungal cream

  • B. Start potent topical steroid

  • C. Reassure and monitor

  • D. Arrange breast imaging and biopsy

✅ Answer: D. Arrange breast imaging and biopsy

 🧠 Clue: Unilateral eczema-like nipple lesion = Paget's → suspect cancer

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