Shalof Q-bank breast.
﷽
"و َﻣﺎ أُوﺗِﯾﺗُم ِ ّﻣ َن ا ْﻟ ِﻌ ْﻠ ِم ِإ ﱠﻻ ﻗَ ِﻠﯾﻼ"
ﺑﺳم ﷲ اﻓﺗﺗﺢ ھذا اﻟﻌﻣل اﻟﺟدﯾد واﻟذي اﺳﻣﯾﺗﮫ shalof-Qbankواﻟذي ﯾﻌﺗﺑر ﺑﻧك ﻷﺳﺋﻠﺔ اﻟﺟراﺣﺔ ﻣﻊ اﻻﺟﺎﺑﺎت واﻟﺗﻔﺳﯾر.
اھم اﻟﻣﻌﻠوﻣﺎت اﻟﻣﻔﯾدة ﻗﺑل اﻟﺑدء ﻓﻲ ﻣذاﻛرة ھذا اﻟﺑﻧك:
.1اﻟﺑﻧك ﯾﻌﺗﺑر ﻣﻔﯾد ﺑﺎﻟدرﺟﺔ اﻻوﻟﻰ ﻟطﻠﺑﺔ اﻟﺟراﺣﺔ ﺳﻧﺔ ﺧﺎﻣﺳﺔ ﻻﻧﮫ ﯾﺿم اﺳﺋﻠﺔ ﺳﻧوات ﻻﺧر 12دور ﻣن اﻣﺗﺣﺎﻧﺎت
ﺟراﺣﺔ ﺳﺎﺑﻘﺔ ﻟزﻣﻼﺋﮭم.
.2اﻟﺑﻧك ﻻﯾﻌﺗﺑر ﻓﻘط ﻣﺟرد ﺗﻘﯾﯾم ﻟدراﺳﺗك ﻟﻠﻣﺎدة ،ﺑل أﯾﺿﺎ وﺳﯾﻠﺔ ﺗﺛﺑﯾت ﻟﻠﻣﻌﻠوﻣﺎت ،او ﺣﺗﻰ ﻟدراﺳﺔ اﻟﻣﺎدة ﻻﻧﮫ
ﯾﺣﺗوي ﻋﻠﻰ ﻛم ﻣﺣﺗرم ﻣن اﻟﻣﻌﻠوﻣﺎت اﻟﻣﺗﻧﺎﺳﻘﺔ واﻟﻣرﺗﺑﺔ اﻟﺗﻲ ﺗﺳﺎﻋد ﻓﻲ ﺑﻧﺎء ﻓﻛرة ﻣﺗراﺑطﺔ ﻋن اﻟﻣوﺿوع أو
اﻟﻣواﺿﯾﻊ اﻟﺗﻲ ﯾﺗﻧﺎوﻟﮭﺎ اﻟﺳؤال.
.3ھذه اﻟطرﯾﻘﺔ ﺗﻌﺗﺑر راﺋدة ﺣﺎﻟﯾﺎ ﻓﻲ أﻏﻠب دول اﻟﻌﺎﻟم ،وھﻲ ﻣن اﻓﺿل اﻟﺳﺑل ﻟﻠﺗﺣﺿﯾﯾر ﻟﻼﻣﺗﺣﺎﻧﺎت اﻟزﻣﺎﻟﺔ اﻟﻌﺎﻟﻣﯾﺔ
ﻣﺛل ) ،(USMLE, PLAB, etcﻧﺳﺄل ﷲ أن ﯾوﻓﻘﻧﻲ ﻓﻲ إﺳﺗﻛﻣﺎل ھذه اﻟﻣﮭﻣﺔ ﻟﻠﻧﮭﺎﯾﺔ.
ﻛﻣﺎ أﻋﻠم وﯾﻌﻠم اﻟﺟﻣﯾﻊ اﻧﮫ ﻗد ﯾطرأ ﺑﻌض اﻟﺟدل ﺣول اﺧﺗﯾﺎري ﻟﻼﺟﺎﺑﺎت او ﺗﺣﻠﯾﻠﻲ ﻟﮭﺎ ،وﻣﻊ ذﻟك ﻟﻘد أرﺗﺄﯾت ﻓﻲ ﻧﻔﺳﻲ
اﻟﻛﻔﺎءة واﻟﺷﺟﺎﻋﺔ اﻟﻛﺎﻓﯾﺔ ﻟﻼﻗدام ﻋﻠﻰ ھذه اﻟﺧطوة ھﺎدﻓﺎ ﻟﻧﺷر ھذه اﻟﻔﺎﺋدة اﻟﻛﺑﯾرة واﻟﺗﻲ ﻟم ﺗﺗوﻓر ﺳﺎﺑﻘﺎ ﻓﻲ ﺑﻼدﻧﺎ ،ﺳﺎﺋﻼ
ﷲ ﺗﻌﺎﻟﻰ أن ﯾﻠﮭﻣﻧﻲ اﻟﺻواب واﻟﺗوﻓﯾﻖ .ﻋﻠﻣﺎ ﺑﺎﻧﻲ أﺳﺗدل ﻓﻲ اﻻﺟﺎﺑﺎت واﻟﺗﺣﻠﯾل ﺑﺄﻛﺑر واﺣدث اﻟﻣﺻﺎدر اﻟﻣﻌﺗﻣدة وﺧﺎﺻﺔ:
)(Bailey & love's, SCHWARTZ'S PRINCIPLES OF SURGER
ﻓﻲ اﻟﺧﺗﺎم ﯾﺳﻌدﻧﻲ ان ﯾﺗواﺻل ﻣﻌﻲ اي ﺷﺧص ﯾﺣﻣل وﺟﮭﺔ ﻧظر ﻣﺧﺗﻠﻔﺔ ﻣؤﯾدة ﺑﻣﺻدر ﻣوﺛوق ﻟﻛﻲ ﺗﻌم اﻟﻔﺎﺋدة ﻟﻠﺟﻣﯾﻊ.
"إن أﺻﺑت ﻓذﻟك ﻣن ﻓﺿل ﷲ ،وإن أﺧطﺄت ﻓﻣن ﻧﻔﺳﻲ"
Questions + answers + explanations Shalof 2019
, Shalof Q-bank breast.
A. Breast cancer
1) 50 years old lady presented with painless mass at upper right quadrant of the breast for the last
six months. She had only one child 15 years old. On examination the mass was ill defined, firm
and irregular surfaces with no history of trauma. What is the most likely diagnosis?
A. Fibroadenoma
B. Fibroadenosis
C. Antibioma
D. Fatty necrosis
E. Breast cancer
Answer: E
Explanation: the above findings are typical for breast cancer manifestations:
There is risk factors of cancer: (the age "50", late first pregnancy)
The lump (recent history "6months"+ painless with irregular surface ,and ill defined borders), it
is important to know that malignant lump can be firm in the early stages then it often become
hard in consistency.
Fibroadenoma presents with lump that is: small, firm, with smooth surface & well defined borders.
Antibioma: is a lump that forms when breast abscess is treated only with antibiotic (not by drainage
which is the recommended treatment of most abscess)
Fatty necrosis presents with a hard lump after blunt trauma to the breast. However, there is no
history of trauma in the above case.
Fibroadenosis is the other name of ANDI, which often presents with mastalgia & nodularity "lumpy
area , not adiscrete lump" in the reproductive age"20-40. However, the above patient is old & there
is no pain & the lump is discrete.
Questions + answers + explanations Shalof 2019
, Shalof Q-bank breast.
2) All of the following to establish the diagnosis, EXCEPT:
A. True-cut needle biopsy
B. Mammography
C. Ultrasound of the breast
D. Female hormonal assessment
Answer: D
Explanation: hormonal level assessment is not needed to assess suspicious breast cancer lump.
Any lump should be assessed by triple assessment:
1-clincal (history and examination)
2- Imaging (breast ultrasound & or mammography), it is important to know that mammography is not
beneficial for patients below the age of 35 because there breast is dense which prevents the penetration
of the x-ray; thus, the details of the breast cannot be clearly seen. However, above the age of 35
mammography is superior to ultrasound because it can show the (microcalcificaitons , speculated mass,
distortion of parynchyma) which are specific signs of malignant lump.
3-cyto-histopathology (FNAC, true cut biopsy "cor-needle", incisional biopsy or exisional biopsy):
We often start by FNAC: this is lump aspiration by fine needle under ultrasound guide, then the
aspirated cells are examined under microscope for assessment for any signs of neoplasia. It is
important to know that FNAC can show cell but not tissues, so it cannot give information about
invasion to the blood vessels, lymphatics or tissues surrounding the lump (those information are
needed for the definitive diagnosis & assessment of cancer)
True cut biopsy "core-needle biopsy": is large needle that can take tissue specimen, so it can show
invasion. This type of biopsy is the biopsy of choice for malignant lump because it can show
invasion and it is less invasive that incisional or excisional biopsies. However, if true cut biopsy is
not conclusive then we may need to do incisional or excisional biopsies. Note: most of doctors in
Libya prefer exisional over incisional biopsy when the core-needle is not conclusive or not
available.
Questions + answers + explanations Shalof 2019
, Shalof Q-bank breast.
3) A 50-year-old Libyan, a mother of six living children, presented to the surgical OPD with two
months history of painless lump at the upper outer quadrant of her left breast with no nipple
discharge. Her menarche was at the age of 13 years and had her first child at the age of 20 years
and L.M.P was five years ago. Two of her sisters have a history of breast cancer. In the above
patient, which of the following in the history has the highest risk for breast cancer?
A. Family history
B. Her age of menarche
C. Age when she had her first child
D. Age of menopause
E. All the above
Answer: A
Explanation: first degree of family history is considered as one of the highest risk factors for risk cancer
(in the above case the patient has not one but two of her sister had breast cancer. it is also important
know the age of breast cancer onset for both sisters because if they got cancer in young age, then the
possibility of hereditary breast cancer as breast cancer syndrome or genetic mutation may be present in
the family ( eg: BRCA-I, BRCA-II, Li furmani syndrome, etc.). In cases of suspicions hereditary breast
cancer it is necessary to do genetic testing & frequent screening for the other family members to
measure the risk & detect cancer in early stages if the individual has any mutated gene.
Questions + answers + explanations Shalof 2019
﷽
"و َﻣﺎ أُوﺗِﯾﺗُم ِ ّﻣ َن ا ْﻟ ِﻌ ْﻠ ِم ِإ ﱠﻻ ﻗَ ِﻠﯾﻼ"
ﺑﺳم ﷲ اﻓﺗﺗﺢ ھذا اﻟﻌﻣل اﻟﺟدﯾد واﻟذي اﺳﻣﯾﺗﮫ shalof-Qbankواﻟذي ﯾﻌﺗﺑر ﺑﻧك ﻷﺳﺋﻠﺔ اﻟﺟراﺣﺔ ﻣﻊ اﻻﺟﺎﺑﺎت واﻟﺗﻔﺳﯾر.
اھم اﻟﻣﻌﻠوﻣﺎت اﻟﻣﻔﯾدة ﻗﺑل اﻟﺑدء ﻓﻲ ﻣذاﻛرة ھذا اﻟﺑﻧك:
.1اﻟﺑﻧك ﯾﻌﺗﺑر ﻣﻔﯾد ﺑﺎﻟدرﺟﺔ اﻻوﻟﻰ ﻟطﻠﺑﺔ اﻟﺟراﺣﺔ ﺳﻧﺔ ﺧﺎﻣﺳﺔ ﻻﻧﮫ ﯾﺿم اﺳﺋﻠﺔ ﺳﻧوات ﻻﺧر 12دور ﻣن اﻣﺗﺣﺎﻧﺎت
ﺟراﺣﺔ ﺳﺎﺑﻘﺔ ﻟزﻣﻼﺋﮭم.
.2اﻟﺑﻧك ﻻﯾﻌﺗﺑر ﻓﻘط ﻣﺟرد ﺗﻘﯾﯾم ﻟدراﺳﺗك ﻟﻠﻣﺎدة ،ﺑل أﯾﺿﺎ وﺳﯾﻠﺔ ﺗﺛﺑﯾت ﻟﻠﻣﻌﻠوﻣﺎت ،او ﺣﺗﻰ ﻟدراﺳﺔ اﻟﻣﺎدة ﻻﻧﮫ
ﯾﺣﺗوي ﻋﻠﻰ ﻛم ﻣﺣﺗرم ﻣن اﻟﻣﻌﻠوﻣﺎت اﻟﻣﺗﻧﺎﺳﻘﺔ واﻟﻣرﺗﺑﺔ اﻟﺗﻲ ﺗﺳﺎﻋد ﻓﻲ ﺑﻧﺎء ﻓﻛرة ﻣﺗراﺑطﺔ ﻋن اﻟﻣوﺿوع أو
اﻟﻣواﺿﯾﻊ اﻟﺗﻲ ﯾﺗﻧﺎوﻟﮭﺎ اﻟﺳؤال.
.3ھذه اﻟطرﯾﻘﺔ ﺗﻌﺗﺑر راﺋدة ﺣﺎﻟﯾﺎ ﻓﻲ أﻏﻠب دول اﻟﻌﺎﻟم ،وھﻲ ﻣن اﻓﺿل اﻟﺳﺑل ﻟﻠﺗﺣﺿﯾﯾر ﻟﻼﻣﺗﺣﺎﻧﺎت اﻟزﻣﺎﻟﺔ اﻟﻌﺎﻟﻣﯾﺔ
ﻣﺛل ) ،(USMLE, PLAB, etcﻧﺳﺄل ﷲ أن ﯾوﻓﻘﻧﻲ ﻓﻲ إﺳﺗﻛﻣﺎل ھذه اﻟﻣﮭﻣﺔ ﻟﻠﻧﮭﺎﯾﺔ.
ﻛﻣﺎ أﻋﻠم وﯾﻌﻠم اﻟﺟﻣﯾﻊ اﻧﮫ ﻗد ﯾطرأ ﺑﻌض اﻟﺟدل ﺣول اﺧﺗﯾﺎري ﻟﻼﺟﺎﺑﺎت او ﺗﺣﻠﯾﻠﻲ ﻟﮭﺎ ،وﻣﻊ ذﻟك ﻟﻘد أرﺗﺄﯾت ﻓﻲ ﻧﻔﺳﻲ
اﻟﻛﻔﺎءة واﻟﺷﺟﺎﻋﺔ اﻟﻛﺎﻓﯾﺔ ﻟﻼﻗدام ﻋﻠﻰ ھذه اﻟﺧطوة ھﺎدﻓﺎ ﻟﻧﺷر ھذه اﻟﻔﺎﺋدة اﻟﻛﺑﯾرة واﻟﺗﻲ ﻟم ﺗﺗوﻓر ﺳﺎﺑﻘﺎ ﻓﻲ ﺑﻼدﻧﺎ ،ﺳﺎﺋﻼ
ﷲ ﺗﻌﺎﻟﻰ أن ﯾﻠﮭﻣﻧﻲ اﻟﺻواب واﻟﺗوﻓﯾﻖ .ﻋﻠﻣﺎ ﺑﺎﻧﻲ أﺳﺗدل ﻓﻲ اﻻﺟﺎﺑﺎت واﻟﺗﺣﻠﯾل ﺑﺄﻛﺑر واﺣدث اﻟﻣﺻﺎدر اﻟﻣﻌﺗﻣدة وﺧﺎﺻﺔ:
)(Bailey & love's, SCHWARTZ'S PRINCIPLES OF SURGER
ﻓﻲ اﻟﺧﺗﺎم ﯾﺳﻌدﻧﻲ ان ﯾﺗواﺻل ﻣﻌﻲ اي ﺷﺧص ﯾﺣﻣل وﺟﮭﺔ ﻧظر ﻣﺧﺗﻠﻔﺔ ﻣؤﯾدة ﺑﻣﺻدر ﻣوﺛوق ﻟﻛﻲ ﺗﻌم اﻟﻔﺎﺋدة ﻟﻠﺟﻣﯾﻊ.
"إن أﺻﺑت ﻓذﻟك ﻣن ﻓﺿل ﷲ ،وإن أﺧطﺄت ﻓﻣن ﻧﻔﺳﻲ"
Questions + answers + explanations Shalof 2019
, Shalof Q-bank breast.
A. Breast cancer
1) 50 years old lady presented with painless mass at upper right quadrant of the breast for the last
six months. She had only one child 15 years old. On examination the mass was ill defined, firm
and irregular surfaces with no history of trauma. What is the most likely diagnosis?
A. Fibroadenoma
B. Fibroadenosis
C. Antibioma
D. Fatty necrosis
E. Breast cancer
Answer: E
Explanation: the above findings are typical for breast cancer manifestations:
There is risk factors of cancer: (the age "50", late first pregnancy)
The lump (recent history "6months"+ painless with irregular surface ,and ill defined borders), it
is important to know that malignant lump can be firm in the early stages then it often become
hard in consistency.
Fibroadenoma presents with lump that is: small, firm, with smooth surface & well defined borders.
Antibioma: is a lump that forms when breast abscess is treated only with antibiotic (not by drainage
which is the recommended treatment of most abscess)
Fatty necrosis presents with a hard lump after blunt trauma to the breast. However, there is no
history of trauma in the above case.
Fibroadenosis is the other name of ANDI, which often presents with mastalgia & nodularity "lumpy
area , not adiscrete lump" in the reproductive age"20-40. However, the above patient is old & there
is no pain & the lump is discrete.
Questions + answers + explanations Shalof 2019
, Shalof Q-bank breast.
2) All of the following to establish the diagnosis, EXCEPT:
A. True-cut needle biopsy
B. Mammography
C. Ultrasound of the breast
D. Female hormonal assessment
Answer: D
Explanation: hormonal level assessment is not needed to assess suspicious breast cancer lump.
Any lump should be assessed by triple assessment:
1-clincal (history and examination)
2- Imaging (breast ultrasound & or mammography), it is important to know that mammography is not
beneficial for patients below the age of 35 because there breast is dense which prevents the penetration
of the x-ray; thus, the details of the breast cannot be clearly seen. However, above the age of 35
mammography is superior to ultrasound because it can show the (microcalcificaitons , speculated mass,
distortion of parynchyma) which are specific signs of malignant lump.
3-cyto-histopathology (FNAC, true cut biopsy "cor-needle", incisional biopsy or exisional biopsy):
We often start by FNAC: this is lump aspiration by fine needle under ultrasound guide, then the
aspirated cells are examined under microscope for assessment for any signs of neoplasia. It is
important to know that FNAC can show cell but not tissues, so it cannot give information about
invasion to the blood vessels, lymphatics or tissues surrounding the lump (those information are
needed for the definitive diagnosis & assessment of cancer)
True cut biopsy "core-needle biopsy": is large needle that can take tissue specimen, so it can show
invasion. This type of biopsy is the biopsy of choice for malignant lump because it can show
invasion and it is less invasive that incisional or excisional biopsies. However, if true cut biopsy is
not conclusive then we may need to do incisional or excisional biopsies. Note: most of doctors in
Libya prefer exisional over incisional biopsy when the core-needle is not conclusive or not
available.
Questions + answers + explanations Shalof 2019
, Shalof Q-bank breast.
3) A 50-year-old Libyan, a mother of six living children, presented to the surgical OPD with two
months history of painless lump at the upper outer quadrant of her left breast with no nipple
discharge. Her menarche was at the age of 13 years and had her first child at the age of 20 years
and L.M.P was five years ago. Two of her sisters have a history of breast cancer. In the above
patient, which of the following in the history has the highest risk for breast cancer?
A. Family history
B. Her age of menarche
C. Age when she had her first child
D. Age of menopause
E. All the above
Answer: A
Explanation: first degree of family history is considered as one of the highest risk factors for risk cancer
(in the above case the patient has not one but two of her sister had breast cancer. it is also important
know the age of breast cancer onset for both sisters because if they got cancer in young age, then the
possibility of hereditary breast cancer as breast cancer syndrome or genetic mutation may be present in
the family ( eg: BRCA-I, BRCA-II, Li furmani syndrome, etc.). In cases of suspicions hereditary breast
cancer it is necessary to do genetic testing & frequent screening for the other family members to
measure the risk & detect cancer in early stages if the individual has any mutated gene.
Questions + answers + explanations Shalof 2019
