Breast: breast conservation: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Surgery · Breast: breast conservation

Sample item

A 40-year-old woman has a 2 cm invasive ductal carcinoma in the upper outer quadrant of the left breast. At 19 years of age she received mantle field radiotherapy for Hodgkin lymphoma. Which surgery is most appropriate?

AQuadrantectomy with a second course of mantle radiotherapyBMastectomy, because breast radiotherapy cannot be repeated safelyCWide local excision followed by whole breast radiotherapyDWide local excision alone without radiotherapy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Mastectomy, because breast radiotherapy cannot be repeated safely

Breast conservation depends on postoperative whole-breast radiotherapy. A previous therapeutic dose to the chest wall or breast is a contraindication to further radiation, because of the cumulative risk to skin, lung and heart. Other contraindications include multicentric disease, diffuse malignant calcification and a large tumour-to-breast ratio.

Option by option

A. Quadrantectomy with a second course of mantle radiotherapy
A repeat mantle-field course would exceed safe tissue tolerance and is not offered.
B. Mastectomy, because breast radiotherapy cannot be repeated safely (correct)
Correct. Prior chest irradiation precludes the radiotherapy that conservation needs, so mastectomy is advised.
C. Wide local excision followed by whole breast radiotherapy
Whole breast radiotherapy would be a second high-dose course to an already irradiated field.
D. Wide local excision alone without radiotherapy
Omitting radiotherapy after conservation substantially increases local recurrence.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Mastectomy, because breast radiotherapy cannot be repeated safely. Breast conservation depends on postoperative whole-breast radiotherapy.

Why is "Quadrantectomy with a second course of mantle radiotherapy" not the answer?

A repeat mantle-field course would exceed safe tissue tolerance and is not offered.

Why is "Wide local excision followed by whole breast radiotherapy" not the answer?

Whole breast radiotherapy would be a second high-dose course to an already irradiated field.

Why is "Wide local excision alone without radiotherapy" not the answer?

Omitting radiotherapy after conservation substantially increases local recurrence.

What concept does this question test?

It tests Breast: breast conservation in General Surgery. A previous therapeutic dose to the chest wall or breast is a contraindication to further radiation, because of the cumulative risk to skin, lung and heart. Other contraindications include multicentric disease, diffuse malignant calcification and a large tumour-to-breast ratio.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Breast: breast conservation?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.