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.Year 3 > Breast > Flashcards

Breast Flashcards

1
Q

Breast hx associated sx

A

Relationship to LMP + sx
Pain
Nipple
- discharge: amount, colour, consistency
- bleeding
- inversion
Skin changes
FLAWS
Back pain/ breathlessness
Any other lumps/gland swelling

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2
Q

Breast hx RFs

A

FHx of breast/ovarian cancer
PMHx of breast disease/malignancy
DHx; OCP, HRT
Age of menarche + menopause; date of LMP
Previous pregnancies; number, age of 1st one, breastfeeding

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3
Q

What to assess when examining a breast lump?

A

S he C uts T he F ish

S => site, size, skin, single
C => colour, contour, consistency, compressibility
T => tenderness, temperature, transilluminable
F => fluctuance, fixity (tethering), free to move

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4
Q

Fibroadenoma summary card

A

Benign neoplasm of a lobule from stroma and globular epithelium
= single, well demarcated, firm consistency, smooth, often painless, mobile lump
= breast ‘mouse’ of young women of child-bearing age
= USS/mammography
= observe, surgical excision lumpectomy or cryoblation if needed

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5
Q

Breast cysts summary card

A

Fluid filled sacs in breast
= simple/multiple, unilateral/bilateral, well demarcated, clear nipple discharge sometimes, painless mainly, transilluminable, fluctuant, mobile
= occurs in peri-menopausal women (40-50s)
= USS/mammography + FNA
= observe, FNA to drain fluid if needed

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6
Q

Duct ectasia summary card

A

Dilation of milk ducts due to blockage/non-lactational mastitis
= sub-areolar mass, nipple inversion, form consistency, thick and yellow/green nipple discharge, tender, fixed
= occurs in smokers, peri-post menopausal women
= USS/mammography
= Reassure and discharge, surgical incision if needed

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7
Q

Fat necrosis summary card

A

Occurs at any age secondary to traume
= painful, irregular hard lump with overlying bruising/redness of skin

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8
Q

Intraductal papilloma summary card

A

Benign neoplasm growing within ducts of breast
= small subareolar mass with bloody/clear nipple discharge
= peri/post menopausal women

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9
Q

Mastitis summary card

A

Inflammation of breast due to milk-stasis/overproduction
= generalised swelling of skin, inflamed skin, cracked nipple, redness and firm, very tender and uncomfortable to touch, flu-like sx
= Staphylococcus aureus most common pathogen
= Mx: encourage breast-feeding, analgesia, Abx if required

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10
Q

What can mastitis lead to?

A

Abscess
= Ix + mx: surgical incision and drainage, FBC, blood cultures, US guided FNA, IV/oral Abx
= complications: mammary fistula, rarely overlying skin may undergo necrosis

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11
Q

Sx + signs of breast cancer

A

S
= increased size, lump, skin changes (dimpling, discharge, peu d’orange)
C
= hard lumps, irregular, redness, non-compressible
T
= generally painless, inflammatory breast
F
= tethered to underlying tissue, not free to move

Mets
= bone pain, breathlessness, neuro sx (rare)

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12
Q

Ix for breast cancer

A

*Triple assessment
1. clinical examination
2. imaging (<35: USS, >35 mammogram)
3. tissue diagnosis (FNA, core biopsy)

Bloods
- ESR, bone profile, LFTs, Ca2+, U&Es, FBC

Staging
- CXR, liver USS, CT brain/chest, bone scan
- mets to liver, bone, lungs common

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13
Q

Types of breast cancer

A

Non-invasive
- ductal carcinoma in situ

Invasive
- infiltrative ductal carcinoma (most common)
- infiltrative lobular carcinoma
- Paget’s disease of the breast

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14
Q

Mx of breast cancer

A

Radiotherapy
- reduce recurrence post-surgery

Monoclonal antibodies

Chemo
- neo-adjuvant/adjuvant

Meds
- ER antagonists (tamoxifen)
- aromatase inhibitors (letrozole)

Surgery
- total masectomy
- lumpectomy
- sentinel LN biopsy/axillary LN clearance

*treatment based on type, staging and grade of tumour

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15
Q

Neck lump ddx

A

Infection
- lymphadenopathy, fever, fatigue
= glandular fever, HIV
Malignancy
- lymphadenopathy, FLAWS, growing lump
= thyroid cancer, salivary gland cancer
Endocrine
- goitre
= hyper/hypothyroidism
Derm
= sebaceous cyst; blocked hair follicle
= lipoma; benign tumour of fat tissue
Vascular
= carotid body aneurysm
Congenital/developmental
= bronchial cyst
= thyroglossal cyst; persistent duct-embryonic structure

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16
Q

Midline lump ddx

A

Moves on tongue protrusion
= thyroglossal cyst
Moves on swallowing
= thyroid gland
Superficial
= lipoma, epidermal cyst, dermoid cyst, abcess
Deep
= thyroid

17
Q

Anatomy of anterior and posterior neck triangles

A

Anterior
= SCM, midline of neck, mandible

Posterior
= SCM, trapezius, clavicle

18
Q

A 36-year-old woman presents to the urgent care centre with a small
tender mass under her left nipple. The area is tender to touch and she’d
noticed a small amount of yellow-green discharge from the nipple. She
mentions to you that she’s smoked since her early 20s.

What is the most likely diagnosis?

A – Breast cyst
B – Lobular carcinoma
C – Non-lactational mastitis
D – Duct ectasia
E – Breast abscess

A

D – Duct ectasia

19
Q

A 22-year-old woman presents to the GP with a lump in her right breast.
She found the lump incidentally and has not experienced any symptoms.
On examination, the lump is located in the upper outer quadrant and is 2cm.
It feels firm, smooth and well demarcated and is mobile.

What is the most likely diagnosis?

A – Phyllodes tumour
B – Fibroadenoma
C – Breast cyst
D – Ductal carcinoma in situ
E – Mastitis

A

B – Fibroadenoma

20
Q

A 32-year-old woman comes to the GP complaining of a painful left
breast. She gave birth a few weeks ago and has been breast-feeding every
few hours. On examination, the breast is tender, there is marked erythema
and her nipple is cracked. You do not suspect there are any abscesses
present.

Given the likely diagnosis, which of the following is NOT a recommended
treatment option?

A – Stopping breast feeding
B – Antibiotics if symptoms are severe
C – Analgesia
D – Anti-fungals if nipple candidiasis suspected
E – FNA to rule out an abscess

A

A – Stopping breast feeding

21
Q

A 55-year-old is referred for an urgent mammogram after noticing a lump
in her right breast.

Which of these is NOT a recognised risk factor for breast cancer?

A – Increased age
B – Use of the combined oral contraceptive pill
C – Obesity
D – Having more than 1 child
E – Family history of ovarian cancer

A

D – Having more than 1 child

22
Q

A 60-year-old woman presents to the GP after noticing some changes in
her right nipple. On examination, the nipple is erythematous and crusty with
some apparent scaliness of the skin.

What is the most likely diagnosis?

A – Eczema
B – Paget’s disease of the breast
C – Intraductal papilloma
D – Ductal carcinoma
E – Phyllodes tumour

A

B – Paget’s disease of the breast

23
Q

A 56-year-old lady presents to the GP with a lump on her neck. She doesn’t
report any other symptoms, apart from being a bit more anxious and tired
than usual, and some infrequent diarrhoea. On examination, the lump is
2x3 cm and appears to be in the mid-line of the neck. The lump does not
move when the patient sticks out her tongue however does move when she
swallows.

What is the most likely diagnosis?

A – Thyroglossal cyst
B – Goitre
C – Thyroid nodule
D – Lipoma
E – Dermoid cyst

A

C – Thyroid nodule

24
Q

A 60 year old obese woman presents to her GP with a
lesion on her breast. The lesion is red, crusted, around her
right nipple. The most likely diagnosis is

A. Breast cyst
B. Breast abscess
C. Paget’s disease of the breast
D. Fibroadenoma
E. Fibrocystic disease

A

C. Paget’s disease of the breast

25
Q

22 year old woman presents to clinic with a single lump in
her right breast. Examination reveals a mobile, firm, smooth
and non-tender lump of 2cm in the lower outer quadrant that
is not attached to the overlying skin. No axillary lymph nodes
are palpable. The most likely diagnosis is:

A. Acute mastits
B. Breast abscess
C. Breast cyst
D. Fibroadenoma
E. Periductal mastitis

A

D. Fibroadenoma

26
Q

A 21 year old woman presents to her GP with pain in her
right breast. She has just given birth to her first child. On
examination, right breast appears swollen, red and there is
tenderness on palpation. You do not suspect there are any
abscesses present. The most appropriate management
plan would be:

A. Antibiotics
B. Refer to surgeon for incision and drainage
C. Refer to breast feeding support group and prescribe
analgesia
D. Watch and wait
E. Confirm diagnosis with USS

A

C. Refer to breast feeding support group and prescribe
analgesia

27
Q

Risk factors for developing breast cancer include:

A. Having only one child
B. Early menarche
C. Early menopause
D. Anaemia
E. HIV/AIDS

A

B. Early menarche

28
Q

A 56 year old woman presents to her GP after noticing a
breast lump 3 weeks ago. On examination, the lump is 3 cm
in diameter, firm and tethered to the skin and immobile.
There are no overlying skin changes. The next most
appropriate investigation is:

A. Total mastectomy
B. Urgent mammogram
C. Urgent USS
D. FNAC
E. Core biopsy

A

B. Urgent mammogram

29
Q

A 22 year old medical student presents to her GP
complaining of ‘lumpiness’ in her breasts and nipple
discharge for 2 weeks. She is concerned as her mother,
who had breast cancer, had the same symptoms before she was diagnosed. What is the next most appropriate
investigation?

A. Refer for urgent mammogram
B. Refer for urgent USS
C. Blood hCG levels
D. Reassure and discharge
E. CT Head

A

C. Blood hCG levels

30
Q

BRCA gene mutations are associated with breast and
which other type of cancer?

A. Biliary
B. Uterine
C. Gastric
D. Ovarian
E. Colon

A

D. Ovarian

31
Q

A 30 year old female presents with a bruise on her
breast. O/E The underlying tissue is tender and lumpy.
When asked about trauma, she says she was injured whilst
playing a rugby match. What is the most likely diagnosis?

A. Fibroadenoma
B. Fat necrosis
C. Paget’s disease of the breast
D. Mastitis
E. Duct ectasia

A

B. Fat necrosis

32
Q

Which of the following statements regarding breast
disease is FALSE?

A. Orange peel skin may be a sign of inflammatory breast
cancer
B. Ulcerated breast lumps are generally not concerning
C. Alcohol intake is a modifiable risk factor for breast cancer
D. Women ages 50-70 are offered routine screening every
3 years
E. USS are more suitable for women aged <35 years

A

B. Ulcerated breast lumps are generally not concerning

.Year 3 (32 decks)

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