Breast

Question 1

Px - breast lump caused by localised trauma

Answer 1

Fat necrosis

Question 2

Px - Tender, red, hot breast lump

Answer 2

Abscess

Question 3

Px - Painless, firm, discrete, mobile breast lump in age <35

Answer 3

Fibroadenoma

Question 4

Px - Painless, hard, irregular, fixed in place breast lump in age >45

Answer 4

Breast carcinoma

Question 5

Px - Ill defined +/- tender +/- changes with menses

Answer 5

Fibrocystic changes

Question 6

What does triple assessment consist of?

Answer 6

Clinical assessment

Imaging
o <40 ultrasound
o >40 Mammography + ultrasound

FNA or core biopsy

Question 7

What is the two-week referral criteria for breast cancer?

Answer 7

Unexplained lump in breast or axilla in patient >30

Unilateral nipple changes in patient >50

Question 8

Mx of lactational mastitis?

Answer 8

1. Conservative – heat packs, warm showers, analgesia + continue breast feeding
2. Antibiotics if no improvement in 12-24hours with breast milking
   - Flucloxacillin
   - Erythromycin/clarithromycin if pen allergic

Question 9

Non-lactational mastitis mx?

Answer 9

Analgesia, mx underlying eczema or fungal infection

Broad spectrum antibiotics – co-amoxiclav, erythromycin + metronidazole

Question 10

Rx of breast cancer?

Answer 10

• Increased oestrogen exposure (early menarche, late menopause, COCP and HRT)
• Denser breast tissue
• Obesity
• Smoker
• Genetics – BRCA1. BRCA2 gene

Question 11

What is offered to a patient if high rx of breast cancer due to family history?

Answer 11

Annual mammography + chemoprevention offered:
- Tamoxifen if pre-menopausal
- Anastrozole if post-menopausal

Question 12

Px of breast cancer?

Answer 12

• Change in breast size / shape
• Palpable mass – single, non-tender, firm mass, poorly defined
• Skin changes – redness, oedema, retractions or dimpling
• Nipple changes – inversion or blood-tinged discharge

Question 13

What are the receptors tested for in breast cancer?

Answer 13

Oestrogen (ER) & progesterone (PR) – immunohistochemical staining

Human epidermal growth factor (HER2) – FISH or immunohistochemical staining

Question 14

Mx of breast cancer?

Answer 14

Surgery +/- axillary lymph node clearance & sentinel lymph node biopsy
1. Wide local excision +/- radiotherapy
2. Mastectomy

Chemo – adjuvant or neo-adjuvant

Specific receptors
o Oestrogen receptor positive:
Pre-menopausal -> Tamoxifen
Post-menopausal -> Aromatase inhibitors (anastrozole)
o HER2 -> Trastuzumab (Herceptin)

Question 15

What is Paget’s disease of the breast?

Answer 15

Px like eczema of nipple (unilateral). Due to high grade DCIS which extend along ducts to epidermis of nipple.

Question 16

What is a phyllodes tumour?

Answer 16

Tumour of connective tissue (stroma) of beast
- Painless, smooth, multinodular, fast-growing
- 50% benign, 25% borderline, 25% malignant

Question 17

What is inflammatory breast cancer?

Answer 17

Px similar to mastitis but doesn’t respond to antibiotics

Question 18

What is duct ectasia?

Answer 18

Dilatation of ducts with inflammation -> white, grey or green discharge

Question 19

Who is at risk of duct ectasia?

Answer 19

Peri-menopausal, smokers

Question 20

Mx of duct ectasia?

Answer 20

Reassurance, antibiotics if infection, excision if problematic

Question 21

What are the hormones involved in lactation?

Answer 21

Dopamine inhibits the secretion of prolactin
Oestrogen & progesterone inhibit secretion of prolactin
Prolactin produces breast milk
Oxytocin stimulates breast milk excretion

Question 22

Causes of galactorrhoea?

Answer 22

Prolactinoma
Endocrine abnormality - hypothyroidism, PCOS
Dopamine antagonist medication
Idiopathic

Question 23

Prolactinoma Px?

Answer 23

Headaches
Bitemporal hemianopia

^Prolactin suppresses GnRH -> decreased LH & FSH which px:
- Menstrual irregularities
- Reduced libido
- Erectile dysfunction
- Gynaecomastia

Question 24

Mx for hyperprolactinaemia?

Answer 24

Dopamine agonists - bromocriptine or cabergoline