Breast

Question 1

A patient got episodic breast pain after giving birth, months before her pregnancy and a week before her menstruation. What is the diagnosis?

Answer 1

Cyclical mastalgia

Question 2

A patient has a hormone positive breast cancer with no mets, what is the treatment plan?

Answer 2

1. local exicision
   then
2. Whole breast radiotherapy to reduce risk of reaccurance
3. then hormone therapy (as +ve) again to reduce risk

Question 3

If a patient has palpable lymph nodes and ultrasound is positive, what is next step in treatment?

Answer 3

Perform axillary lymph node clearance

Question 4

If they find no lymph node involvement in the ultrasound in breast cancer, what procedure should be done next and why?

Answer 4

• Sentinel lymph node biopsy (SLNB)
• the ultrasound only indicates the presence of mets however it does not detect any abnormal lymph nodes or rule out microscopic metastases.
• The SLNB is to provide an accurate assessment of mets

Question 5

Patient has breast cancer and ultrasound confirms axillary node involvement, what are the 2 options for the patient?

Answer 5

1. surgery to remove the lymph nodes
2. Axillary radiotherapy

Question 6

What are features of a breast abscess?

Answer 6

• fever and a tender, fluctuant mass on the affected breast
• Maybe systemically unwell
• Painful

Question 7

What does a ‘snowstorm’ indicate?

Answer 7

Implant rupture

Question 8

What is a complication of axillary node clearance?

Answer 8

arm lymphedema and functional arm impairment

Question 9

What is a complication of mastitis + treatment?

Answer 9

• Breast abscess
• Incision + drainage

Question 10

What is a side effect of aromatase inhibitors?

Answer 10

osteoprosis

Question 11

What is a side effect of tamoxifen?

Answer 11

venous thromboembolism

Question 12

What is a side effect trastuzumab?

Answer 12

cardiotoxic

Question 13

What is first and second (only 2) treatment of mastitis?

Answer 13

Continue breastfeeding + (analgesia, warm compressions)
If no improvement after 12-24h then oral flucloxacillin for 10-14 days
Most caustive organism Staphylococcus aureus

Question 14

What is the first most appropriate step in management of paget’s disease of the nipple?

Answer 14

Refer for a two week wait breast clinic appointment
cuz 50% of those with padget’s have cancer

Question 15

What is the traid for intraductal papilloma?

Answer 15

• Commoner in younger patients
• May cause blood stained discharge
• There is usually no palpable lump -> a benign tumour of fibrovascular tissue that develops within the lactic ducts therefore can’t feel
• Can be painful and grow

Question 16

What is the traid for mammary duct ectasia?

Answer 16

Dilatation breast ducts.
Most common in menopausal women
Discharge typically thick and green in colour
Most common in smokers

Question 17

What type of breast cancer are Aromatase inhibitors used for and give 2 exmaples?

Answer 17

Oestrogen-sensitive breast cancers in post-menopausal
Letrozole + Anastrozole

Question 18

What type of breast cancer are Receptor modulators used for and give 1 example?

Answer 18

Oestrogen-sensitive breast cancers in pre-menapausal women
Tamoxifen

Question 19

What warrants an urgent referral to breast clinic?

Answer 19

Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral

Question 20

What would warrant a routine referral to breast clinic?

Answer 20

<30 y
unexplained breast lump
with or without pain
NOT URGENT

Question 21

When would you use ultrasound instead of a mammogram to check for breast cancer?

Answer 21

<35 Y use ultrasound due to denser breast tissue

Question 22

When do you remove a fibroadenoma?

Answer 22

> 3 cm