breast

Question 1

what does lactational mastitis pre-dispose a woman to

Answer 1

candida infection of the nipple

Question 2

what is puerperal [lactational] mastitis

Answer 2

a condition characterized by the inflammation of the breast tissue, typically presenting in lactating, postpartum women.

Question 3

how is lactational mastitis managed

Answer 3

• analgesia + warm compresses.
• Abx - broad spec given if:
  
  • infected nipple fissure,
  • no improvement of sx after 12-24 hrs of milk removal OR
  • +ve milk culture
• continue pumping of breastfeeding.
• surgical drainage if an abscess forms

Question 4

how is candida of the nipple managed

Answer 4

anti fungal on the nipple + oral treatment for baby e.g. miconazole

Question 5

what does HER2 stand for

Answer 5

Human Epidermal growth factor Receptor 2

Question 6

what drugs could you use in oestrogen +ve breast cancer - class name and who gets what

Answer 6

• aromatase inhibitors in post menopausal women - letrozole or anastrazole
• selective oestrogen receptor modulator - tamoxifen in premenopausal women

Question 7

what is triple negative breast cancer

Answer 7

Triple-negative breast cancer is a subtype of breast cancer that is negative for oestrogen receptor, progesterone receptor, and HER2 expression

Question 8

how is triple negative BC treated

Answer 8

1. neoadjuvant chemotherapy
2. surgery: e.g. lumpectomy, mastectomy axillary node clearance
3. adjuvant therapy: radiotherapy, chemo or both

Question 9

tamoxifen MoA

Answer 9

It blocks oestrogen receptors in the breast tissue and stimulates those in the uterus and bones
∴ prevents osteoporosis BUT ↑ risk of endometrial cancer.

Question 10

should you refer a pt with a fibroadenoma

Answer 10

YES
<30yo: routine referral
>30yo: urgent referral

Question 11

definitive Mx for a breast abscess

Answer 11

• incision and drainage - especially if >3cm and systemic sx.
• Abx

Question 12

MC BC

Answer 12

invasive ductal carcinoma
followed by invasive lobular carcinoma

Question 13

key feature of fibroadenoma

Answer 13

cyclical in nature as they are rich in oestrogen receptors therefore they grow and shrink throughout the menstrual cycle and shrink after menopause

Question 14

key differential for fibroadenoma

Answer 14

phyllodes tumour

• rare stromal tumour
• Large and fast growing
• May ulcerate when advanced
• can be benign, borderline or malignant
• Mx = WLE ± chemo for malignant cases

Question 15

key features of pagets disease of the nipple

Answer 15

• eczema like rash on nipple
• Bloody nipple discharge
• Burning sensation, increased sensitivity, or pain in the nipple
• Changes to the nipple, such as retraction or inversion
• ± palpable breast lump or ulceration.

Question 16

when would you not refer for a triple assessment

Answer 16

• a breast cyst
• a USS or mammogram can be used to visualise the cyst
• the cyst can then be aspirated and the fluid sent for cytology to rule out malignancy.
• this also serves as Mx

Question 17

lymphoedema =

Answer 17

Lymphoedema, characterized by swelling, joint stiffness, arm weakness, and skin changes

Question 18

seroma =

Answer 18

A seroma is an accumulation of fluid under the skin at the site of a surgical incision.

Question 19

what is fibrocystic breast disease

Answer 19

• a common benign condition that affects women predominantly between the ages of 20 to 50.
• It is characterised by bilateral “lumpy” breasts, breast pain and cyclical symptoms that typically peak in the week before menstruation.
• caused by cumulative effects of hormones –> breast tissue changes and cyst formation.

Question 20

who gets a mammogram and who gets a USS and why

Answer 20

• USS in pts <40 yrs as they have denser breasts that mammograms can’t image well
• Mammogram in pts >40 as their breasts are less dense.

Question 21

RFs for BC

Answer 21

• alcohol
• ↑ oestrogen exposure (obesity, early menarche and later menopause)
• female
• BRCA gene mutation [Fam hx 1st degree relative]
• Late pregnancy/nulliparity
• smoking

Question 22

protective factors for BC

Answer 22

multiparity + breast feeding

Question 23

Big RF for mastitis and why

Answer 23

Smoking as substances within tobacco smoke can cause damage to the breast tissue.

Question 24

how does breast carcinoma show up on mammogram

Answer 24

• opaque, high-density mass on a mammogram
• soft tissue opacitiy with or without associated calcification

Question 25

Her mammogram shows a star-shaped pattern of scarring, with a translucent centre in the left breast.

Answer 25

radial scar

• central scarring surrounded by proliferating glandular tissue

Question 26

In women over 40 with a rapidly growing, mobile breast lump, consideration should be given to the possibility of…

Answer 26

a phyllodes tumour.

Question 27

T/F
fat necrosis of the breast –> increased risk of breast cancer

Answer 27

FALSE

Question 28

presentation of invasive ductal carcinoma Vs invasive lobular carcinoma

Answer 28

IDC: presents with a discrete lump. commonly unilateral and unifocal
ILC: presents with a thickened area of breast tissue alongside changes to the nipple or to the skin. commonly bilateral and multifocal

Question 29

Carriers of the BRCA1+/or 2 gene mutation have an increased risk for developing…

Answer 29

breast
ovarian
pancreatic
gastric cancers