Breast

Question 1

what is the most common benign neoplasm of the breast

Answer 1

fibroadenoma

Question 2

when are fibroadenomas most common

Answer 2

early reproductive years of a womans life

Question 3

what are the typical features of a papilloma

Answer 3

can occur within a cyst and is often associated with bloody cyst fluid

Question 4

what is the most common aetiology of spontatneous nipple discharge

Answer 4

intraductal papilloma or papillomas

Question 5

what is pagets disease a variant of

Answer 5

ductal carcinoma

Question 6

how can pagets disease present

Answer 6

as an erythematous weeping lesion on the surface of the nipple and areola, although it usually presents as a dry, scaly erythematous lesion

Question 7

should breastfeeding be continued if the mother has mastitis

Answer 7

yes

Question 8

how is mastitis treated

Answer 8

flucloxacillin or augmentin

Question 9

how often should the patient be examined if they have mastitis

Answer 9

every 3 days to be certain the infection is responding to treatment and there is no evidence of abscess formation

Question 10

why is being overweight a risk factor for breast cancer

Answer 10

it causes more oestrogen to be produced

Question 11

where does carcinoma of the breast arise from `

Answer 11

the lining epithelium of the duct system

Question 12

which cells is testosterone produced in

Answer 12

Leydig cells

Question 13

How is NPI calculated

Answer 13

tumour size (x 0.2) + lymph node score + grade score

Question 14

how are lymph nodes scored

Answer 14

0 involved=1
1-3 lymph nodes=2
3 or more=3

Question 15

do you give radiotherapy for DCIS

Answer 15

yes after the area has been surgically removed

Question 16

when do you give a boost to the tumour bed

Answer 16

if women under 54 on day of surgery

posterior margins <1mm for invasive disease after full thickness excision

Question 17

when do you give chest wall radiotherapy

Answer 17

tumour ize >5cm
4 or more involved nodes
involved resected margins
t4 disease

Question 18

when do you give radiotherapy to ipsilateral axilla

Answer 18

> 1 positive macrometastases sentinel node

extensive ECS post clearance

Question 19

when do you give radio to supraclavicular fossa

Answer 19

> 4 involved nodes

Question 20

describe the secretory tissue of the breast

Answer 20

15-25 lobes each consisting of a compound tubule-acinar gland which drains via a series of ducts leading to the nipple

Question 21

what is adjacent to secretory lobules

Answer 21

dense fibrous tissue which is surrounded by adipose tissue

Question 22

what is the basic functional secretory unit

Answer 22

terminal duct lobular unit

Question 23

describe the histology of the nipple

Answer 23

thin, highly pigmented keratinized stratified squamous epithelium with a dense core of irregular connective tissue

Question 24

how does the breast change during menstrual cycle

Answer 24

epithelial cells increase in height
lumina of ducts become enlarged
small amount of secretions in the ducts

Question 25

what happens to the breast in pregnancy

Answer 25

1st trimester-elongation and branching of smaller ducts and proliferation of gland epithelial cells and myoepithelial cells
2nd-glandular tissue continues to develop with differentiation of secretory alveoli and plasma and lymphocytes in connective tissue
3rd=secretory alveoli mature and development of extensive rER

Question 26

what type of tissue in the breast becomes sparse in pregnancy

Answer 26

fibro-fatty tissue

Question 27

what makes up human milk

Answer 27

88% water, 1.5 % protein mainly lactoalbumin and casein, 7% carb-mainly lactulose 3.5% lipid, ions and vitamins

Question 28

what Ig is in human milk

Answer 28

IgA

Question 29

how are lipids secreted

Answer 29

apocrine secretion

Question 30

how are proteins secreted

Answer 30

merocrine secretion