BREAST

Question 1

What is the tumour marker for breast cancer?

Answer 1

CA 15-3

Question 2

What is galactorrhoea?

Answer 2

Milk discharge not associated with lactation

Question 3

What is the most common cause of galactorrhoea?

Answer 3

Hyperprolactinaemia

Question 4

What typically causes hyperprolactinaemia?

Answer 4

Pituitary adenoma

Drugs (SSRI, anti-psychotics)

Hypothyroidism (High TRH stimulates prolactin release)

Question 5

What investigations are there for patients with galactorrhoea?

Answer 5

Pregnancy test

Serum prolactin levels

TFT

LFTs

MRI head (if pituitary tumour suspected)

Question 6

What is the treatment of galactorrhoea caused by pituitary tumour?

Answer 6

Dopamine agonist therapy

Question 7

What does mastalgia mean?

Answer 7

Breast pain (cyclical / non-cyclical)

Question 8

What is the breast triple assessment?

Answer 8

History + examination

Imaging (Mammography >35 / Ultrasound <35)

Histology (Core biopsy = full histology / FNA - for cyst)

Question 9

Name some benign breast lumps?

Answer 9

Fibroadenoma

Adenoma

Papilloma

Lipoma

Question 10

How does a fibroadenoma present?

Answer 10

20-40 year old

Highly mobile

Well-define and rubbery

Question 11

What is an indication for excision of a fibroadenoma?

Answer 11

>3cm in diameter

Question 12

What is an adenoma?

Answer 12

Benign glandular tumour in typically older females

Lesions are nodular

Question 13

What is a papilloma?

Answer 13

Lesions occurring in 40-50 year olds in sub areolar area

Bloody / clear nipple discharge

Question 14

What is a lipoma?

Answer 14

Soft and mobile benign adipose tumour

Question 15

What is Gynaecomastia?

Answer 15

Condition in which male breast tissue develops (usually reversible)

Question 16

What are the physiological causes of gynaecomastia?

Answer 16

Delayed puberty

Less testosterone with aging

Question 17

What are pathological causes of gynaecomastia?

Answer 17

Lack of testosterone (e.g. Klinefelter’s)

Renal disease

Medication (e.g. digoxin, metronidazale and spironolactone)

Question 18

What is pseudogynaecomastia?

Answer 18

Adipose tissue in breast associated with being overweight

Question 19

What medication can help alleviate symptoms of gynaecomastia?

Answer 19

Tamoxifen

Question 20

When is non-lactational mastitis seen?

Answer 20

With other conditions e.g. duct ectasia, tobacco smoking is a risk factor

Question 21

How is mastitis managed?

Answer 21

Antibiotic therapy and simple analgesia

Question 22

What is a breast abscess and when is it seen?

Answer 22

Collection of pus lined with granulation tissue most commonly from acute mastitis

Question 23

How does a breast abscess present?

Answer 23

Tender, erythematous masses, pyrexia

Question 24

How is a breast abscess diagnosed?

Answer 24

USS

Question 25

How do breast cysts appear and at what age?

Answer 25

Distinct **smooth mass** **Peri-menopausal** **HALO SHAPE** on mammography

Question 26

What is duct ectasia?

Answer 26

**Dilatation and shortening of major lactiferous ducts** Presents in perimenopausal women

Question 27

How does duct ectasia present?

Answer 27

Green/yellow nipple discharge

Question 28

How can duct ectasia be identifies on mammography?

Answer 28

**Dilated and calcified ducts**

Question 29

What causes fat necrosis of the breast?

Answer 29

Trauma Previous surgery

Question 30

How does fat necrosis of the breast present?

Answer 30

Lump, fluid discharge

Question 31

How is fat necrosis managed?

Answer 31

Pain relief and reassurance

Question 32

What is the most common type of non-invasive breast cancer (pre-malignant condition)?

Answer 32

**Ductal carcinoma in situ** (not lobar)

Question 33

What are the risk factors for invasive ductal carcinoma?

Answer 33

**Female** sex Increasing **age** Mutation to **TSGs** BRAC1 and BRAC2 **FH** (1st degree relative)

Question 34

What are the features of breast cancer?

Answer 34

**Lump** **Asymmetry** Nipple **discharge** Nipple **retraction** **Skin changes**

Question 35

What screening programmes are there for breast cancer?

Answer 35

Women **50-70** have **mammogram every 3 years**

Question 36

How can Paget’s disease be distinguished from Eczema?

Answer 36

**Paget’s always affects the nipple** whereas eczema spares it