Breast disease

Question 1

what is the triple assessment

Answer 1

clinical exam
mammogram/US
core needle biopsy

Question 2

what do you see on mammogram in DCIS

Answer 2

micro-calcifications

Question 3

staging method for breast cancer

Answer 3

TMN
Tumour (T0-T4 based on size)
Nodes (N0-N3 depending on how many and which lymph nodes it had migrated to)
Metastasis (M0-M1)

Question 4

what requires an urgent referral to breast clinic

Answer 4

> 30 unexplained breast mass
50 nipple discharge, skin changes

Question 5

what requires a non-urgent referral to breast clinic

Answer 5

<30 unexplained breast mass

Question 6

Drug for ER+ pre menopausal

Answer 6

Tamoxifen

Question 7

Drug for ER+ post-menopausal

Answer 7

Anastrazole

Question 8

Drug for HER+ and main side effect

Answer 8

Trastuzumab, cardiotoxicity

Question 9

presentation of fibroadenoma

Answer 9

firm, non-tender, highly mobile

Question 10

what is fibrocystic disease of the breast?

Answer 10

cyclical pain and lumpiness of breasts bilaterally, associated with menstrual cycle

Question 11

management of fibrocystic disease

Answer 11

supportive
soft bra, avoid caffeine

Question 12

presentation of Phyllodes tumour

Answer 12

smooth, hard lump, grows rapidly

Question 13

differentiating between phyllodes tumour and fibroadenoma

Answer 13

FA doesn’t grow as rapidly, FA occurs in younger women

Question 14

presentation of Paget’s disease

Answer 14

eczema around nipple area
bloody/straw discharge
burning
inverted nipple

Question 15

presentation of mastitis

Answer 15

unilateral inflammation of breast
painful + tender
associated with fever, myalgia, rigors

Question 16

what is fat necrosis

Answer 16

happens secondary to trauma to the breast
lump w overlying bruising/inflammation

Question 17

what is a complication of puerperal mastitis that causes symptoms of mastitis and erythema?

Answer 17

lactational breast abscess
accumulation of pus
caused by staph aureus

Question 18

when is mammogram used instead of ultrasound

Answer 18

mammogram for age >35

Question 19

common side effect of tamoxifen

Answer 19

hot flushes
changes in ,menstrual pattern

Question 20

lateral part of the breast drains to..

Answer 20

axillary lymph nodes

Question 21

medial part of the breast drains to…

Answer 21

internal thoracic/parasternal lymph nodes

Question 22

what actually is pages disease

Answer 22

DCIS coming out of the nipple
it is neoplastic

Question 23

differentiating mastitis and breast abscess

Answer 23

breast abscess may have a lump (tense, or fluctuant)

Question 24

side effect of anastrazole

Answer 24

osteoporosis, myalgia and arthralgia

Question 25

MOA of anastrazole

Answer 25

inhibits peripheral oestrogen synthesis

Question 26

MOA of tamoxifen

Answer 26

complete oestrogen receptor antagonism

Question 27

why can’t post menopausal women take tamoxifen

Answer 27

increased risk of endometrial bleeding and endometrial hyperplasia in post menopausal women

so aromatase inhibitors used instead

Question 28

blood stained discharge coming from the nipple

Answer 28

duct papilloma

Question 29

eczema around the nipple

Answer 29

pages disease of breast

Question 30

difference in skin changes in Paget’s disease compared to nipple eczema

Answer 30

both start around the nipple
Pagets will spread to other areas of the breast as well

Question 31

when to do WLE vs masctectomy

Answer 31

if tumour is <4cm do WLE

Question 32

1st line course of Abx for mastitis

Answer 32

10 days flucox

Question 33

what is duct ectasia and Mx?

Answer 33

dilatation and shortening of the terminal breast ducts
Px: creamy white discharge
Mx: reassurance or microdochectomy if its bothering them

Question 34

periductal mastitis cause, Px, risk factors and Mx

Answer 34

ducts under the nipple become infected
pain, periareolar mass, discharge

Risk factors: young woman, smoker,
Mx: Abx