Breast Disease

Question 1

minor factors on history for someone with breast changes?

Answer 1

any children before?
breastfeed
menarche
menopause (natural/artificial)
HRT
past medical of breast disease
radiation therapy (hodkin's lymphoma)
smoking, ETOH
allergies

Question 2

breast lump history type that are worrying?

Answer 2

atypical ductal hyperplasia

Question 3

if mastalgia and varies with menstrual cycle, should we be worried?

Answer 3

less so

Question 4

differential for young woman with breast lump that doesn’t vary with menstrual cycle?

Answer 4

fibroadenoma (usu younger age group)

cyst

Question 5

redness and tenderness/pain around a lump in breast ddx??

Answer 5

inflammatory breast cancer

abcess

Question 6

fibroadenomas and cysts painful?

Answer 6

just on palpation, mild tenderness

Question 7

which nodes to examine in breast exam?

Answer 7

axilla

supraclav

Question 8

quick breast cancer screen to rule out metastatic disease

Answer 8

hepatomegaly
lung
spine punch

Question 9

how to investigate new breast lump in young woman?

Answer 9

U/S both breasts

Question 10

38 year old 3/12 hx, breast tenderness that varies with menstrual cycle ddx? inv?

Answer 10

fibrocystic change (30s-40s pre-menopausal)

mammogram
U/S

Question 11

breast pain rx?

Answer 11

not caffeine
vitamin B6
can try evening primrose oil

tamoxifen/androgens but has side effects

Question 12

U/S for breast screening?

Answer 12

Nope, better for lumps

screen with mammogram

Question 13

send off the breast cystic fluid?

Answer 13

yes if there’s blood
otherwise discard
could have any colour

Question 14

nipple discharge questions?

Answer 14

blood?
pus?
milk?
clear/yellow
any masses?

spontaneous or express-able (which duct)

Question 15

investigations for nipple discharge

Answer 15

mammogram

U/S focused retro-areola

Question 16

if bloody discharge from nipple, why investigate so fiercely?

Answer 16

1. papilloma (growth inside duct)
2. cancer
3. duct ectasia (dilation of ducts)
   - green,

Question 17

what to ask someone who presents with breast lump?

Answer 17

nipple changes
growing?
family history: 1st and secondary degree
lymph node tenderness
ovarian cancers
BRCA1 BRC2

Question 18

when you want to use adjuvant therapies?

Answer 18

high grade
lymph involvement
or HER2