breast disease

Question 1

what is the most common cancer in women

Answer 1

breast

Question 2

what is the most common type of breast cancer

Answer 2

ductal

Question 3

what are relatively low risk factors for breast cancer

Answer 3

early menarche 
late menarche 
nulliparity 
proliferative benign disease 
obesity 
alcohol 
HRT

Question 4

what are medium risk factors for breast cancer

Answer 4

age >35 at first birth
1st degree relative with breast cancer
radiation exposure
previous breast cancer

Question 5

what are high risk factors for breast cancer

Answer 5

gene mutation
lobular carcinoma in situ
ductal carcinoma in situ
atypical hyperplasia

Question 6

what are protective factors against breast cancer

Answer 6

routine vigorous physical activity

maintenance of healthy body weight

Question 7

what are some of the most common breast cancer symptoms

Answer 7

dimpled or depressed skin
visible lump
nipple change eg inversion 
bloody discharge 
texture change 
colour change

Question 8

which cancer accounts for around 80% of breast malignancies

Answer 8

ductal

Question 9

what are typical characteristics of a ductal carcinoma

Answer 9

stellate solid mass

pleomorphic casting micro calcifications

Question 10

what imaging modality is best for young woman

Answer 10

USS

Question 11

what is needed for definitive diagnosis

Answer 11

core-needle biopsy

vacuum assisted biopsy

Question 12

lobular carcinoma in situ is a tumour marker for which type of cancer

Answer 12

ductal

Question 13

what is the preferred treatment option for breast cancer

Answer 13

breast-conserving surgery

Question 14

what is removed during a total mastectomy

Answer 14

entire breast
overlying skin
axillary lymph nodes

Question 15

what should be preserved during mastectomy to allow for reconstruction

Answer 15

pectoralis major

Question 16

indications for post-mastectomy radiotherapy

Answer 16

involvement of more than 3 nodes
positive surgical margins
tumours >5 cm

Question 17

what is tamoxifen

Answer 17

ER antagonist

Question 18

what drug targets HER2

Answer 18

trastuzumab (Herceptin)

monoclonal Ab

Question 19

what is the most common benign neoplasm

Answer 19

fibroadenoma

Question 20

when is fibroadenoma most common

Answer 20

20-30

Question 21

characteristics of a fibroadenoma

Answer 21

rubbery to firm 
mobile 
smooth 
distinct borders 
non tender

Question 22

how do phyllodes tumours differ from fibroadenoma

Answer 22

larger
older women
tend to increase in size

Question 23

how does management of phyllodes tumour differ from fibroadenoma

Answer 23

they should be excised with 1 cm margins and followed up

Question 24

clinical characteristics of a breast cyst

Answer 24

palpable 
clearly defined
soft
mobile 
smooth 
tender

Question 25

when to suspect intracyctis carcinoma

Answer 25

grossly bloody fluid aspirated from a cyst

residual mass after aspiration of cyst

Question 26

what is nipple discharge most commonly a sign of

Answer 26

intraductal papilloma (benign)

Question 27

management of intraductal papilloma

Answer 27

excisions and histologically examined to rule out intraductal carcinoma

Question 28

investigations of pathological nipple discharge

Answer 28

mammography
USS
surgical excision of the discharging ducts

Question 29

erythematous weeping lesion on the surface of the nipple and the areola

Answer 29

Paget’s disease

Question 30

common presentation of Paget’s disease

Answer 30

dry, scaly, eczematous lesion of nipple

Question 31

clinical signs of mastitis

Answer 31

fever 
erythema 
induction
tenderness
swelling

Question 32

treatment of mastitis

Answer 32

fluclox

co-amoxiclav

Question 33

treatment of breast abscess

Answer 33

aspiration
may need repeated every 3 days
open surgical drainage if aspiration not effective

Question 34

management of non-puerperal mastitis

Answer 34

co-amoxiclav