breast diseases

Question 1

how do breast diseases commonly present

Answer 1

50% asymptomatic via screening

50% symptomatic (half with a with a lump)

Question 2

symptoms of breast disease

Answer 2

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

Question 3

what is triple assessment

Answer 3

clinical assessment
imaging
histology

Question 4

what type of imaging is used

Answer 4

mammogram in older women

USS in younger

Question 5

why is mammogram less effective in younger women

Answer 5

denser breast tissue

Question 6

how do DCIS calcifications appear on mammography

Answer 6

pleomorphic casting

Question 7

how is definitive diagnosis of DCIS established

Answer 7

vacuum-assisted core biopsy

Question 8

LCIS most commonly progresses into which type of cancer

Answer 8

ductal

Question 9

what is the preferred surgical treatment of breast ca

Answer 9

breast conserving surgery

Question 10

what is the normal form of breast conserving surgery

Answer 10

wide local excision with or without an oncoplastic procedure to shape breast

Question 11

what is an essential non-surgical component of breast conserving surgery

Answer 11

radiation therapy

Question 12

what is removed in modified radical mastectomy

Answer 12

entire breast including overlying skin and axillary lymph nodes
preservation of pec major

Question 13

what types of breast reconstruction are possible

Answer 13

immediate (during the same operation as mastectomy)

delayed (performed at a later date)

Question 14

how is the result of non-skin sparing mastectomy reconstruction aesthetically poor

Answer 14

often results in prominent scars on new breast and a paddle of skin of a different colour/texture

Question 15

what are indications for post-mastectomy radiation

Answer 15

involvement of three or more nodes

positive surgical margins

tumours larger than 5 cm

Question 16

what is the most commonly used hormonal therapy

Answer 16

tamoxifen (oestrogen receptors)

Question 17

what is trastuzamab

Answer 17

recombinant monoclonal antibody which targets HER-2 receptors

Question 18

how do phyllodes tumour differ from fibroadenoma

Answer 18

tend to be larger (3-6 cm)

occur in older women (35-35 years)

Question 19

management of phyllodes tumour

Answer 19

excision with 1 cm margin

follow up

Question 20

how are cysts diagnosed

Answer 20

FNA

Question 21

when should fluid from a cyst be sent for cytology

Answer 21

if bloody

Question 22

what is the most common aetiology of spontaneous nipple discharge

Answer 22

intraductal papilloma

Question 23

investigations for pathological nipple discharge

Answer 23

mammography
ultrasonography
surgical excision of the discharging ducts

Question 24

dry, scaly, eczematous nipple

Answer 24

paget’s

Question 25

management of mastitis (lactational)

Answer 25

fluclox examination every 3 days pump infected breast until mastitis clears

Question 26

wen should antibiotics be started for mastitis

Answer 26

signs of fever, erythema, induration, tenderness, swelling

Question 27

management of breast abscess

Answer 27

aspiration (diagnostic and therapeutic) surgical drainage under anaesthesia if not responding to aspiration antibiotics

Question 28

mastitis that doesn't respond the antibiotics and seems to be diffuse over the breast is suggestive of

Answer 28

inflammatory carcinoma