Breast Medicine

Question 1

What are the three parts of the triple assessment?

Answer 1

1) History taking and examination
2) Imaging (USS/mammogram)
3) Biopsy (FNA/core biopsy)

Question 2

What six symptoms need to be remembered in breast medicine?

Answer 2

1) Breast lump
2) Breast pain (mastalgia)
3) Nipple change (e.g. inversion)
4) Nipple discharge
5) Change in breast size/shape
6) Skin changes

Question 3

What is indicated by a lump which changes size with menstruation?

Answer 3

Fibrocystic change

Question 4

What is Paget’s disease of the breast?

Answer 4

A malignant condition that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast.The condition is an uncommon disease accounting for 1-4% of all breast cancers

Question 5

What % of breast cancers are caused by germline mutations in BRCA1 / BRCA2?

Answer 5

5% (People with a BRCA1 or BRCA2 mutation have a lifetime risk of developing breast cancer of 80-90%)

Question 6

Having a pre-menopausual first degree relative with breast cancer confers a lifetime risk of ?%

Answer 6

25% (if post-menopausal first degree relative: 14%)

Question 7

Does benign breast disease make you more likely to develop breast cancer?

Answer 7

Several benign breast conditions can increase a patient’s risk of developing breast carcinoma. Atypical lobular or ductal hyperplasia (increased number of cells), confers a 4 or 5 times increased risk.

Question 8

Name two causes of nipple inversion

Answer 8

Sub-areolar carcinoma and duct ectasia

Question 9

What type of lump is sometimes called a “breast mouse” due to its high mobility?

Answer 9

Fibroadenoma. (Fibroadenomas of the breast are lumps composed of fibrous and glandular tissue. Unlike typical lumps from breast cancer, fibroadenomas are easy to move, with clearly defined edges)

Question 10

FNA results are categorised as C1, C2, C3, C4 OR C5.Which is the only one of these categories that does not require a core biopsy to be required to obtain a histological diagnosis?

Answer 10

C2 since this implies benign cells

C1 = Insufficient cells for diagnosis
C2 = Benign cells
C3 = Atypical cells probably benign
C4 = Atypical cells probably malignant
C5 = Malignant cells (DCIS or invasive cancer)

Question 11

What type of drug is Tamoxifen?

Answer 11

An oral anti-oestrogen

Question 12

What drug is given to women testing positive for HER2 over expression? (Human Epidermal growth factor Receptor 2)

Answer 12

Trastuzumab (trade name Herceptin)

Question 13

Gynaecomastia is a known side effect of digoxin. True or false

Answer 13

True