Breast Surgery

Question 1

mobile firm breast lump in 18-25 year old

Answer 1

fibroadenoma

Question 2

management of fibroadenoma

Answer 2

more than 3cm then excise
often reduce in size spontaneously

Question 3

middle aged woman with painful lumpy breasts that worsen prior to menstruation

Answer 3

fibroadenosis
(fibrocystic disease, benign mammary dysplasia)

Question 4

smooth, soft and discrete breast lump with a halo sign on imaging

Answer 4

breast cyst

Question 5

management of a breast cyst

Answer 5

aspirate - if blood or persistently refill then excise/biopsy

slight increased risk of malignancy

Question 6

breast lump with pain and mammographic changes that mimic cancer

Answer 6

sclerosing adenosis

Question 7

management of sclerosing adenosis

Answer 7

BIOPSY

Question 8

varied history of a lump/lumps

Answer 8

epithelial hyperplasia

Question 9

management of epithelial hyperplasia

Answer 9

atypical features - refer
no atypical features - conservative

Question 10

obese woman presents with a firm and round mass increasing in size after trauma
(can progress to hard and irregular)

Answer 10

fat necrosis

Question 11

management of fat necrosis

Answer 11

image and biopsy to rule out cancer as fat necrosis is rare

Question 12

blood stained nipple discharge

Answer 12

duct papilloma

Question 13

dilation of the breast ducts around menopause causing a tender lump around the nipple/areola with green nipple discharge and slit nipple retraction

Answer 13

mammary duct ectasia

Question 14

red hot and tender swelling in lactating women

Answer 14

breast abscess

Question 15

cause of recurrent breast infections in smokers

Answer 15

periductal mastitis

Question 16

hard and irregular lump with nipple inversion and skin tethering

Answer 16

breast cancer

Question 17

what is the most common breast cancer

Answer 17

invasive ductal carcinoma

Question 18

intraductal carcinoma presenting with red eczematous nipple/areola

Answer 18

pagets disese of the breast

Question 19

first line treatment for breast cancer

Answer 19

wide local excision

Question 20

management of lymphadenopathy in breast cancer

Answer 20

axillary lymphadenopathy then node clearance
no lymphadenopathy then sentineal node biopsy

Question 21

when is radiotherapy given in breast cancer

Answer 21

after local excision/mastectomy

Question 22

when would you give hormone therapy in breast cancer

Answer 22

if oestrogen receptor positive

Question 23

which medications are given for hormone therapy and why

Answer 23

pre-peri menopausal: TAMOXIFEN
post menopausal = ANASTRAZOLE

tamoxifen increased VTE and endometrial cancer risk
anastrazole increases osteoporosis

Question 24

when is trautzumab given in breast cancer

Answer 24

if HER2 receptor positive

Question 25

why is chemotherapy given as a neo-adjuvant

Answer 25

to reduce size allowing breast conservation surgery rather than mastectomy

Question 26

BRCA1 - chances that siblings or children have the gene

Answer 26

50%

Question 27

breast cancer screening

Answer 27

every 3y from the age of 50-70 years

Question 28

management of a over 30 years old and breast lump

Answer 28

2ww

Question 29

snowstorm sign

Answer 29

ruptured implant