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Finals > Breast surgery > Flashcards

Breast surgery Flashcards

1
Q

what are the aspects of the triple assessment of a breast lump?

A

Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Histology (fine needle aspiration or core biopsy)

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2
Q

what are some clinical features which may suggest breast cancer?

A

Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction
Skin dimpling or oedema (peau d’orange)

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3
Q

The NICE guidelines (updated January 2021) recommend a two week wait referral for suspected breast cancer for:

A

An unexplained breast lump in patients aged 30 or above
Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)

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4
Q

how would you describe a fibroadenoma on examination?

A

Painless
Smooth
Round
Well circumscribed
Firm
Mobile (moves freely under the skin and above the chest wall)
Usually up to 3cm diameter

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5
Q

what is the management of fibrocystic breast changes?

A

Wearing a supportive bra
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
Avoiding caffeine is commonly recommended
Applying heat to the area
Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance

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6
Q

On examination, breast cysts are:

A

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

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7
Q

On examination, fat necrosis can be:

A

Painless
Firm
Irregular
Fixed in local structures
There may be skin dimpling or nipple inversion

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8
Q

what is a galactocele?

A

breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk. They present with a firm, mobile, painless lump, usually beneath the areola.

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9
Q

The three main things to exclude when someone presents with breast pain are:

A

Cancer (perform a thorough history and examination)
Infection (mastitis)
Pregnancy (perform a pregnancy test)

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10
Q

State 3 causes of gynaecomastia?

A

Obesity
Testicular cancer (Leydig cell tumour)
Liver cirrhosis and liver failure
Hyperthyroidism
Human chorionic gonadotrophin (hCG) secreting tumour, notably small cell lung cancer
Testosterone deficiency in older age
Hypothalamus or pituitary conditions that reduce LH and FSH levels
Klinefelter syndrome
Orchitis
Testicular damage

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11
Q

what medications can cause gynaecomastia?

A

Anabolic steroids
Antipsychotics
Digoxin
Spironolactone
Gonadotrophin-releasing hormone (GnRH) agonists
Opiates

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12
Q
A
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13
Q

what hormone stimulates breast milk excretion?

A

Oxytocin

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14
Q

what are the management options for galactorrhoea ?

A

Dopamine agonists (e.g., bromocriptine or cabergoline)
Trans-sphenoidal surgical removal of the pituitary tumour is the definitive treatment of hyperprolactinaemia secondary to a prolactinoma.

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15
Q

what is mammary duct ectasia?

A

dilation of the large ducts in the breasts. There is inflammation in the ducts, leading to intermittent discharge from the nipple. The discharge may be white, grey or green.

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16
Q

what is a significant risk factor for mammary duct ectasia?

A

Smoking

17
Q

How may mammary duct ectasia present?

A

Nipple discharge
Tenderness or pain
Nipple retraction or inversion
A breast lump (pressure on the lump may produce nipple discharge)

18
Q

what is the key finding of mammary duct ectasia on mammogram?

A

Microcalcifications

19
Q

How may intraductal papilloma present?

A

Nipple discharge (clear or blood-stained)
Tenderness or pain
A palpable lump

20
Q

what is the management of intraductal papilloma?

A

complete surgical excision

21
Q

what is the most common bacterial cause of mastitis?

A

Staphylococcus aureus

22
Q

how does mastitis present?

A

Breast pain and tenderness (unilateral)
Erythema in a focal area of breast tissue
Local warmth and inflammation
Nipple discharge
Fever

23
Q

what is the management of lactational mastitis?

A

1st: continue breast feeding, massage, heat packs, analgesia
2nd: Flucloxacillin

24
Q

Candida infection of the nipple may present with:

A

Sore nipples bilaterally, particularly after feeding
Nipple tenderness and itching
Cracked, flaky or shiny areola
Symptoms in the baby, such as white patches in the mouth and on the tongue, or candidal nappy rash

25
Q

what is the treatment of Candida infection of the nipple

A

Topical miconazole 2% to the nipple, after each breastfeed
Treatment for the baby (e.g., oral miconazole gel or nystatin)

26
Q

what is a key feature that suggests a breast abscess?

A

swollen, fluctuant, tender lump within the breast

27
Q

Management of a breast abscess requires:

A

Referral to the on-call surgical team in the hospital for management
Antibiotics
Ultrasound (confirm the diagnosis and exclude other pathology)
Drainage (needle aspiration or surgical incision and drainage)
Microscopy, culture and sensitivities of the drained fluid

28
Q

State 4 risk factors for breast cancer

A

Female
Increased oestrogen exposure (earlier onset of periods and later menopause, HRT, COCP)
More dense breast tissue (more glandular tissue)
Obesity
Smoking
Family history (first-degree relatives)

29
Q

The BRCA1 gene is on chromosome 17. In patients with a faulty gene:

A

Around 70% will develop breast cancer by aged 80
Around 50% will develop ovarian cancer
Also increased risk of bowel and prostate cancer

30
Q

The BRCA2 gene is on chromosome 13. In patients with a faulty gene:

A

Around 60% will develop breast cancer by aged 80
Around 20% will develop ovarian cancer

31
Q

Name 3 types of breast cancer

A

Invasive Ductal Carcinoma
Invasive Lobular Carcinomas
Inflammatory Breast Cancer

32
Q

name 2 pre-cancerous conditions of the breast

A

Ductal Carcinoma In Situ (DCIS)
Lobular Carcinoma In Situ (LCIS)

33
Q

when and who is screened for breast cancer?

A

mammogram every 3 years to women aged 50 – 70 years.

34
Q

what are the 3 types of breast cancer receptors?

A

Oestrogen receptors (ER)
Progesterone receptors (PR)
Human epidermal growth factor (HER2)

35
Q

where are the most common sites of breast cancer metastasis?

A

L – Lungs
L – Liver
B – Bones
B – Brain

36
Q

what are the 2 surgical options for breast cancer?

A

Breast-conserving surgery (e.g., wide local excision), usually coupled with radiotherapy
Mastectomy (removal of the whole breast), potentially with immediate or delayed breast reconstruction

37
Q

axillary clearance increases the risk of what?

A

chronic lymphoedema in that arm

38
Q

what are the 2 main hormonal treatments for oestrogen-receptor positive breast cancer?

A

Tamoxifen for premenopausal women
Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)
given for 5 – 10 years

Finals (21 decks)

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