Breast/Vascular Conditions

Question 1

Non cancerous lesions - fibroadenoma, cysts, lipoma, mastalgia

Answer 1

Ix: Triple assessment to exclude cancer, breast pain diary for cyclical breast pain, pregnancy test
Mx: conservative management with supportive bra, heat packs, simple analgesia + avoid caffeine

Question 2

Cancerous lesions - DCIS, LCIS, NST, ILC

Answer 2

Ix: screening (every 3 yrs women 50-70 + high risk pts), triple assessment, sentinel lymph node biopsy, gene expression profiling (ER, PR, HER2), Staging: trip assessment + CT for staging + mets to lungs, liver, bones
Mx: Tumour removal: mastectomy, axillary clearance, radiotherapy, chemotherapy (neoadj, adj, treatment), hormone treatment (tamoxifen premenopausal, aromatase inhibitor anastrozole for postmenopausal - can also be used for chemoprevention, herceptin for HER2+ve), reconstructive surgery of breasts with implants/flaps

Question 3

Infections - [lactational] mastitis, breast abscess

Answer 3

Ix: mastitis - conservative with continued breastfeeding, supportive bra, heat packs, simple analgesia, if ? infection MC+S of milk sample
Mx: fluclox if infection and incision + drainage if abscess, if non lactational mastitis need broad spectrum Abx (e.g. coamox or erythromicin+metronidazole)

Question 4

Duct pathology: mammary duct ectasia, intraductal papilloma

Answer 4

Ix: triple assessment, ductography/doctoscopy/cytology of discharge
Mx: conservative (supportive bra, heat packs, simple analgesia) if needed surgical excision + Abx (necessary for IDP)

Question 5

Other - gynaecomastia, gallactorhoea/prolactinaemia, prolactinoma

Answer 5

Ix: FBC, U+E, LFT (liver disease), TFT (hyperthyroidism), Oestrogen/Testosterone, SHBG, prolactin, AFP/bHCG (leydic cell testicular tumor), Genetic karyotyping (Kleinefelter), Breast USS/mammogram/biopsy, testicular USS/CXR
Mx: Depends on cause, tamoxifen, cabergoline/bromocriptine for prolactioma, transphenoid removal of tumour

Question 6

PAD - intermittent claudication/critical limb ischaemia,arterial ulcers

Answer 6

Ix: ABPI, Duplex USS, Angiography
Mx: lifestyle, manage CV RFs, surgery: endovascular angioplasty + stenting, endovascular thrombolysis/thrombectomy, endarterectomy, bypass, amputation. Arterial ulcer mx is the same as PAD mx

Question 7

Chronic venus insufficiency, venous ulcers, varicose veins

Answer 7

Ix: varicose veins - tap/cough/trendelenburg/perthes test, duplex USS
Mx: lifestyle, keep leg elevated, compression stockings. Surgery for varicose veins is endothermal ablation/sclerotherapy. Ulcers: keep skin healthy - emollients/topical steroids, lifestyle change, compression stockings, abx/analgesia if infected, wound care

Question 8

DVT

Answer 8

Ix: same as PE, wells score, d-dimer imaging: doppler USS/CTPA for PE
Mx: Prophylaxis with anticoag (LMWH, DOAC, Warfarin), compression stockings unless PAD