breasts

Question 1

triple assessment for breast cancer involves

Answer 1

Triple assessment, as the name indicates, includes three modalities, physical examination, imaging (mammography and/or ultrasound), and biopsy (FNAC and core biopsy).

Question 2

tumoru of T2 what would happen

Answer 2

wide local excision and adjuvant radiotherapy

Question 3

tumour at T3 or more

Answer 3

mastectomy plus adjuvant

Question 4

abx of choice for mastitis

Answer 4

flucloxacillin

Question 4

abx of choice for mastitis

Answer 4

flucloxacillin

Question 5

difference between mastitis and breast abscess

Answer 5

accumulation of pus within breast - fever and tender fluctuant mass - complication of mastitis - need to drain and oral/IV abx

Question 6

if mamography comes back abnormal and yeild a degree of suspicion for breast cancer what shoudl you do

Answer 6

core-needle biopsy of the mass

Question 7

if over 30 with unexplained breast mass what should happen

Answer 7

2ww for triple assessment - ultrasound for young women

Non-urgent referral should be carried out for patients under 30 years old with an unexplained breast mass.

Question 8

letrozole treats - oestrogen receptor positive what shiudl you measure with this drug

Answer 8

bone mineral denisty due to osteoporosis risk

Question 9

new expanding lump, non-tender and freely moveable in 49yr old

Answer 9

phyllodes tumour - connective tissue - fast growing

firbo-adenoma - firm non tender mobile 20-30 - slow growing and unliekly to double in 2w

Question 10

trastuzumab - HER2 receptor positive what shoudl you monitor

Answer 10

cardiac function - cardiotoxicity

Question 11

anastrozole used when

when tomoixfen

Answer 11

oestrogen receptor postive in post-menopausal women

tamoxifen - ostrogen receptor psotive in pre or peri menopausal

Question 11

anastrozole used when

when tomoixfen

Answer 11

oestrogen receptor postive in post-menopausal women

tamoxifen - ostrogen receptor psotive in pre or peri menopausal

Question 12

major risk factor for periductal mastitis

Answer 12

smoking

Question 13

ultrasound under what age if symtpomatic and if asymtpomati what age due to dense breast tissue

Answer 13

35 and 40

mammogrpahy afterwards

Question 14

less than 4cm

Answer 14

wide excision of mastecotmy

Question 15

less than 4cm

Answer 15

wide excision of mastecotmy

Question 16

A 31 year old woman attends her booking visit at 10 weeks gestation. This is her first pregnancy and other than some morning sickness she has had no vaginal bleeding or other problems so far. The results of her booking bloods come back which show no abnormalities, but her Rhesus status is found to be negative. She is worried that she will need injections.

Which of the following is the most appropriate management?

Answer 16

anit d is given as immunoglobulins at 28weeks with further doses if sensitising event occurs

Question 17

A 31-year-old woman presents to the GP with a new breast lump. On examination, there is a hard, 2cm lump in the upper outer quadrant of her left breast. It is highly mobile and smooth to the touch. It is not painful, and there are no overlying skin changes.

Which is the most appropriate management?

Answer 17

Urgent referral to the outpatient breast clinic

The likely diagnosis for this patient is a benign fibroadenoma; however, as she is over 30 with a new breast lump, she should be urgently referred to the breast clinic for assessment for triple assessment.

Question 18

blood stained discharge

Answer 18

Intraductal papilloma

Question 19

high risk of breast cancer criteria

Answer 19

Breast cancer in a first-degree male relative of any age
Breast cancer in a first-degree relative under the age of 40
Bilateral breast cancer in a first-degree relative under the age of 50
Breast cancer in two first-degree relatives

Question 20

what can occur after infective puerperal mastitis.is treated

Answer 20

candida of the nipple

Question 21

swelling of arm after a breast surgery 4 years ago what we thinking

Answer 21

This patient has had breast surgery, which is a major risk factor for developing lymphoedema, which can occur months to years after surgery. It is more common in patients who have also undergone axillary node clearance.

Question 22

axillary node clearance can injure what

Answer 22

Lymphoedema
Damage to brachial plexus
Axillary artery/vein injury

Question 23

can mammography distinguish between cancer and fat necrosis

Answer 23

no so need triple assessment

Question 24

differnence between urgent and routine referral to the breast clinic

Answer 24

This patient presents with symptoms of a benign fibroadenoma. For patients under 30, a routine referral to the breast clinic for further assessment or imaging is indicated. If the patient is over 30, this should be an urgent referral.

Patients considered high familial risk should also be referred for urgent assessment. The criteria for this include:

Breast cancer in a first-degree male relative of any age
Breast cancer in a first-degree relative under 40
Bilateral breast cancer in a first-degree relative under 50
Breast cancer in two first-degree relatives
As this patient is under 30, and her mother was over 40 when diagnosed, a routine referral would be indicated for this patient.

Question 25

what is a galactocele

Answer 25

A galactocele is a breast lesion most commonly occurring in women who have recently ceased breastfeeding. Milk builds up and stagnates within the lactiferous ducts, leading to the formation of a mobile, cyst-like lesion which can be tender.

Question 26

A 33 year old G1P1 comes in for a routine 6 week post-partum check-up after uneventful pregnancy with an uncomplicated vaginal delivery. She reports no problems and is getting on well with the care of the baby. Her examination shows an irregular, firm, and non-tender uterus at about 14 week size. Which of the following is the most likely explanations for this finding?

Answer 26

Fibroids

Fibroids are abnormal growths of tissue occurring in the uterus. They are highly vascular and often cause heavy bleeding. The examination findings are most consistent with uterine fibroids as they cause the uterus to be enlarged, irregular, and firm

Question 27

What else can be done to aid the effectiveness of McRobert’s manoeuvre?

Answer 27

applying suprapubic pressure