finals

Question 1

mastitis (± abscess) - investigations

Answer 1

mastitis - clinical

abscess - refer breast clinic, USS breast, 2ww if not lactational

Question 2

mastitis without abscess - management

Answer 2

warm compress
keep feeding - express if can’t
breastfeeding counsellor

10-14d fluclox if:
infected, systemically unwell, fissure
no better after 12-24h

safety net!! return if not better

Question 3

mastitis with abscess - management

Answer 3

refer breast clinic:
fluclox - s.aureus
USS-guided aspiration

2ww if not lactational

Question 4

how should you image breasts?

Answer 4

<40y - USS

>40y - USS + mammogram

Question 5

breast lump - investigation

Answer 5

triple assessment:
clinical assessment
imaging
core biopsy

Question 6

breast lump - differentials

Answer 6

benign nodularity
fibroadenoma
cyst
cancer

Question 7

breast cancer - management

Answer 7

triple assessment:

1) USS breast AND axilla AND mammogram (all ages)
2) core biopsy
3) CT staging

then:

1) sentinel biopsy
2) if +ve - axillary clearance or radio (axillary nodes follow sentinel)
3) wide excision + whole breast radio, or mastectomy ± radio
4a) hormonal therapy if ER+
4b) biological therapy if HER2
4c) adjuvant chemo
5) reconstruction

Question 8

DCIS - management + followup?

Answer 8

<4cm - wide local excision
>4cm - mastectomy
annual mammogram + clinical exam for 5y

Question 9

mastalgia - management

Answer 9

topical/NSAIDs - cyclical + noncyclical
tamoxifen

can image for reassurance

Question 10

suspected fibroadenoma - investigation

Answer 10

triple assessment:
examination - firm, v mobile
imaging - depends on age as per
core biopsy - tho no need if <25y + USS + exam are benign

Question 11

fibroadenoma - prognosis + management

Answer 11

none but excise if >3cm
may shrink over time but most stay same
may increase in pregnancy

Question 12

breast cyst - investigation + management

Answer 12

triple assessment - black centre on USS
treatment not needed
if painful/lump - US-guided fluid aspiration

Question 13

breast screening - who for and how often?

Answer 13

50-70y every 3y

or if RFs eg BRCA mutation, hx supra diaphragmatic irradiation for hodgkin’s lymphoma

Question 14

how does a malignant lump look on mammogram?

Answer 14

hyperdense
well-demarcated
irregular
spiculated

Question 15

what are the common sites for metastasis of breast cancer?

Answer 15

brain
lung
bone

Question 16

what muscles are used in a breast reconstruction?

Answer 16

latissimus dorsi flap

deep inferior epigastric perforators (DIEP) flap (tummy tuck)

Question 17

additional treatment for HER2+ women

Answer 17

herceptin (trastuzumab)

Question 18

additional treatment for ER+ women

Answer 18

pre-menopausal - tamoxifen 5 years

post-menopausal - aromatase inhibitor (anastrozole) + bisphosphonates (prevent bone mets)

Question 19

fibroadenoma - what is it? (explanation)

Answer 19

unknown cause - ?hormones
breasts made of lobules (milk-producing glands) + ducts that carry it
surrounded by glandular, fibrous + fatty tissue
fibroadenomas - when glandular tissue + ducts grow over a lobule

Question 20

mastitis - causes/RFs

Answer 20

milk stasis - poor attachment
less feeding on breast
dummy + bottle use, tight bra
infectious or non infectious - staph aureus if so

Question 21

role of aromatase inhibitors in ER+ postmenopausal women? risk?

Answer 21

post-menopause, oestrogen is made by aromatisation in peripheral tissues (aromatase enzyme)

risk osteoporosis

pre-menopause - made by ovary

Question 22

tamoxifen - SEs + risks

Answer 22

hot flushes, vaginal dryness, menopausal sx, menstrual disturbance
endometrial cancer
VTE

Question 23

biological therapy in breast cancer - herceptin (traztuzumab) - use? CI?

Answer 23

HER2+ cancers - but only useful in 25%

CI - hx heart problems

Question 24

role of chemo in breast cancer

Answer 24

downstage a primary lesion

post-surgery depending on stage, eg if there’s axillary node disease

Question 25

breast cancer - RFs

Answer 25

BRCA 1 + 2 - assoc ovarian too
FH - 1st degree + premenopausal
HRT + COCP
obesity
nulliparity
early menarche + late menopause
ionising radiation

Question 26

inflammatory breast cancer - skin sign

Answer 26

peau d’orange