MedEd

Question 1

22 year old woman presents to clinic with a three-month history of a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis

Answer 1

fibroadenoma

Question 2

A 54 year old patient who is febrile, presents with an irregular, firm mass in her left breast. The overlying skin appears red and is warm to touch. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis

Answer 2

breast abscess

Question 3

A 31 year old presents with an ill-defined, tender mass in her left breast, 2 weeks after giving birth. The affected segment is diffusely red and hot. Fine needle aspiration cytology (FNAC) of the mass shows neutrophils and inflammatory debris. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis

Answer 3

acute mastitis

Question 4

what is (lactational) acute mastitis

Answer 4

acute inflammation of the breast tissue

Question 5

what is the main cause of acute mastitis

Answer 5

s aureus

Question 6

what are the risk factors for acute mastitis

Answer 6

2Bs
Breastfeeding (hence lactational)
Birth

Question 7

what are clinical features of acute mastitis

Answer 7

painful red swelling of the breast

skin is ‘hot to touch’

Question 8

what is the main complication of acute mastitis

Answer 8

abscesses

Question 9

what buzzwords are associated with acute mastitis

Answer 9

2Bs (breastfeeding + birth)

painful red swelling

Question 10

what is periductal mastitis

Answer 10

inflammation around the dilated milk ducts

Question 11

what are risk factors for periductal mastitis

Answer 11

smoking

non-lactating young women

Question 12

of acute mastitis and periductal mastitis, which is not associated with birth or breastfeeding

Answer 12

periductal mastitis

Question 13

what are clinical features of periductal mastitis

Answer 13

painful red subareolar mass

inverted nipple

Question 14

what is a breast abscess

Answer 14

collection of pus in the breast

Question 15

what are clinical features of a breast abscess

Answer 15

febrile patient

painful red lump near the nipple

Question 16

what is the management for a breast abscess

Answer 16

aspirate (FNA) or surgical drainage

Question 17

what is a fibroadenoma

Answer 17

benign neoplasm of a lobule arising from the stroma (fibro) and glandular epithelium (adenoma)

Question 18

who is commonly affected by fibroadenomas

Answer 18

young women

Question 19

what name are fibroadenomas also called

Answer 19

breast mouse due to being very mobile

Question 20

what are clinical features of fibroadenoma

Answer 20

painless, smooth, well circumscribed mobile mass

Question 21

what is a breast cyst

Answer 21

fluid filled cavity in the breast

Question 22

who is commonly affected by breast cysts

Answer 22

women around menopause

>35yrs

Question 23

what are clinical features of a breast cyst

Answer 23

fluctuant, distinct, round mass

often tender

Question 24

what is the management for a breast cyst

Answer 24

aspirate (FNA)

Question 25

what coloured aspirate is common with breast cysts

Answer 25

usually clear or green or yellow aspirates

Question 26

what is duct ectasia

Answer 26

dilation of ducts due to blockage or clogging of lactiferous ducts

Question 27

who commonly gets duct ectasia

Answer 27

post menopause | >50yrs

Question 28

what are clinical features of duct ectasia

Answer 28

similar features to cancer nipple retraction or slit like nipple a thick cheese discharge

Question 29

what is seen on imaging with duct ectasia

Answer 29

microcalcification

Question 30

what is the management for duct ectasia

Answer 30

reassure and discharge

Question 31

what are the buzzwords associated with duct ectasia

Answer 31

cheeky thick yellow green discharge | nipple retraction or slit like nipple

Question 32

``` A 56 year old female presents with thick creamy discharge from the right nipple. USS shows dilated subareolar ducts. Cytology of discharge shows macrophages and debris but no epithelial cells. The most likely diagnosis is: Acute Mastitis Ductal carcinoma in-situ Duct Ectasia Invasive Breast Cancer Paget’s Disease of the Breast ```

Answer 32

Duct Ectasia

Question 33

``` A 55 year old presents with a firm, irregular, painless lump in her left breast. On examination you find an enlarged apical lymph node. The most likely diagnosis is: Acute Mastitis Ductal carcinoma in-situ Duct Ectasia Invasive Breast Cancer Paget’s Disease of the Breast ```

Answer 33

Invasive Breast Cancer

Question 34

``` A 48 year old woman presents with red, scaly lesions around the nipple of the right breast. The most likely diagnosis is: Acute Mastitis Ductal carcinoma in-situ Duct Ectasia Invasive Breast Cancer Paget’s Disease of the Breast ```

Answer 34

Paget’s Disease of the Breast

Question 35

what are malignant breast cancer conditions

Answer 35

``` non-invasive -DCIS invasive -infiltrative ductal carcinoma -infiltrative lobular carcinoma -pagets disease of the breast ```

Question 36

what is DCIS

Answer 36

ductal carcinoma that has not invaded the basement membrane

Question 37

what are clinical features of DCIS

Answer 37

no lump

Question 38

what would be seen on imaging with DCIS

Answer 38

microcalcification

Question 39

what is a mneumonic for risk factors of breast cancer

Answer 39

History ALONE ``` History (PMHx/FHx of breast or ovarian cancer, or BRCA genes, or radiotherapy, DHx of OCP or HRT) Age Late menopause >51yrs Obesity or Nulliparity Early menarche <13yrs ```

Question 40

what are different types of invasive breast cancer

Answer 40

infiltrative ductal carcinoma | infiltrative lobular carcinoma

Question 41

what is the most common invasive breast cancer

Answer 41

infiltrative ductal carcinoma

Question 42

what are clinical features of invasive breast cancer

Answer 42

painless, immobile, irregular hard lump lymphadenopathy peau d'orange

Question 43

how is suspected invasive breast cancer investigated

Answer 43

triple assessment

Question 44

what biopsy is performed on a invasive breast cancer lump

Answer 44

sentinel lymph node biopsy

Question 45

what is the management for an invasive breast cancer

Answer 45

wide local excision

Question 46

what medication is used in oestrogen receptor positive tumours

Answer 46

tamoxifen (oestrogen antagonist)

Question 47

what medication is used in Her2 receptor positive tumours

Answer 47

trastuzumab (herceptin)

Question 48

what is pagets disease of the breast

Answer 48

presence of pagets cells in the nipple | spread of breast cancer to the skin!!

Question 49

what conditions is pagets disease of the breast seen in

Answer 49

DCIS | invasive breast carcinoma

Question 50

what are clinical features of pagets disease of the breast

Answer 50

red itchy lesion of the nipple | crusty and scaly skin

Question 51

what buzzwords are associated with pagets disease of the breast

Answer 51

``` eczematous lesion (red, itchy lesion) skin of the nipple ```

Question 52

``` A 25 year old woman is seen in breast clinic as she has noticed a small lump in her right breast. This is confirmed on examination and she is sent for further investigation. What is the next investigation she should have? Core Biopsy Fine Needle Aspiration Mammography None Needed – Send Home Ultrasound ```

Answer 52

Ultrasound

Question 53

what is the triple assessment

Answer 53

``` clinical assessment imaging -USS <35yrs -mammogram >35yrs biopsy -FNA for cytology (fluid) -tru-cut core biopsy for histology (solid) ```

Question 54

what is fat necrosis

Answer 54

post trauma necrosis of fatty breast tissue

Question 55

what are the risk factors for fat necrosis

Answer 55

trauma

Question 56

what are clinical features of fat necrosis

Answer 56

painless, irregular hard lump | bruising overlying skin

Question 57

what is fibroadenosis

Answer 57

normal of physiological changes in breast tissue which leads to fibrous tissue and cyst formation

Question 58

what are the risk factors for fibroadenosis

Answer 58

hormonal changes in >35yrs

Question 59

what are features of fibroadenosis

Answer 59

appears just before period | multiple painful lumps

Question 60

what are buzzwords for fibroadenosis

Answer 60

multiple lumpy masses

Question 61

what is an intraductal papilloma

Answer 61

benign neoplasm within the ducts of the breast

Question 62

who gets intraductal papillomas

Answer 62

common around menopause

Question 63

what are clinical features of intraductal papillomas

Answer 63

bloody or clear nipple discharge | subareolar mass

Question 64

what is phyllodes tumour

Answer 64

phyllodes means life-like | a fibroepithelial tumour formed from periductal stromal cells

Question 65

is phyllodes tumour benign or malignant

Answer 65

can be either

Question 66

what are clinical features of a phyllodes tumour

Answer 66

rapidly growing | tear drop appearance of the breast

Question 67

what buzzwords would suggest a phyllodes tumour

Answer 67

rapidly growing tumour