MLA Breast

Question 1

Which benign breast disorder is characterised as a well-circumscribed mobile breast lump?

Answer 1

Fibroadenoma

Question 2

What is the age threshold for a diagnostic mammogram?

Answer 2

> 35 years of age

Question 3

What is the most common benign breast lump in women aged 20-30 years?

Answer 3

Fibroadenoma

Question 4

What is the first line of imaging for patients with a fibroadenoma (<35 years)?

Answer 4

Breast ultrasound

Question 5

What is the first line management for fibroadenoma?

Answer 5

Reassurance - will spontaneously reduce in size

Question 6

What are the surgical indications for fibroadenoma management?

Answer 6

Size >3 cm and symptomatic

Question 7

Which benign breast disorder is associated with nipple discharge and retraction?

Answer 7

Duct ectasia

Question 8

What is a significant risk factor for duct ectasia?

Answer 8

Smoking

Question 9

What is mammography finding is observed in patients with duct ectasia?

Answer 9

Microcalcifications

Question 10

What is the symptomatic management for duct ectasia?

Answer 10

Warm compress and supportive bra

Question 11

What is the breast cancer referral indications for suspected cancer?

Answer 11

1. Unexplained breast lump with or without pain in >30 years of age.
2. Nipple changes of concern (in one nipple only e.g., discharge, retraction) in >50 years of age.

Question 12

Which genes are associated with an increased predisposition to developing breast cancer?

Answer 12

(BRCA1, BRCA2 or TP53)

Question 13

FHx of breast cancer in a first-degree relative <x years warrants screening?

Answer 13

<40 years

Question 14

What pre-operative investigation is performed in patients with suspected breast cancer?

Answer 14

Axilla ultrasound

Question 15

What is performed in in patients with breast cancer + axillary lymph node involvement?

Answer 15

Axillary node clearance

Question 16

What is performed if axilla ultrasound demonstrates no lymph node involvement in patients with breast cancer?

Answer 16

Sentinel lymph node biopsy

Question 17

What are the indications for a mastectomy?

Answer 17

Central tumour

Multifocal tumour

Large lesion in small breast

DCIS >4 cm

Pregnancy

Question 18

What is offered post-wide local excision of the breast to reduce cancer recurrence?

Answer 18

Whole beast radiotherapy

Question 19

What neoadjuvant endocrine therapy is offered to pre-menopausal women with Oestrogen receptor positive breast cancer?

Answer 19

Tamoxifen

Question 20

What neoadjuvant endocrine therapy is offered to post-menopausal women with Oestrogen receptor-positive breast cancer?

Answer 20

Anastrozole (aromatase inhibitor)

Question 21

What adverse effects are associated with tamoxifen?

Answer 21

Increased risk of thrombosis, and endometrial cancer; pregnancy

Question 22

The risk of which cancer is increased in tamoxifen use?

Answer 22

Endometrial cancer

Question 23

Pregnancy should be be attempted until how many months following tamoxifen discontinuation?

Answer 23

> 2 months

Question 24

What is the main adverse effect associated with aromatase inhibitor?

Answer 24

Osteoporosis

Question 25

What neoadjuvant therapy is prescribed to patients that are HER-2 positive?

Answer 25

Trastuzumab

Question 26

What is the most common type of breast cancer?

Answer 26

Invasive ductal carcinoma

Question 27

Which cancer does ‘no special type’ refer to?

Answer 27

Invasive ductal carcinoma

Question 28

What are the main risk factors associated with invasive ductal carcinoma?

Answer 28

• Hormone exposure – Early menarche, late menopause, late 1st live birth; nulliparity OCP/HRT –i.e degree of unopposed oestrogen exposure.

Question 29

What forms part of the triple assessment?

Answer 29

1. Examination and history
2. Imaging
3. Biopsy

Question 30

What prognostic index s used to stage primary breast cancer prognosis?

Answer 30

The Nottingham Prognostic index

Question 31

What is the NHS breast screening programme?

Answer 31

Mammogram every 3 years for women aged 50-71 years of age.

Question 32

Which breast malignancy is associated with Eczematoid changes of the nipple?

Answer 32

Paget’s disease of the nipple

Question 33

What is the classic presentation of an intraductal papilloma?

Answer 33

Bloody or clear nipple discharge

Question 34

What benign breast disease condition is characterised by cyclical breast lumpiness according to the menstrual cycle?

Answer 34

fibrocystic breast disease

Question 35

Which breast disease can exhibit both benign and malignant characteristics?

Answer 35

Phyllodes tumour

Question 36

What is revealed on fine needle aspiration of a breast cyst?

Answer 36

Straw-coloured fluid

Question 37

What is a mimicker of breast cancer and typically occurs following trauma?

Answer 37

Fat necrosis

Question 38

What is the most common cause of infective mastitis?

Answer 38

Staph aureus

Question 39

What are the symptoms of a breast abscess?

Answer 39

• Fever/general malaise.
• A painful swollen lump in the breast, redness, heat, and swelling of the overlying skin.
• Lump may be fluctuant with skin discolouration.

Question 40

What is the first line management for lactational mastitis?

Answer 40

Reassurance – CONTINUE breastfeeding (including from the affected breast)
- Provide analgesia e.g., paracetamol and ibuprofen.

Question 41

What are the indications for prescribing antibiotics in mastitis?

Answer 41

Empirical: 500 mg flucloxacillin 500 mg QDS 10-14 days (alternative – erythromycin 250-500 mg)
* Nipple fissure that is infected
* Symptoms have not resolved/worse after 12-24 hours despite effective milk removal
* Breast milk culture is positive

Question 42

What is the first line management for a breast abscess?

Answer 42

Urgent referral to breast surgeon for diagnostic ultrasonography.
* Ultrasound-guided needle aspiration + culture of fluid.
* Advice to continue breastfeeding.