Obstetrics and gynaecology

Question 2

Fibroadenoma

Answer 2

Highly mobile, encapsulated breast masses.

Question 3

Breast cysts

Answer 3

Presence of breast lumps, potentially with distension.

Question 4

Mastitis

Answer 4

reast redness, mastalgia, malaise, and fever.

Question 5

Intraductal Papilloma

Answer 5

• Bloody discharge from the nipple
• +/-mass.
• Breast tenderness may also be present.

Question 6

Radial scar

Answer 6

Presents on mammogram as a stellate pattern of central scarring surrounded by proliferating glandular tissue.

Question 7

Fat necrosis

Answer 7

Painless breast mass, skin thickening, or radiographic changes on mammography.

Question 8

Fibrocytic breast disease

Answer 8

Breast lump
pain
tender

Question 10

Mammary duct ectasia

Answer 10

• Palpable peri-areolar breast mass,
• thick nipple discharge,
• mammographic similarities to cancer.

Question 11

Risk of breast cancer

Answer 11

• Advancing age
• Caucasian ethnicity
• Obesity and lack of physical activity
• Alcohol and tobacco use
• History of breast cancer
• Previous radiotherapy treatment
• BRACA1/2
• Increase hormone exposure

Question 12

Common symptoms for breast cancer

Answer 12

• Unexplained breast mass in patients aged 30 and above, with or without pain
• 50 and older, nipple discharge, retraction or other concerning symptoms
• Skin changes suggestive of breast cancer (peu’d orange)
• Unexplained axillary mass in those aged 30 and above

Question 13

Lymphoedema

Answer 13

• common after breast surgery- axillary clearance

Question 14

Cyclical mastalgia

Answer 14

Breast tenderness that fluctuates around monthly menstrual cycle

Question 15

Epidemiology of cyclical mastalgia

Answer 15

experienced by peri- and premenopausal women

Question 16

Signs and symptoms of breast mastalgia

Answer 16

• Breast tenderness
• Pain usually beginning a few days before the onset of menstruation and subsiding by the end of the period
• Possible breast “lumpiness” associated with fibrocystic changes
• Potential presentation of duct ectasia

Question 17

cyclical mastalgia investigations

Answer 17

• Mammography or ultrasound: especially for women over 40
• hormone panel

Question 18

Managment of cyclical mastalgia

Answer 18

• NSAIDs
• Severe cases: oral contraceptives or danazol

Question 19

Fat necrosis of the breast

Answer 19

• non-malignant condition in which there is death of adipose tissue (fat cells) within the breast
• comon in obese patients
• associated with trauma

Question 20

Signs and symptoms of fat necrosis

Answer 20

• Firm/hard, irregular lump in the breast
• skin inflammation, warmth, or bruising

Question 21

Investigations of fat necrosis

Answer 21

• Clinical examination
• Imaging: Mammography and/or ultrasound
• Tissue sampling: Fine needle aspiration cytology (FNAC) or core biopsy

Question 22

Fat necrosis managment

Answer 22

conservative

Question 23

Signs and symptoms of mastitis

Answer 23

• Localised symptoms: Painful, tender, red, and hot breast.
• Systemic symptoms: Fever, rigors, myalgia, fatigue, nausea, and headache.
• usually the first week postpartum.

Question 24

Mastitis investigation

Answer 24

• Ultrasound: Utilised to identify a potential abscess, appearing as a collection of pus.
• Additional information: Early referral to secondary care is vital if an abscess is suspected.

Answer 25

• continue breast feeding
• manual expression
• analgesia
• cephalexin
• consider intravenous antibiotics or surgical intervention, especially if a breast abscess develops.

Question 26

Managment of puperal mastitis

Answer 26

• continue expression
• analgesia
• surgical drainage
• miconazole

Question 27

risk of puperal mastitis

Answer 27

candidiasis of the nipple can occur

Question 28

Fibroadenoma

Answer 28

• benign tumours that consist of a mixture of fibrous and epithelial tissue.
• They originate from the lobules, the milk-producing glands in the breast.

Question 29

epidemiology of fibroadenoma

Answer 29

• highest incidence occurring in the early 20s
• seen in puberty, pregnancy, and perimenopause.

Question 30

Signs and symptoms of fibroadenoma

Answer 30

• A firm, non-tender breast mass
• smooth edges
• highly mobile upon palpation, often referred to as having a “rubbery” consistency
• The mass typically does not grow beyond 3cm in diameter

Question 31

Investigations of fibroadenoma

Answer 31

• reassure
• Clinical examination
• ultrasound and/or mammogram
• Needle biopsy (fine needle aspiration or core biopsy)

Question 32

Managment of fibroadenoma

Answer 32

• reassurance
• surgical excision

Question 33

Managment of fibrocytic disease

Answer 33

• Encouraging the use of a soft but well-fitting bra for comfort.
• Providing appropriate analgesia for pain relief.
• Most cases resolve after menopause, and reassurance can be provided about this natural course.