Surgery (inc breast)

Question 1

Green nipple discharge like cheese with slit retraction of the nipple

Answer 1

Mammary duct ectasia

Question 2

Hard irregular lump with skin tethering in obese women after small trauma

Answer 2

Fat necrosis

Question 3

Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral

Question 4

Blood stained nipple discharge

Answer 4

Papilloma

Question 5

Snowstorm sign on ultrasound of axillary lymph nodes

Answer 5

breast implant rupture

Question 6

reddening and thickening of the nipple/ areola. It may resemble eczema

Answer 6

pagets disease of the breast

Question 7

Bilateral, small volumes of pale or colourless discharge in a teenager

Answer 7

hormonal changes of puberty

Question 8

what is pagets disease of the breast

Answer 8

intraductal carcinoma

requires immediate referral

Question 9

Chemotherapy regimes

Answer 9

FEC-D chemo for node +ve

Aromatase inhibitors for post menopause (anastrozole) and tamoxifen for pre menopause in ER +ve
Herceptin (trastuzumab) for HER2 +ve

Question 10

Management of breast fibroademoma

Answer 10

Over 3cm and discomfort then surgical excision

Question 11

mobile firm and smooth breast lump

Answer 11

fibroadenoma

Question 12

Breast feeding - tender fluctuant mass

Answer 12

Abscess

Question 13

Creamy nipple discharge and nipple inversion

Answer 13

Duct ectasia

Question 14

Reason for neo-adjuvant chemo

Answer 14

Downsize the rumour to allow breast conserving surgery rather than mastectomy

Question 15

After surgery for breast cancer:

• no mets
• mets in axilla

Answer 15

No mets: radio

Mets in axilla: cytotoxic chemo

Question 16

BRCA1 inheritance

Answer 16

There is a 50/50 chance of siblings and children of BRCA1 carrier to also have the gene

Question 17

Fibroadenoma vs Fibroadenosis

Answer 17

Adenoma: discrete, mobile and non-tender
Adenosis: lumpy breasts worsen during menstruation

Question 18

Duct ectasia treatment

Answer 18

Reassurance

Question 19

Fibroadenoma management

Answer 19

Routine breast clinic referral

Question 20

Most common breast cancer

Answer 20

Invasive ductal cardinoma

Question 21

Risk factor of aromatase inhibitors

Answer 21

Osteoporosis

Question 22

In women with breast cancer and no palpable lymphadenopathy, if a pre-operative axillary ultrasound is positive then they should have a sentinel node biopsy to assess the nodal burden

Question 23

Grey gelatinous surface

Answer 23

Mucinous carcinoma

Question 24

Bloody nipple discharge with comedo necrosis

Answer 24

Ductal carcinoma in situ

Question 25

Tumour less than 4cm

Answer 25

Wide local excision

Question 26

Halo sign on mammogram

Answer 26

Breast cyst - aspiration if symptomatic

Question 27

Breast screening

Answer 27

3 years

Question 28

Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds

Question 29

Periductal mastitis is common in smokers and may present with recurrent infections