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MRCS A > BREAST > Flashcards

BREAST Flashcards

1
Q

What is a fibroadenoma?

A

Common benign breast lump

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2
Q

Who gets fibroadenoma’s

A

Young F (<30)

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3
Q

Features of fibroadenoma

A

Not fixed to Chx wall
Smooth/rubbery
Solid
Painless
Well-circumscribed
Painless

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4
Q

When may a fibroadenoma want to be removed for cosmetic purposes?

A

If the woman has small breasts
b/c can cause a large deviation

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5
Q

Why do fibroadenosis + cysts occur

A

Menstrual cycle

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6
Q

What age group gets fibroadenosis + cysts

A

30-50 y/o

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7
Q

What may cysts + fibrous nodules feel like o/e

A

Bubble wrwap

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8
Q

If cysts are multiple, what are they related to?

A

Homones

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9
Q

Which quadrant of the breast has the highest % of carcinoma?

A

Upper outer quadrant

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10
Q

What is the most common cancer in females?

A

Breast cancer

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11
Q

What are the 2 main cell types in breast cance r

A

Ductal
Lobar

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12
Q

Can you usually palpate breast carcinoma in situ

A

No

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13
Q

PS breast carcinoma (5)

A

Breast mass
Pain
Nipple changes
Dimpling breast tissue
Local oedema

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14
Q

Non specific Sx breast carcinoma

A

W loss
Loss appetitie
Fatigue

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15
Q

Features of lump - breast carcinoma (4)

A

Hard
Spiky
Not well circumscribed
Fixed to chest wall

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16
Q

How does breast carcinoma spread

A

Via direct extension
Lymphatics + bloods
Pleura + peritoneum

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17
Q

Symptom + related mets: SOB

A

Lung mets + pleural effusion

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18
Q

Symptom + related mets:
Headache/vision change/seizure

A

Brain mets

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19
Q

Symptom + related mets: abdo pain

A

Liver mets

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20
Q

Symptom + related mets: abdo distention

A

Ascites

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21
Q

Symptom + related mets: bone pain, weakness, numbness

A

SC compression

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22
Q

RF breast carcinoma (10)

A

= ALL TO DO W/ HIGH CIRCULATING OESTROGEN
Female
Late menopause/early menarche
OCP
HRT
FHx
Age
Nulliparity
< time breast feeding
‘Western lifestyle’

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23
Q

What % breast cancers are familial

A

5-10%

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24
Q

What assessment are most breast lumps referred for?

A

Triple assessment

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25
Q

What is ‘triple assessment’

A

Combo of 3 tests
Clinical exam, radiology + pathology

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26
Q

How are biopsies of the breast performed

A

Either Freehand if not palpable
Stereotactic if cant be seen on mammogram

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27
Q

What is the sensitivity of triple assessment?

A

99%

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28
Q

Why are mammograms not useful on young patients

A

Because their breast tissue is very dense
So all comes up as white hence = difficult to see anything

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29
Q

USS - black circle w/ well defined margin =

A

cyst

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30
Q

USS - grey/black circle w/ well defined margin =

A

Something capsulated :)

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31
Q

USS - grey/black circle w/ ill-defined margin =

A

Cancer

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32
Q

Nipple discharge - what does clear mean

A

Physiological

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33
Q

Nipple discharge - what does milky mean (2)

A

Pregnancy
Hyperprolactinaemia

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34
Q

Nipple discharge - what does green discharge mean

A

Duct ectasia around menopause
Fibroadenotic cyst

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35
Q

Nipple discharge - what does single blood stained duct discharge mean

A

V worrying

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36
Q

What to do if pt has Single blood stained duct discharge

A

Microducetomy

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37
Q

What is most suspicious, single or multiduct discharge

A

Single duct

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38
Q

What is periductal mastitis

A

Infection of ducts beneath the nipple

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39
Q

Who is more likely to suffer from periductal mastitis (2)

A

Smokers
Those w/ nipple piercings

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40
Q

Mx periductal mastitis

A

co-amoxiclav

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41
Q

What is the most common cause of breast pain?

A

MSK

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42
Q

Mx cyclical breast pain

A

Tamoxifen/danzol

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43
Q

Mx all breast pain

A

Evening primrose oil

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44
Q

Breast TNM: T1

A

<2cm

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45
Q

Breast TNM: T2

A

2-5cm

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46
Q

Breast TNM: T3

A

> 5cm

47
Q

Breast TNM: T4

A

Fixed to chest wall
Or Peau d’orange

48
Q

Breast TNM: N0

A

No nodes

49
Q

Breast TNM: N1

A

Mobile ipsilateral nodes

50
Q

Breast TNM: N2

A

Fixed nodes

51
Q

Breast TNM: M0

A

No distant mets

52
Q

Breast TNM: M1

A

Distant mets

53
Q

Further Ix if you suspect a patient of having mets

A

Liver USS
CXR
Bone scan

54
Q

What is another name for breast conserving surgery?

A

WLE - Wide local excision

55
Q

What does WLE involve

A

Excising tumour w/ 1cm margin
Making sure microscopically margins are clear

56
Q

When is a mastectomy used? (4)

A

Multifocal disease
High tumour:breast
Disease recurrence
Pt choice

57
Q

What are the 2 types of axillary surgery

A

Sentinel node biopsy
Axillary node clearance

58
Q

What is sentinel node biopsy

A

Remove the 1st LN into which tumour drains
This involves using a blue dye
Node is removed + sent for histological analysis

59
Q

What is Axillary node clearance

A

Remove all nodes in axilla

60
Q

What treatment is most surgery combined with?

A

Radiotherapy

61
Q

When to consider using chemo for Tx breast cancer

A

If nodal disease
High grade tumours

62
Q

Chemotherapeutic agents used in breast cancer (3)

A

Anthracyclines
Cyclophosphamides
methotrexate

63
Q

What additional Tx is given to pt who are either HER2 or ER +ve - pre-menopausal

A

5 y of tamoixfen

64
Q

What additional Tx is given to pt who are either HER2 or ER +ve - post menopausal

A

Aromastase inhibitors e.g. letrazole, aromisin

65
Q

What additional Tx is given to pt who are HER2 +ve

A

Herceptin

66
Q

If there are mets, what Tx is recommended

A

Surgery for Sx relief
Radiotherapy for palliation

67
Q

What is the NPI

A

Nottingham porgnostic index which assesses survival and risk relapse

68
Q

How is the NPI calculated?

A

Size (cm x 0.2) + grade (1-3) + nodes (0 = 1point, 1-3 = 2 points, >3 = 3 points)

69
Q

10 y survival rate (after surgery) NPI <2.4

A

95%

70
Q

10 y survival rate (after surgery) NPI 2.4-3.4

A

85%

71
Q

10 y survival rate (after surgery) NPI 3.4-4.4

A

70%

72
Q

10 y survival rate (after surgery) NPI 4.4-5.4

A

50%

73
Q

10 y survival rate (after surgery) NPI >5.4

A

20%

74
Q

Age at which breast cancer screening starts

A

47-50

75
Q

How often are women screen for breast cancer?

A

Every 3 years

76
Q

When does breast screening end

A

After 73 y/o

77
Q

If a women is older than 73 can she been screened?

A

No but she can request a scan

78
Q

Which type of breast cancer has the poorest prognosis?

A

HER2+

79
Q

which cancer is use of tamoxifen associated with?

A

Endometrial

80
Q

Mastectomy vs WLE - multifocal tumour

A

Mastectomy

81
Q

Mastectomy vs WLE - DCIS >4cm

A

Mastectomy

82
Q

Mastectomy vs WLE - DCIS <4cm

A

WLE

83
Q

Mastectomy vs WLE - peripheral tumour

A

WLE

84
Q

Mastectomy vs WLE - Central tumour

A

Mastectomy

85
Q

Mastectomy vs WLE - solitary lesion

A

WLE

86
Q

SE Axillary Node Clearance (3)

A

Lymphoedema
Cellulitis
Frozen shoulder

87
Q

What are the 4 types of ductal carcinoma in situ?

A

Comedo
Cribiform
Micropapillary
Solid

88
Q

Which DCIS is most likely to form microcalcifications?

A

Comedo

89
Q

When does DCIS require mastectomy? (3)

A

Multifocal
Large
High nuclear grade

90
Q

What is high nuclear grade DCIS associated with (2)

A

Loss p53
Increased erbB2

91
Q

Growth pattern - DCIS vs Lobular carcinoma in situ

A

Ductal - more common
Ductal - multigrowth pattern
Lobular - single growth pattern
Lobular - doesnt form microcalcifications

92
Q

Mx low grade lobular carcinoma in situ

A

Monitoring

93
Q

features of intraductal papilloma

A

blood stained discharge
usually no palpable lump

94
Q

age group intraductal papilloma

A

younger patients

95
Q

intraductal papilloma - benign or malignant?

A

benign

96
Q

biologic agent used in HER + breast cancers

A

Trastuzumab

97
Q

biologic agent used in HER + breast cancers

A

Trastuzumab

98
Q

Parasthesia post mastectomy - which nerve supplies patch under armpit

A

intercostobrachial

99
Q

what is a Phyllodes tumour

A

rare breast tumour of the stromal/connective tissue

100
Q

Are Phyllodes tumours benign or malignant?

A

benign

101
Q

Medullary breast cancer - defining feature

A

marked lymphocytic infiltrate

102
Q

prognosis medullary breast cancer

A

v good

103
Q

mucinous breast cancinoma - PS

A

soft breast lump
Macroscopically there is a grey, gelatinous surface

104
Q

prognosis mucinous breast carcinoma

A

v good

105
Q

Drugs causing gynaecomastia - DISCO

A

D igitalis
I soniazid
S pironolactone
C imetidine
O estrogen

106
Q

causes of gynaecomastia - METOCLOPERAMIDE

A

METOCLOPRAMIDE

M etoclopramide
E ctopic oestrogen
T rauma skull/tumour breast, testes
O rchitis
C imetidine, Cushings
L iver cirrhosis
O besity
P araplegia
R A
A cromegaly
M ethyldopa
I soniazid
D igoxin
E thionamide

107
Q

Paget’s disease of the nipple vs eczema of the nipple

A

eczema of the nipple will usually originate in the areolar area
pagets will usually originate in the nipple first and then spread to the areolar area

108
Q

Ix Paget’s disease of the nipple

A

punch biopsy

109
Q

why is tamoxifen associated with increased risk of endometrial cancer?

A

because although it acts as a oestrogen receptor antagonist in the breast
it can act as an oestrogen receptor agonist in the endometrium

110
Q

inflammatory breast carcinomas - aggressive or benign

A

aggressive

111
Q

inflammatory breast carcinomas - associated with which states

A

pregnancy
lactation

112
Q

BRCA1 positive young female screening

A

yearly breast MRI

113
Q

damage to long thoracic nn in axillary surgery –>

A

winging scapula

114
Q

damage to thoracodorsal trunk in breast surgery –>

A

loss of supply to the latissimus dorsi mm

MRCS A (36 decks)

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