questions

Question 1

criteria if which present warrants treatment for mastitis

Answer 1

• systemically unwell
• nipple fissure present
• symptoms not improving after 12-24 hours of effective milk removed
• culture indicates infection

Question 2

Breast cancer referral for a woman over 30?

Answer 2

have an unexplained breast lump (with or without pain)

Question 3

Breast cancer referral for a woman over 50? with what symptoms in a single nipple?

Answer 3

• discharge
• retraction
  any other concerning changes

Question 4

pattern of eczematous skin changes occuring in

a) pagets disease
b) eczema

Answer 4

in Pagets: involves the nipple primarily and only latterly spreads to the areolar

opposite in eczema

Question 5

how is diagnosis of pagets disease of breast made?

Answer 5

• punch biopsy
• mammogram
• USS

Question 6

prior to surgery what is the management in presence & absence of palpable axillary lymphadenopathy?

Answer 6

• palpable: axillary node clearance at primary surgery

- non palpable: pre-operative axillary ultrasound

Question 7

management if woman with no palpable axillary lymphadenopathy has pre-operative axillary ultrasound
- if positive
?

Answer 7

positive: sentinel node biopsy?

Question 8

4 types of breast cancer features that make wide local excision the choice of surgery over mastectomy?

Answer 8

• solitary lesion
• peripheral tumour
• small lesion in large breast
• DCIS < 4cm

Question 9

4 types of breast cancer features that make mastectomy the choice of surgery over wide local excision?

Answer 9

• multifocal tumour
• central tumour
• large lesion in small breast
• DCIS > 4 cm

Question 10

what treatment should always be offered following wide local excision & why?

Answer 10

radiotherapy

as this may reduce the recurrence by 2/3rds.

Question 11

which women require radiotherapy following mastectomy?

Answer 11

for T3-T4 tumours

and those with 4 or more positive axillary lymph nodes

Question 12

hormonal therapy of choice for post menopausal women with oestrogen receptor positive tumours?

Answer 12

Aromatase inhibitors = anastrozole or letrozole

Question 13

important side effects of tamoxifen?

Answer 13

• VTE
• Menopausal symptoms
• increased risk of endometrial cancer

Question 14

who is contraindicated for trastuzumab?

Answer 14

• patients with a hx of heart disorders

Question 15

when can neoadjuvant chemo be used?

Answer 15

either prior or after surgery in a number of criteria e.g. if have axillary node disease

Question 16

marker used to montor response to breast cancer treatment & disease recurrence

Answer 16

CA 15-3

Question 17

apearance of breast in inflammatory breast cancer

Answer 17

progressive, erythema and oedema of the breast

Question 18

typical symptoms of duct ectasia?

Answer 18

• greenish nipple discharge
• peri-areolar lump
• around menopause
• slit like retraction of nipple
• cheese like discahrge

Question 19

why does duct ectasia occur?

Answer 19

reflects a shortening and widening of the terminal breast ducts around th enipple

Question 20

discrete soft fluctuant areas in UOQ & mammogram halo sign

Answer 20

breast cyst

Question 21

what is the major adverse effect of aromatase inhibitors?

Answer 21

osteoporosis

Question 22

episode of clear nipple discharge which has blood when tested & originates from a single duct

Answer 22

intraductal papilloma

Question 23

comedo necrosis

Answer 23

feature of high nuclear grade ductal carcinoma in situ

Question 24

grey gelatinious surface when lump is sliced apart

Answer 24

mucinous carcinoma

Question 25

Most common in middle-aged women

‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation

Answer 25

Fibroadenosis

fibrocystic disease, benign mammary dysplasia

Question 26

whos given trastuzumab?

Answer 26

HER2 positive

Question 27

blood stained discharge is most likely associated with:

Answer 27

duct papilloma

Question 28

what does ‘snowstorm’ sign on ultrasound of axillary lymph nodes indicate?

Answer 28

extracapsular breast implant rupture?

Question 29

fibroadenoma > 3 cm and causing patient moderate discomfort?

Answer 29

surgical excision

Question 30

side effects of tamoxifen (4)

Answer 30

• post menopausal symptoms (vaginal dryness, nausea, low libido, hot flushes)
• cataracts
• DVT
• endometrial thickening

Question 31

when other than breast ca may tamoxifen or danazol be indicated?

Answer 31

severe, prolonged cyclical breast pain which hasn’t improved with standard treatment

Question 32

risk factors for non breastfeeding breast abscess

Answer 32

• smoking
• diabetes
• nipple piervcing
• immunocomprimised

Question 33

tramline’ appearance of breast arterial calcification

Answer 33

associated with increasing age, diabetes, CVD

Question 34

what drug can be used for chemoprevention in women with BRCA gene mutation

Answer 34

tamoxifen