Boobies

Question 1

Fat necrosis?

Answer 1

Direct trauma to the breast
e.g. accident, breast surgery
Fibrosis
Foam cells
Lymphocytosis
Skin tethering

Question 2

Acute mastitis?

Answer 2

Milk stasis leading to infection with S. Aureus
Poor attachment of baby
Continue feeding

Question 3

Most common benign breast tumour?

Answer 3

Fibroadenoma

Question 4

Fibroadenoma?

Answer 4

Stag-horn cell arrangement

Changes size with oestrogen exposure

Question 5

Serous/bloody nipple discharge?

Answer 5

Intraductal papilloma

Fibrovascular stalk

Question 6

Phyllodes tumour?

Answer 6

Leaf like cell tumour

Question 7

Intraductal carcinoma in Situ

Answer 7

Non palpable
No basement membrane penetration
E-Cadherin present
Myoepithelium cell layer in tact
Calcifications

Question 8

Interlobular carcinoma in Situ?

Answer 8

Non palpable
No basement membrane penetration
E-Cadherin not present

Question 9

Invasive lobular carcinoma?

Answer 9

Single file arrangement of cells
Progression of LCIS
Can occur bilaterally

Question 10

Most common malignant tumour?

Answer 10

Invasive ductal carcinoma

Question 11

Invasive ductal carcinoma?

Answer 11

Firm breast mass

Metastasises to the lung - cannonball

Question 12

Paget’s disease of the breast?

Answer 12

Arises from DCIS
Cells move from duct to dermis
Erythematous, scaly, crusted lesion
Histology - clear halo - excess cytoplasm - Paget cell

Question 13

Inflammatory carcinoma?

Answer 13

Peau d’Orange
Invasion of dermal lymphatics
Skin dimpling

Question 14

Breast screening programme?

Answer 14

Every 3 years
47-73
Mammogram - 4 images

Question 15

Incidence of breast cancer?

Answer 15

1 in 8 women

Question 16

Benefit of screening?

Answer 16

43 deaths prevented for every 10,000

Question 17

What happens at breast clinic?

Answer 17

Triple assessment
Clinical assessment
Mammogram
Ultrasound

Question 18

What is Cowden’s syndrome?

Answer 18

PTEN gene mutation
Breast cancer
Thyroid cancer
Uterine cancer
Hamartomatous lesion of skin

Question 19

Genes involved with breast cancer risk?

Answer 19

BRCA1 - 65-85%
BRCA2 - 40-85%
TP53 - young age 
PTEN
ATM
CHEK2
BRIP1
PALB2

Question 20

Risk factors for breast cancer?

Answer 20

Gene carrier
Age
Family history
Nulliparity
No breastfeeding
Early menarche
Late menopause
Chest radiation
Obesity + western diet
Alcohol consumption
HRT
Combined pill

Question 21

What is lymphedema?

Answer 21

Swelling in arms/legs caused by abnormal drainage in your lymphatic system

Question 22

Causes of lymphedema?

Answer 22

Primary - congenital malformation of lymphatic system
Secondary:
Removal of nodes
Radiotherapy
Infection
Trauma
DVT
Inflammation 
Overweight or immobile

Question 23

Symptoms of lymphedema?

Answer 23

Uncomfortable swelling
Restriction of movement
Heaviness/aching limb
Tight skin
Leaking clear fluid
Skin thickening

Question 24

Complication of lymphedema?

Answer 24

Cellulitis

Red, hot, painful, swollen skin with fever

Question 25

Risk reduction of breast cancer?

Answer 25

Avoid hormonal contraception in high risk patient Limit alcohol consumption Smoking cessation Weight loss advice Tamoxifen - reduce risk in high risk patients Bilateral prophylactic mastectomy - very high risk patients

Question 26

Why multimodality examination at breast clinic?

Answer 26

Allows for differentiation between benign and malignant growths Mammogram - detect lumps not yet palpable Better idea of prognosis Less false-positives Less false-negatives

Question 27

Risk of mammogram?

Answer 27

Worry factor Over diagnosis False reassurance Risk of radiation

Question 28

Reasons for wide local excision?

Answer 28

Solitary lesion Peripheral tumour Small lesion in large breast DCIS <4cm

Question 29

Post wide local excision?

Answer 29

Whole breast radiotherapy | Recurrence reduces by 2/3

Question 30

Reasons for mastectomy?

Answer 30

Central lesion Multifocal tumour Large lesion in small breast DCIS >4cm

Question 31

When do you give radiotherapy post mastectomy?

Answer 31

T3 and T4 tumours

Question 32

Oestrogen receptor positive tumour treatment?

Answer 32

Pre-menopause - tamoxifen Peri-menopause - tamoxifen Post-menopause - anastrozole

Question 33

Side effects of tamoxifen?

Answer 33

Risk of endometrial cancer VTE Menopausal symptoms

Question 34

Treatment for HER2 positive patients?

Answer 34

Trastuzumab | Cannot be given with history of heart disorders

Question 35

Bilateral, colourless nipple discharge

Answer 35

Hormonal changes

Question 36

Duct ectasia?

Answer 36

Dilation in breast ducts Thick, green discharge Slit like retraction of the nipple Most common in smokers

Question 37

Other cause of breast discharge?

Answer 37

Hyperprolactinemia

Question 38

Snowstorm sign?

Answer 38

Implant rupture

Question 39

BRCA1 inheritance?

Answer 39

50%

Question 40

Pathogen causing breast abscess?

Answer 40

S. Aureus

Question 41

Fibroadenosis

Answer 41

Multiple fibroadenomas Painful, lumpy breasts Affected by hormones