Breast

Question 1

Fibroadenomas: common in women who are what age
> 3cm should be:
Any increased risk of malignancy?

Answer 1

<30 yrs
Excision core biopsied to exclude phyllodes tumour
No

Question 2

“Halo” appearance on breast US

Answer 2

Breast cyst

Question 3

Tamoxifen:
Used in:
Adverse effects:

Answer 3

Oestrogen receptor positve breast cancer

Menstrual disturbance: Vaginal bleeding, amenorrhoea
Hot flushes
VTE
Endometrial cancer (increased risk)

Question 4

Aromatase inhibitors adverse effects:

Answer 4

OSTEOPOROSIS (DEXA before initiating tx.)
Hot flushes
Arthralgia
Insomnia

Question 5

Duct papilloma:
Presents with:
Treatment:

Answer 5

Nipple discharge

Mircodochectomy

Question 6

Most common type of breast cancer:

Answer 6

Invasive ductal carcinomas

Question 7

Characteristics of tumour for mastectomy:

Answer 7

Central
multifocal 
Large lesion in small breast 
DCIS >4cm 
Patient choice

Question 8

Breast cancer prognostic tool:

Answer 8

Nottingham prognostic index:

Question 9

Most breast cancers are treated surgically:
If no palpable axillary lymphadenopathy:
If palpable axillary lymphadenopathy:

Answer 9

Pre-operative US should be done before surgery and if positive a sentinel node biopsy should be taken.

Axillary node clearance at primary surgery

Question 10

Axillary node clearance complications:

Answer 10

Lymphoedema of the arm and functional impairment

Question 11

Women who undergo WLE for breast cancer or Mastectomy for T3/4 tumours or with 4+ axillary lymphnodes should receive:

Answer 11

Radiotherapy

Question 12

Hormonal therapy:
given if:
Pre/peri menopausal women:
Post menopausal women

Answer 12

Hormone receptor positive

Tamoxfien

Aromatase inhibitor (As this would INDUCE menopause in a pre-menopausal woman)

Question 13

HER2 positive breast tumour biologic:

Answer 13

Herceptin (Trastuzumab)

Question 14

Urgent referral for Breast cancer assessment if:

CONSIDER urgent regerral if:

Answer 14

Aged 30 or over w/ unexplained breast lump
Aged 50 or over with unilateral symptoms of discharge or retraction

Skin changes that suggest breast cancer
Aged 30 or over with an unexplained lump in axilla

Question 15

Breast cancer risk factors:

Answer 15

Nulliparity
Late first pregnancy (<30 years)
Early menarche, late menopause (oestrogen exposure)
Obesity

Question 16

Breast cancer screening programme between which ages:

can women be offered at an earlier age:

Answer 16

50 - 70 yrs
After 70 women are encouraged to make own mammogram appts.
Yes, if deemed high risk

Question 17

Paget’s disease of the nipple:

Diagnose by:

Answer 17

Eczematoid change of the nipple assoc. w/ underlying breast malignancy

Punch biopsy, mammography and ultrasound of the breast.

Question 18

Cyclical mastalgia mx.

when to refer?

Answer 18

Advise wearing well supported bra
Oral and topical analgesia

Refer if pain unresponsive to conservative treatments after 3 months: Bromocriptine/danazol may be used.

Question 19

Dilation and shortening of terminal breast ducts resulting in creamy thick green nipple discharge in smoker

Management:

Answer 19

Duct ectasia

Pts. w/ troublesome nippple dishcharge may be treated with microdochectomy (young) or duct excision (older)

Question 20

Mastitis:
Organism:
Antibiotics:

Answer 20

Staph aureus most commonly

Flucloxacillin 10-14 days

Question 21

Benign cause of bloody nipple discharge:

Answer 21

Intraductal papilloma

Question 22

Nipple discharge plus mass =

Answer 22

Triple assessment

Question 23

Breats lump investigative imaging
>40 yrs
<35-40 yrs

Answer 23

Mammogram +/- US

Ultrasound