breast

Question 1

when should someone be urgently referred for triple assessment

Answer 1

patient over 30 with an unexplained breast lump
patient over 50 with one sided nipple changes

Question 2

what is another name for herceptin

Answer 2

trastuzumab

Question 3

management of triple negative breast cancer

Answer 3

neoadjuvant chemo followed by surgery and adjuvant therapy

Question 4

what is the most common type of breast cancer

Answer 4

invasive ductal carcinoma

Question 5

classic vignette for candida of the nipple

Answer 5

following antibiotics (usually for mastitis)
painful, itchy nipples with flaky cracked skin around the areola

Question 6

how do you manage candida of the nipple

Answer 6

antifungal e.g. miconazole

Question 7

investigation needed in pagets disease of the nipple

Answer 7

need triple assessment as highly associated with underlying cancer

Question 8

management of oestrogen-receptor positive breast cancer in post-menopausal patients

Answer 8

aromatase inhibitors e.g. anastrozole

Question 9

management of oestrogen-receptor positive breast cancer in premenopausal women

Answer 9

tamoxifen

Question 10

mnemonic to remember presentation of phyllodes tumour

Answer 10

3F’s : forties, fast growing and fibroadenoma (presents like)

Question 11

who usually presents with phyllodes tumour

Answer 11

women in their 40-50s

Question 12

what does a phyllodes tumour feel like

Answer 12

fast growing, smooth, hard mass
can ulcerate in later stages

Question 13

describe the discharge commonly seen in mammary duct ectasia

Answer 13

thick, sticky green / yellow
can be bilateral

Question 14

most common differential for one sided clear, blood-stained nipple discharge and no palpable lumps

Answer 14

intraductal papilloma

Question 15

genetic mutation most commonly associated with breast cancer

Answer 15

BRCA

Question 16

antibiotic for lactational mastitis in penicillin allergic patient

Answer 16

erythromycin

Question 17

wedge shaped breast lump

Answer 17

mastitis

Question 18

most common primary site in patient with axillary lymphadenopathy that is cancerous

Answer 18

breast cancer

Question 19

microcalcifications on mamography

Answer 19

DCIS

Question 20

mechanism of action of tamoxifen

Answer 20

selective oestrogen receptor antagonist

Question 21

what is a seroma and when does it present

Answer 21

localised fluid accumulation beneath the skin surface, usually 7-10 days following surgery

Question 22

first line imaging of breast based on age

Answer 22

ultrasound preferred <35 as tissue is more dense
otherwise mammogram

Question 23

what needs to be monitored during the treatment of HER2 positive cancer and why

Answer 23

cardiac function - herceptin is known to cause cardiotoxicity

Question 24

clinical presentation of fat necrosis of the breast

Answer 24

recent history of trauma
small, painless, irregular and immobile lump

Question 25

what type of cancer is the BRCA gene linked to in men

Answer 25

prostate

Question 26

how does axillary web syndrome present

Answer 26

tight, painful, cord-like structures under the skin limited range of movement

Question 27

name some indications for a routine referral to breast clinic

Answer 27

Breast cancer in a first-degree male relative of any age Breast cancer in a first-degree relative under 40 Bilateral breast cancer in a first-degree relative under 50 Breast cancer in two first-degree relatives