Breast

Question 1

What are the relevant anatomical structures for breast-related pathologies?

Answer 1

Nipple
Lobules
Milk ducts
Fatty tissue

Question 2

What is duct ectasia?

Answer 2

Blockage of the milk ducts

Question 3

What is the epidemiology of duct ectasia?

Answer 3

Peri/post menopausal women (40-50+)

Question 4

What is a fibroadenoma?

Answer 4

Benign breast tumour

Question 5

What is the epidemiology of fibroadenomas?

Answer 5

Young women of child-bearing age

Question 6

What is a breast cyst?

Answer 6

Fluid filled sac in the breast

Question 7

What is the epidemiology of breast cysts?

Answer 7

Pre-menopausal women (30-40s)

Question 8

What should you ask when a Pt presents with a breast lump?

Answer 8

Site, size, skin, single
Colour, contour, consistency
Tenderness, temperature, transilluminable
Fluctuant, fixed

Question 9

What are the characteristics of duct ectasias?

Answer 9

Small lump behind nipple, nipple inversion
Discharge (watery/thick/blood stained/green), firm consistency
Tender
Fixed

Question 10

What are the characteristics of fibroadenomas?

Answer 10

1-5cm, single
Well demarcated, firm consistency, highly mobile
Non-tender

Question 11

What are the characteristics of breast cysts?

Answer 11

Single
Well demarcated, highly mobile
Non-tender, transilluminable
Fluctuant

Question 12

What are the investigations for duct ectasias?

Answer 12

Biopsy

Question 13

What are the investigations for fibroadenomas?

Answer 13

FNA

USS/mammography

Question 14

What are the investigations for breast cysts?

Answer 14

FNA

USS/mammography

Question 15

What is the management for duct ectasias?

Answer 15

Self limiting

Question 16

What is the management for fibroadenomas?

Answer 16

Surgical- cryoablation, excision

Medical- ormeloxifene

Question 17

What is the management for breast cysts?

Answer 17

FNA/fluid drain

Question 18

What is the epidemiology of breast cancer?

Answer 18

Most common cancer in the UK
Most common cause of death in women 35-55yrs
1 in 8 are diagnosed with breast cancer

Question 19

What are the risk factors for breast cancer?

A FROG MAN

Answer 19

Age
FHx
Radiation exposure
Obesity and OCP
Genetics
Menarche/menopause
Alcohol
Nulliparity (not having children)

Question 20

What are the characteristics of breast cancer?

Answer 20

Increased size, lump in breast/armpit, skin thickening, peau d’orange, skin dimpling, discharge, inversion.
Hard lump, irregular margin, redness.
Tenderness, warm, tethered to underlying tissue.

Question 21

What are the investigations for breast cancer?

Answer 21

Triple assessment:

• history and exam
• mammography/USS (if young)
• fine needle aspiration cytology

Question 22

What is the management for breast cancer?

Answer 22

Removal of tumour and LNs
ER antagonists (tamoxifen)
Aromatase inhibitors (letrozole)
Chemotherapy (cyclophosphatamide, doxorubicin)
Monoclonal antibodies (trastuzumab)
Radiotherapy to reduce recurrence

Question 23

What is mastitis?

Answer 23

Inflammation of the breast

Can develop into an abscess

Question 24

What is the epidemiology of mastitis?

Answer 24

Breastfeeding women- milk stasis
Immunocompromised- HIV/AIDS, diabetes, chronic illness
Primiparous (given birth to 1 child)
Over 30

Question 25

What is the characteristics of mastitis?

Answer 25

Generalised swelling of the breast Red, firm, very tender, warm to touch Flu-like symptoms (fever, aches, chills, fatigue)

Question 26

What are the investigations for mastitis?

Answer 26

Clinical diagnosis | Can do USS/biopsy

Question 27

What is the management for mastitis?

Answer 27

Encourage breastfeeding Analgesia Antibiotics

Question 28

What is the management for breast abscesses?

Answer 28

US guided FNA | Surgical excision and drainage

Question 29

A 60 year old obese woman presents to her GP with a lesion on her breast. The lesion is red, crusted, around her right nipple. The most likely diagnosis is: ``` A. Breast cyst B. Breast abscess C. Paget’s disease of the breast D. Fibroadenoma E. Fibrocystic disease ```

Answer 29

C. Paget’s disease of the breast

Question 30

22 year old woman presents to clinic with a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable. The most likely diagnosis is: ``` A. Acute mastitis B. Breast abscess C. Breast cyst D. Fibroadenoma E. Periductal mastitis ```

Answer 30

D. Fibroadenoma

Question 31

A 21 year old woman presents to her GP with pain in her right breast. She has just given birth to her first child. On examination, right breast appears swollen, red and there is tenderness on palpation. You do not suspect there are any abscesses present. The most appropriate management plan would be: A. Antibiotics B. Refer to surgeon for incision and drainage C. Refer to breast feeding support group and prescribe analgesia D. Watch and wait E. Confirm diagnosis with USS

Answer 31

C. Refer to breast feeding support group and prescribe analgesia

Question 32

Risk factors for developing breast cancer include: ``` A. Having only one child B. Early menarche C. Early menopause D. Anaemia E. HIV/AIDS ```

Answer 32

B. Early menarche

Question 33

A 56 year old woman presents to her GP after noticing a breast lump 3 weeks ago. On examination, the lump is 3 cm in diameter, firm and tethered to the skin and immobile. There are no overlying skin changes. The next most appropriate investigation is: ``` A. Total mastectomy B. Urgent mammogram C. Urgent USS D. FNAC E. Core biopsy ```

Answer 33

B. Urgent mammogram

Question 34

A 22 year old medical student presents to her GP complaining of ‘lumpiness’ in her breasts and nipple discharge for 2 weeks. She is concerned as her mother, who had breast cancer, had the same symptoms before she was diagnosed. What is the next most appropriate investigation? ``` A. Refer for urgent mammogram B. Refer for urgent USS C. Blood hCG levels D. Reassure and discharge E. CT Head ```

Answer 34

C. Blood hCG levels

Question 35

BRCA gene mutations are associated with breast and which other type of cancer? ``` A. Biliary B. Uterine C. Gastric D. Ovarian E. Colon ```

Answer 35

D. Ovarian

Question 36

A 30 year old female presents with a bruise on her breast. O/E The underlying tissue is tender and lumpy. When asked about trauma, she says she was injured whilst playing a rugby match. What is the most likely diagnosis? ``` A. Fibroadenoma B. Fat necrosis C. Paget’s disease of the breast D. Mastitis E. Duct ectasia ```

Answer 36

B. Fat necrosis

Question 37

9. Which of the following statements regarding breast disease is FALSE? A. Orange peel skin may be a sign of inflammatory breast cancer B. Ulcerated breast lumps are generally not concerning C. Alcohol intake is a modifiable risk factor for breast cancer D. Women ages 50-70 are offered routine screening every 3 years E. USS are more suitable for women aged <35 years

Answer 37

B. Ulcerated breast lumps are generally not concerning