Exam 6- breast

Question 1

Smooth discrete lumps, sometimes painful, often seen in pre-menopausal women

Answer 1

Fibrocystic change

Question 2

Painless, highly mobile mass which is the commonest breast lump in younger women

Answer 2

Fibroadenoma

Question 3

Triple assessment of a breast lump (3)

Answer 3

Clinical exam
Imaging (US/MRI/mammogram)
Biopsy (core needle)

Question 4

Caused by trauma to adipose tissue, usually in obese women?

Answer 4

Fat necrosis

Question 5

Tender lump + green discharge

Answer 5

Mammary duct ectasia

Question 6

Red, hot, tender mass in lactating woman

Answer 6

Breast abscess

Question 7

Young female smoker + tender discharging lump

Answer 7

Periductal mastitis

Question 8

Lump with blood-stained discharge

Answer 8

Duct papilloma

? breast cancer

Question 9

Two main types of sclerosing breast lesions

Answer 9

Sclerosing adenosis

Radial scar

Question 10

Treatment of duct papilloma

Answer 10

Microdochectomy or total duct excision

Question 11

Bilateral pain in the outer half of the breast, usually in relationship to menstrual cycle

Answer 11

Cyclical mastalgia

Question 12

Main types of breast cancer; which is commonest?

Answer 12

Ductal and lobular. Ductal is more common

Question 13

Most common presenting symptom of breast cancer. Other symptoms? (4)

Answer 13

Lump which may or may not be painful.

Nipple changes (Paget's, inversion)
Skin changes (peau d'orange)
Lymphoedema of the arm
Nipple discharge

Question 14

Tumour marker for breast cancer?

Answer 14

CA 15-3

Question 15

When is a mastectomy preferred over wide local excision?

Answer 15

Big tumour (>4cm) or multifocal

Question 16

Guidelines for radiotherapy use in breast cancer (2)

Answer 16

After WLE

After mastecomy if axillary nodes are positive

Question 17

Hormonal therapy for ER+ breast cancers? (2)

Answer 17

Pre-menopause: tamoxifen

Post-menopause: aromatase inhibitors

Question 18

What is the clinical significance of HER+ status?

Answer 18

Tamoxifen is less effective; trastuzumab (herceptin) can be used

Question 19

Specific breast ca. risk factors (4)

Answer 19

Family Hx (BRCA)
Nulliparity, early menarche, late menopause
HRT
Combined oral contraceptive

Question 20

Which subtype of breast cancer carries the worst prognosis?

Answer 20

Triple negative

Question 21

What is the Nottingham prognostic index?

Answer 21

A scoring system which accounts for diameter, grade and lymph node status

Question 22

In WLE what distance of margins are aimed for?

Answer 22

1cm

Question 23

Sources of autologous material for breast reconstruction? (4)

Answer 23

Lat dorsi
Transversus rectus abdominus
Inferior gluteal (IGAP) flap
Deep inferior epigrastric (DIEP) flap

Question 24

Options for detecting axillary node status? (2) Treatment options for positive nodes?

Answer 24

Ultrasound + core biopsy
Sentinel node biopsy

Treatment- axillary clearance, radiotherapy

Question 25

Acute side effects of radiotherapy (3)

Answer 25

Skin erythema, moist desquamation Tiredness Dysphagia (supraclavicular fossa)

Question 26

What is comedo necrosis and what is it associated with?

Answer 26

Cancer cells "plug" the duct and become necrosed. Its a feature of high grade ductal carcinoma

Question 27

Nerves frequently injured during axillary dissection?

Answer 27

Intercostobrachial

Question 28

Painless breast lumps secondary to protein plugs blocking the outlet of the mammary glands?

Answer 28

Galactocele