Quesmed Breas

Question 1

When are antibiotics indicated for mastitis?

Answer 1

Indications for oral antibiotics include if:
the woman has a nipple fissure that is infected
symptoms have not improved (or are worsening) after 12–24 hours despite effective milk removal
Breast milk culture is positive

Question 2

Which antibiotic is typically given?

Answer 2

Flucloxacillin

Question 3

Should patients continue breast feeding with mastitis?

Answer 3

Yes, as the blockage will worsen the pain due to lack of clearance of milk

Question 4

Wha is the most common cause of blood stained discharge in perimenopause’s women without a mass?

Answer 4

Intraductal papilloma, a mass in the breast duct

Question 5

What causes a fibrovascular core lined by both epithelial and myoepithelial cells?

Answer 5

Ductal papilloma

Question 6

How would fat necrosis appear on histology?

Answer 6

necrotic fat cells surrounded by inflammatory cells

Question 7

How is a malignant breast mass isolated to the breast with no distant spread managed?

Answer 7

Wide local excision with sentinel lymph node biospy

Question 8

What causes micro-calcifications on mammography?

Answer 8

Ductal carcinoma in situ

Question 9

What is the cutoff age for urgent referral to breast clinic with new unexplained breast mass?

Answer 9

Age over 30

Question 10

What is a common lesion in women who have stopped breast feeding?

Answer 10

Galactocele where milk stagnates in lactiferous ducts causing a mobile and tender cyst-like lesion

Question 11

What is mamma Ductal ectasia?

Answer 11

widening and thickening of the milk ducts within the breast. This can lead to the ducts becoming less patent, resulting in a build-up of fluid. Patients typically present with thick green nipple discharge, with associative nipple inversion

Question 12

What is a side effect of trastuzumab use?

Answer 12

Cardiotoxicity

Question 13

What are the aromatase inhibitor?

Answer 13

Anastrazole and lanatrazole
They can cause osteoporosis so bone density should be monitored

Question 14

What can a fibro-adenom be mistaken for?

Answer 14

Phyllodes tumour but this is more gast growing and can double in size quickly

Question 15

How do phylodes tumour and fibrosis-adenoma feel?

Answer 15

Firm non tender mobile lump

Question 16

What is a side effect of aromatase inhibitor?

Answer 16

Henoch-schonlein purpura
Abominable pain
High cholesterol
Arthralgia

Question 17

What is T1?

Answer 17

TUMOURS under 2cm

Question 18

What is N1?

Answer 18

Less than 4

Question 19

What is n2?

Answer 19

4-9 lymph nodes

Question 20

What is N3

Answer 20

More than 9

Question 21

What causes lumpiness in the breast associated with menstruation?

Answer 21

Fibrocystic disease of breast with breast pain

Question 22

What is a common development after biospy?

Answer 22

Fat necrosis of breast

Question 24

What should be offered with wide local excision?

Answer 24

Radiotherapy

Question 25

What is a common complication after axillary node dissection?

Answer 25

Axillary web syndrome

Question 26

When is tamoxifen used?

Answer 26

Oestrogen receptor modulator for patients with oestrogen receptor positive breast cancer

Question 27

When is anastrazole used?

Answer 27

Aromatase inhibitor used in post-menopausal patients with oestrogen receptor positive breast cancer

Question 28

When is surgical excision performed in benign breasay disease?

Answer 28

Surgical excision in fibrousadenoma if over 3cm is okay

Question 29

How is a pathological nipple discharge from a single Ductal treated?

Answer 29

Microdochectomies involve the surgical removal of a lactiferous duct

Question 30

What causes eczema like appearance of breast?

Answer 30

Paget’s disease a subsect of IDCIS

Question 31

What causes a mobile non tender clear lymp of breast?

Answer 31

Fibroadenoma

Question 32

What causes lumpy breasts worse in premenstrul period?

Answer 32

Fibroadenosis

Question 33

What causes tender lump around areola with green nipple dischagre?

Answer 33

Mammary duct ectasia

Question 34

How is pharyngeal pouch managed?

Answer 34

Surgical repair

Question 35

When are calcium channel blockers used in oesophageal pathology?

Answer 35

Oesopageal spasm

Question 36

What causes swelling and erythema of the breast with no discharge or mass?

Answer 36

Inflammatory breast cancer is likely with high CA 15-3

Question 37

When is mastectomy used?

Answer 37

Multi focal tumour, central tumour Large lesion in small breast DCIS over 4cm

Question 38

When is wide local excision used?

Answer 38

Small lesion in large breast DCIS less than 4cm Peripheral tumour Solitary lesion

Question 39

What indicates survival in breast cancer?

Answer 39

Nottingham prognostic index

Question 40

What should be performed in women with breast cancer and no palpable lymphadenoapthy?

Answer 40

Sentinel node biopsy

Question 41

When are antibiotics given for mastitis?

Answer 41

If effective removal of milk has not improved the symptoms of lactational mastitis after 12-24 hours flucloxacillin is the 1st line empirical treatment

Question 42

What is axillary node clearance associated with?

Answer 42

lymph accumulates, causing oedema and swelling, which in turn leads to sensations of heaviness, tightness, and weakness, along with a limited range of motion. These symptoms can manifest months to years post-surgery

Question 43

What is the action of anastrazole?

Answer 43

Inhibits peripheral oestrogen synthesis

Question 44

What is the actio of tamoxifen?

Answer 44

Selective oestrogen receptor antagonist

Question 45

When is chemotherapy idnicated?

Answer 45

For axillary node positive patients with FEC-D Fluoruacil Erythrocyin Cyclophosphamide Doxorubicin

Question 46

What is the treatment for HER2?

Answer 46

Trastuzumab: biological therapy Herceptin: hormonal therapy

Question 47

What are the side effects of aromatase inhibitors?

Answer 47

Osteoporosis Hot flushes Myalgia Insomnia

Question 48

What is reccomended when starting aromatase inhibitor?

Answer 48

DEXA scan

Question 49

What are the side effects of tamoxifen therapy?

Answer 49

Menstrual disturbance Hot flushes Venous thromboembolism Endometrial cancer

Question 50

What reduces recurrence of breast cancer after wide local excision?

Answer 50

Radiotherapy to the whole breast -> reduced risk by 2/3

Question 51

What is comedo necrosis indicate?

Answer 51

Ductal carcinoma, where comedo necrosis is a buildup of dead cancer cells forming an area of central necrosis

Question 52

What causes a grey gelatinous lump inside the breast?

Answer 52

Mucinous caricnoma which has a good prognsois, rare and axillary node disease is unlikely

Question 53

What does snowstorm sign on ultrasound indicate?

Answer 53

Extracapsular breast implant rupture due to leakage of silicone into the lymphatic system

Question 54

What is periductal mastitis?

Answer 54

Inflammation of the breast unrelated to breastfeeding. It is common in young female smokers

Question 55

What should be performed prior to breast surgery?

Answer 55

Axillary ultrasound, even in the abscence of aplapble lymphadenoapthy

Question 56

What does pain all over breast worse before menstruation with no lump in a woman under 30 mean?

Answer 56

Cyclical Mastalgia -> managed with supportive bra and paracetomol

Question 58

What is the referral for 30 and up?

Answer 58

New explained breast lump is always urgent referral

Question 59

What is the age range for breast cancer screening?

Answer 59

50-70 years old

Question 60

Which patients don’t need referral for breast cancer with family history?

Answer 60

Family history: age of diagnosis < 40 years bilateral breast cancer male breast cancer ovarian cancer Jewish ancestry sarcoma in a relative younger than age 45 years glioma or childhood adrenal cortical carcinomas complicated patterns of multiple cancers at a young age paternal history of breast

Question 62

What area is spared in Paget’s?

Answer 62

Areola

Question 63

What is the role of neo-adjuvant chemotherapy?

Answer 63

Downsize the tumour before the surgery to allow breast conserving surgery rather than mastectomy

Question 64

If pre operative ultrasound is positive, what is the next step?

Answer 64

Go straight to axillary lymph node lcearance

Question 65

What does positive axiallry lymph node and post mastectomy, residual tumour at resection margins indicate?

Answer 65

Ipsilateral chest wall and regional lymph node radiotherapy

Question 66

What is the difference between between cyclical mastalgia and fibricystic disease?

Answer 66

Fibrocystic must have lumpiness

Question 67

What csuses a tender flcutsnt mass in the breast while breastfeeding?

Answer 67

Breast abscess from staph aureus

Question 68

What causes creamy nipple discharge from multiple ducts

Answer 68

Duct ectasia