Breast

Question 1

How does the appearance of Paget’s disease differ from eczema of the breast ?

Answer 1

Paget’s disease includes the nipple and spares the areola (the opposite happens in breast eczema)

Question 2

Mobile firm lump

Answer 2

Fibroadenoma

Question 3

What is the management of Fibroadenoma?

Answer 3

If >3cm surgical excision is usual

Question 4

HALO sign with a smooth discrete lump

Answer 4

Breast Cyst

Question 5

Blood stained nipple discharge

Answer 5

Intraductal papilloma

Question 6

Cheese like discharge, often post-menopausal

Answer 6

Duct Ectasia

Question 7

Middle aged female
Symptoms worse before menustration
Painful breast

Answer 7

Fibroadenosis

Question 8

Women <30 yrs presents with an unexplained breast lump with or without pain, what type of referall?

Answer 8

Non-urgent referall

Question 9

What DCIS will prompt wid local excision and what a mastectomy?

Answer 9

if above 4 then mastectomy,
if bellow wide local excision

Question 10

When is axillary node clearance required ?

Answer 10

at sentinel node biopsy, less than 3 involved nodes are found then no further management of the axilla is required, if more than 3 nodes are involved then axillary node clearance is indicated

Question 11

How do you manage lactational mastitis?

Answer 11

1. 24 hours of effective removal of milk

2.If there is no improvement after 12-24 hours then oral flucloxacillin should be prescribed. (10 days)

Question 12

What is the breast screening program (age-modality)?

Answer 12

Ages 50-70 (women over 70 can request theirs and are not routinely called)

Women are offered a mammogram every 3 years.

Question 13

for women under 35 yrs what modality is prefered ?

Answer 13

USS

Question 14

Oestrogen receptor positive breast cancer

Answer 14

If pre-menopausal then TAMOXIFEN (oestrogen receptor-selective antagonism)

If post-menopausal then ANASTROZOLE (targets aromatization reaction)-LETROZOLE
Perform DEXA scan due to risk for osteoporosis

Question 15

Cyclical Mastalgia, how to manage?

Answer 15

Management:
1. Women should be wearing supportive bra
2. Standard oral and topical analgesia
3. If the pain has not responded to conservative measures after 3 months, and is affecting the quality of life or sleep, then referral should be considered

Question 16

HER-2 receptor positive

Answer 16

HERCEPTIN (biological agent) (trastuzumab