Breast

Question 1

differences between a discrete lump + localised nodularity

Answer 1

discrete lump

• stands out from adjoining tissue
• has definable borders
• is measurable

Question 2

name 7 factors that make a patient more likely to warrant hospital referral

Answer 2

• lump
• pain
• nipple discharge
• nipple retraction or distortion
• nipple eczema
• change in skin contour
• family history

Question 3

2 views on mammography

Answer 3

mediolateral oblique view + cranio-caudal

Question 4

why are breasts compressed in mammography

Answer 4

spread out glandular tissue of the breast, reducing overlapping structures

Question 5

first line imaging in women < 35 years

Answer 5

ultrasound imaging

Question 6

what is ultrasonography?

Answer 6

high frequency sound waves beamed through breast; reflections are detected + turned into images

Question 7

Ultrasound appearance of:

• cysts
• cancers

Answer 7

cysts = transparent objects

(other benign lesions have well demarcated edges)

cancers = indistinct outlines

Question 8

what is colour flow doppler ultrasound used for

Answer 8

Images the blood flow to lesions

Question 9

what is the blood flow to malignant lesions?

Answer 9

have greater blood flow than benign lesions

Question 10

what is the value of MRIs in breast assessment

Answer 10

• assess extent of invasive lobular cancers; sometimes not well seen on mammography
• optimum method for imaging breast implants
• high risk women between 35 and 50 years

Question 11

What is the role of FNAC or needle core biopsy?

Answer 11

establish diagnosis without need for surgical excision

Question 12

1-5 scale for each component of tripple assessment

Answer 12

1 - normal 
2 - benign 
3 - intermediate/probs benign 
4 - suspicious 
5 - malignant

Question 13

2 indications for breast imaging

Answer 13

1) symptomatic

2) breast screening

Question 14

frequency of breast screening

Answer 14

every 3 years from 47 to 73 years of age

Question 15

management of: breast mass + localised nodularity?

Answer 15

clinical + imaging assessment with biopsy

Question 16

investigation for presentation of galactorrhea?

Answer 16

• associated with: pregnancy or breastfeeding
• check prolactin levels
• investigate for pituitary tumours

Question 17

what is nipple retraction

Answer 17

slit like retraction: characteristic of benign disease

Question 18

what is nipple inversion?

Answer 18

whole nipple is pulled inwards

occurs in association with both breast cancers + inflammatory conditions

Question 19

incidence of breast cancer

Answer 19

1 in 8

Question 20

cause of arm swelling following breast cancer?

Answer 20

axillary node clearance –> causes lymphoedema

Question 21

breast changes in breastfeeding

Answer 21

• breasts feel firmer and larger

Question 22

ultrasound changes in breastfeeding breast

Answer 22

• glandular enlargement
• engorgement of breast tissue
• duct dilatation

Question 23

mammographic changes in breast feeding breasts

Answer 23

increases in breast size + density

Question 24

what are the structures seen on a Mammogram

Answer 24

• axillary lymph nodes (in oblique view)
• pectoralis major (oblique view)
• fibroglandular tissue
• fatty tissue

Question 25

what is Paget's disease?

Answer 25

when bone interfers with bodys normal recycling process and new bone and tissue gradually replaces old bone tissue; over time the disease can cause bone to become fragile

Question 26

most commonly affected areas by pagets disease

Answer 26

- pelvis - skull - spine - legs

Question 27

inspection on breast examination

Answer 27

- size - symmetry - lumps - breast distortion - tethering - skin changes - scars from previous surgery - discharge from nipples - change positions to accentuate any lumps

Question 28

3 positions to ask patient to do in breast examination

Answer 28

1) raise arms above head 2) hands on hips + press downwards + forwards 3) lie flat on couch with one arm above head + only expose the breast on that side

Question 29

how to palpate?

Answer 29

concentric movements of (flat of) hands around the breast, also: areolar

Question 30

what is skin tethering

Answer 30

when the lump is attached to the skin; pulling the skin inwards producing a dimple

Question 31

what is skin fixation

Answer 31

lump can not be moved without moving the skin

Question 32

who is offered breast screening?

Answer 32

all women between 47 and 73, every 3 years

Question 33

can you still have breast screening if above 70 years

Answer 33

yes but you need to ask your local breast screening unit

Question 34

duration of breast screening appointment

Answer 34

< 30 mins

Question 35

preparations to take for breast screening

Answer 35

do not wear talcum powder or deodorant as this can cause artefacts

Question 36

contact breast screening unit prior to appointment if: (5)

Answer 36

- physical disability or find climbing stairs difficult - pregnant - had a mammogram recently - breastfeeding - have breast implants

Question 37

when will i get results from breast screenigng

Answer 37

within 2 weeks

Question 38

what % women asked to come back for further testing following breast screen and of these how many will have cancer

Answer 38

4 in 100 and 1 will have cancer

Question 39

which additional women are now screened for breast cancer under NHS breast screening programme

Answer 39

BRCA1/2 mutation Tp53 mutation Previous supradiaphragmatic radiotherapy for Hodgkins lymphoma

Question 40

who reads the mammogram?

Answer 40

independently by 2 trained film readers