Breast week Flashcards by Holly Croxford

Which benign tumour most commonly causes nipple discharge?
A. Phyllodes
B. Papilloma
C. Lipoma
D. Fibroadenoma
E. Hamartoma

Correct answer: B

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Age 30 with sclerosing adenosis
Likely symptom?
A. Fever
B. Burning unilateral pain
C. Mass or focal pain
D. Nipple retraction
E. Peau d’orange

Correct answer: C

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Painful nodularity improves post‑menopause
A 52‑year‑old experiences relief from breast nodularity after menopause.
Most likely diagnosis?
A. Fibrocystic changes
B. Lipoma
C. Fibroadenoma
D. Radial scar
E. Phyllodes tumour

Correct answer: A

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Triple assessment components
Which combination is correct?
A. Clinical exam + ultrasound only
B. Ultrasound + mammogram
C. Clinical exam + imaging + histology
D. FNA + MRI + biopsy
E. Physical exam + blood tests

Correct answer: C

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Blue‑domed cyst histology
Which is true?
A. Thick‑walled apocrine cyst
B. Thin‑walled apocrine‑lined cyst
C. Fibrofatty tumour
D. Contains stromal overgrowth
E. Ductal epithelial papillary fronds

Correct answer: B

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Which benign tumour resembles fibroadenoma but grows faster?
A. Hamartoma
B. Lipoma
C. Phyllodes tumour
D. Radial scar
E. Intraduct papilloma

Correct answer: C

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A stable fibroadenoma confirmed via triple assessment.
Management?
A. Surgical excision
B. Reassurance only
C. Radiofrequency ablation
D. MRI surveillance
E. Chemotherapy

Correct answer: B

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38‑year‑old with well‑circumscribed fatty breast lump which is soft, mobile, painless.
Diagnosis?
A. Hamartoma
B. Lipoma
C. Fibroadenoma
D. Sclerosing adenosis
E. Abscess

Correct answer: B – Lipoma

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In which scenario is imaging not needed?
A. Classic cyclical mastalgia in a 25‑year‑old
B. Bloody nipple discharge
C. Growing breast lump
D. Unilateral hard mass
E. Palpable thickening in woman >50

Correct answer: A

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23‑year‑old with tender, cyclical breast lump.
A lump enlarges pre‑menses and becomes less obvious afterward.
Most likely diagnosis?
A. Fibroadenoma
B. Fibrocystic changes
C. Lipoma
D. DCIS
E. Phyllodes tumour

Correct answer: B – Fibrocystic changes

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A lesion appears papillary on ultrasound.
Investigation of choice?
A. FNA
B. Core needle biopsy
C. PET scan
D. MRI
E. Blood tests

Correct answer: B – Core needle biopsy
Rule‑in: Needed to differentiate papilloma from carcinoma.
Rule‑out:
FNA insufficient to assess atypia.

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A 45‑year‑old has an enlarging breast mass suspected to be a borderline Phyllodes.
Management?
A. Observe
B. Wide local excision
C. Lumpectomy without margins
D. Radiation alone
E. Needle aspiration

Correct answer: B – Wide local excision
Rule‑in: Required to prevent recurrence.
Rule‑out:
Others inadequate or inappropriate.

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55‑year‑old with firm, rapidly enlarging breast mass. A firm, rapidly enlarging breast lump is noted. Core biopsy shows stromal overgrowth.
Diagnosis?
A. Fibroadenoma
B. Phyllodes tumour
C. Lipoma
D. Abscess
E. Hamartoma

Correct answer: B – Phyllodes tumour
Rule‑in: Fast growth + stromal overgrowth.
Rule‑out:
A: Slow growth
C: Fatty
D: Painful, red, febrile
E: Contains mixed normal tissues

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Stellate lesion on mammography
A star‑shaped lesion with translucent centre is seen incidentally.
Most likely diagnosis?
A. Radial scar
B. Phyllodes tumour
C. Lipoma
D. Fibroadenoma
E. Hamartoma

Correct answer: A – Radial scar
Rule‑in: Stellate/rosette mammographic pattern.
Rule‑out:
Others do not show this pattern.

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A 40‑year‑old woman has unilateral bloody nipple discharge, but no mass.
Most likely diagnosis?
A. Intraduct papilloma
B. Fibrocystic disease
C. Mastitis
D. DCIS
E. Phyllodes tumour

Correct answer: A – Intraduct papilloma
Rule‑in: Classic: bloody discharge, no mass.
Rule‑out:
B: Usually pain + cysts
C: Signs of infection
D: Usually abnormal imaging + calcifications
E: Forms a mass

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Clear cystic lesion with blue‑domed appearance is a breast lesion on imaging. It is thin‑walled, multiple, and contains pale fluid.
Most likely diagnosis?
A. Fibrocystic changes
B. Fibroadenoma
C. Lipoma
D. Phyllodes tumour
E. Intraduct papilloma

Correct answer: A – Fibrocystic changes
Rule‑in: Blue‑domed cysts, multiple, benign.
Rule‑out:
B: Solid tumour
C: Fat only
D: Fast‑growing stromal lesion
E: Nipple discharge typically

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A 38‑year‑old has bilateral breast pain, normal exam and normal mammogram. She is very anxious.
Best management?
A. Tamoxifen
B. Reassurance
C. Excision biopsy
D. MRI
E. Antibiotics

Correct answer: B – Reassurance
Rule‑in: Mastalgia with normal exam + normal imaging.
Rule‑out:
A: Only for severe refractory pain
C: No mass
D: Unnecessary
E: No infection

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A 24‑year‑old woman finds a smooth, rubbery, highly mobile breast lump <3 cm “breast mouse”.
Diagnosis?
A. Phyllodes tumour
B. Fibroadenoma
C. Hamartoma
D. Lipoma
E. Radial scar

Correct answer: B – Fibroadenoma
Rule‑in: Young woman, mobile, well‑defined, “breast mouse”.
Rule‑out:
A: Larger/faster growth
C: Contains fat + glandular tissue; “breast within breast” on imaging
D: Soft, fatty
E: Stellate mammogram finding

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A 32‑year‑old woman reports bilateral breast pain that worsens 1–2 weeks before menstruation and improves afterwards. No lumps are felt.
Most likely diagnosis?
A. Fibroadenoma
B. Fibrocystic changes
C. Non‑cyclic mastalgia
D. Intraduct papilloma
E. Phyllodes tumour

Correct answer: B – Fibrocystic changes
Rule‑in: Cyclical, hormone‑related pain; common in 20–50 years.
Rule‑out:
A: Usually painless, mobile lump
C: Non‑cyclic is unilateral, sharp/stabbing
D: Gives nipple discharge
E: Fast‑growing mass, not cyclical

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A 56‑year‑old woman presents for breast screening. She had menarche at 11, menopause at 57, first pregnancy at 34, and has been on HRT for 3 years. BMI 31. Which single factor below is NOT a recognised risk factor for breast carcinoma?
A. Early menarche
B. Late menopause
C. Obesity (postmenopausal)
D. First pregnancy before age 25
E. HRT use

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Correct: D – First pregnancy before 25
Rule‑in: Early menarche, late menopause, post‑menopausal obesity, HRT, older age at first pregnancy (or nulliparity) all ↑ risk.
Rule‑out: First pregnancy before 25 lowers/doesn’t raise risk (older first pregnancy >30 is a risk).

A path report describes malignant epithelial cells arising in the terminal duct lobular unit (TDLU). What is the most accurate classification?
A. Sarcoma
B. Adenocarcinoma
C. Lymphoma
D. Melanoma
E. Phyllodes tumour

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Correct: B – Adenocarcinoma
Rule‑in: Breast carcinoma is an adenocarcinoma from glandular epithelium of the TDLU.
Rule‑out: Others arise from stroma (sarcoma/phyllodes), lymphoid tissue, or melanocytes.

A 65‑year‑old has an invasive breast cancer. Which subtype is most common?
A. Invasive ductal carcinoma (IDC)
B. Invasive lobular carcinoma (ILC)
C. Medullary carcinoma
D. Mucinous (colloid) carcinoma
E. Papillary carcinoma

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Correct: A – IDC
Rule‑in: IDC ≈ 75–85% of invasive cases.
Rule‑out: ILC ≈ ~10%; others are less frequent.

A tumour shows loss of E‑cadherin on immunohistochemistry and a diffuse stromal “single‑file” pattern. What is it?
A. Invasive ductal carcinoma
B. Invasive lobular carcinoma
C. DCIS
D. LCIS
E. Paget’s disease

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Correct: B – ILC
Rule‑in: Loss of E‑cadherin is characteristic for lobular lesions (ILC/LCIS).
Rule‑out: Ductal lesions retain E‑cadherin; Paget’s is an epidermal manifestation of ductal disease.

A 48‑year‑old’s tumour is ER‑negative, PR‑negative, HER2‑negative. Which is true?
A. It is usually indolent
B. It lacks the three common receptors and is often aggressive
C. It is best treated with endocrine therapy alone
D. Trastuzumab is first‑line
E. It cannot receive chemotherapy

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Correct: B
Rule‑in: Triple‑negative tumours lack ER/PR/HER2 and are typically aggressive; chemo is mainstay (often neoadjuvant).
Rule‑out: Endocrine and HER2‑targeted agents won’t work; not indolent.

A woman with newly diagnosed breast carcinoma most commonly spreads to which set of lymph nodes first? A. Cervical B. Axillary (including sentinel) C. Inguinal D. Para‑aortic E. Mediastinal

Correct: B – Axillary/sentinel Rule‑in: Primary drainage is to axillary nodes; sentinel node is first station. Rule‑out: Others are less typical initial basins.

Which feature is most specific for invasive breast carcinoma? A. Bilateral cyclical breast pain B. Eczematous nipple with underlying mass C. Smooth, highly mobile lump in a 22‑year‑old D. Generalised breast swelling pre‑menses E. Axillary tenderness during menses

Correct: B Rule‑in: Paget‑like nipple change with mass suggests underlying carcinoma. Rule‑out: Others fit benign patterns (mastalgia, fibroadenoma).

A 35‑year‑old with a palpable lump and no red flags attends one‑stop clinic. Which initial imaging is most appropriate? A. Mammogram only B. Ultrasound only C. MRI D. PET‑CT E. No imaging

Correct: B – Ultrasound Rule‑in: <40: ultrasound first (denser breasts). Rule‑out: Mammogram more useful >40; MRI/PET are not first‑line in standard triple assessment.

A patient undergoes breast‑conserving surgery (wide local excision) for a small IDC with clear margins. What is the next standard step? A. No further treatment B. Mandatory radiotherapy to the breast C. Chemotherapy for all patients D. Axillary clearance for all patients E. Mastectomy completion

Correct: B Rule‑in: Radiotherapy is standard after WLE to reduce local recurrence. Rule‑out: Chemo/axillary clearance depend on biology/nodal status, not automatic.

Which is the best indication for axillary node clearance rather than just sentinel node biopsy? A. Clinically node‑negative axilla B. Suspicious node on ultrasound but benign FNA C. Proven nodal metastases on biopsy D. Small DCIS without invasion E. LCIS on core biopsy

Correct: C – Proven nodal metastases Rule‑in: Positive nodes → consider clearance (balancing morbidity). Rule‑out: SNB is preferred when node‑negative/uncertain to reduce lymphoedema risk.

Which scenario requires consideration of post‑mastectomy radiotherapy? A. Tumour 1.2 cm, node‑negative, clear margins B. Tumour 2.1 cm, 1 positive node C. Tumour 6 cm, 4 positive nodes D. DCIS treated with mastectomy, clear margins E. LCIS only

Correct: C Rule‑in: Post‑mastectomy RT indicated with >3 nodes, tumour >5 cm, or positive margins. Rule‑out: Small/low‑risk cases typically don’t need PMRT; DCIS post‑mastectomy generally no RT.

Which tumour biology most strongly supports neoadjuvant systemic therapy? A. Small ER+ HER2‑ tumour, node‑negative B. Triple‑negative breast cancer C. LCIS only D. Low‑grade DCIS E. Fibroadenoma

Correct: B – TNBC Rule‑in: TNBC and HER2+ cancers often receive neoadjuvant therapy to downstage, assess response, and buy time (e.g., genetic testing). Rule‑out: LCIS/DCIS/benign don’t need neoadjuvant chemo.

A pre‑menopausal woman with ER+ early breast cancer completes surgery. Best adjuvant endocrine therapy? A. Aromatase inhibitor alone B. Tamoxifen C. Trastuzumab D. Lapatinib E. No therapy for ER+

Correct: B – Tamoxifen Rule‑in: Tamoxifen is standard in pre‑menopausal ER+ patients (SE: hot flushes). Rule‑out: Aromatase inhibitors are for post‑menopausal (or with ovarian suppression).

A patient with HER2+ cancer is planned for trastuzumab. What baseline test is essential? A. Bone mineral density B. FBC only C. Echocardiogram (or cardiac function assessment) D. Spirometry E. D‑dimer

Correct: C Rule‑in: Trastuzumab can cause cardiotoxicity → check heart function first. Rule‑out: Others are not mandatory baselines for HER2 therapy.

What is the most typical screening finding of DCIS? A. Spiculated mass B. Microcalcifications on mammography C. Pure cyst on ultrasound D. Architectural distortion only E. Axillary lymphadenopathy

Correct: B Rule‑in: DCIS often appears as microcalcifications on mammography and is frequently asymptomatic. Rule‑out: Spiculation/adenopathy suggest invasion.

For a localised DCIS resected by lumpectomy, which adjunct reduces local recurrence? A. Chemotherapy B. Endocrine therapy only C. Radiotherapy to the breast D. Axillary clearance E. No further treatment

Correct: C – Radiotherapy Rule‑in: Radiotherapy after BCS for DCIS reduces recurrence risk. Rule‑out: Chemo not indicated for pure DCIS; axilla usually not addressed.

Which statement about LCIS is most accurate? A. LCIS is a cancer that commonly presents with a palpable mass B. LCIS is a marker of increased risk and often incidental on biopsy C. LCIS always visible on mammogram as calcifications D. LCIS shows retained E‑cadherin E. LCIS always requires mastectomy

Correct: B Rule‑in: LCIS is not a true cancer (except high‑grade variants), often incidental, and risk marker; loss of E‑cadherin. Rule‑out: Usually not mammographically visible; management often surveillance/ensure no higher‑grade lesion.

A 62‑year‑old woman has a dry, scaly, erythematous lesion of the nipple‑areola with occasional oozing and an underlying mass on exam. Most likely underlying pathology? A. LCIS B. ILC C. DCIS D. Eczema unrelated to malignancy E. Melanoma

Correct: C – DCIS underlying Rule‑in: Paget’s disease of the nipple often associates with underlying DCIS (± invasive ductal). Rule‑out: LCIS/ILC don’t typically cause Paget‑like nipple change.

Which tumour is a stromal sarcoma‑type breast malignancy that may resemble fibroadenoma but is faster‑growing and can be malignant? A. Medullary carcinoma B. Phyllodes tumour C. Angiosarcoma after radiotherapy D. Lymphoma E. Metastatic ovarian serous carcinoma

Correct: B – Phyllodes tumour Rule‑in: Phyllodes is a fibroepithelial neoplasm dominated by stromal overgrowth; spectrum from benign → malignant; wide excision due to recurrence risk. Rule‑out: Angiosarcoma is vascular; lymphoma is lymphoid; metastases are secondary.

A 14‑year‑old boy presents with a 2 cm rubbery mass beneath the nipple. No other symptoms. Examination is normal. What is the most likely cause? A. Male breast cancer B. Physiological gynaecomastia C. Liver failure D. Testicular tumour E. Drug‑induced gynaecomastia

Correct answer: B – Physiological gynaecomastia Rule‑in: Commonest cause in adolescents Due to delayed testosterone surge relative to oestrogen Rubber/firm mass under nipple = classic Rule‑out: A: Male breast cancer is painless, unilateral, firm, usually in older adults C & D: Would have systemic signs E: No drug history

A 52‑year‑old man develops bilateral gynaecomastia. He takes spironolactone for heart failure. What is the most likely mechanism? A. Prolactin excess B. Increased oestrogen activity C. Decreased progesterone D. Reduced prolactin receptor activity E. Increased LH secretion

Correct answer: B – Increased oestrogen activity Rule‑in: Spironolactone → anti‑androgen → shifts balance to oestrogen dominance Causes ductal growth without lobules Rule‑out: A, C, D, E are not mechanisms for drug‑induced gynaecomastia

A 60‑year‑old man presents with 3‑month history of progressive breast enlargement, no medications. No red flags. What is the first investigation? A. Testosterone and LH levels B. Mammography C. Liver and renal function tests D. MRI chest E. CT abdomen

Correct answer: C – LFTs and U&Es Rule‑in: Guidelines: start with liver and kidney tests Hormonal tests only if LFTs/U&Es normal Rule‑out: A: Secondary, not first test B: Only if malignancy suspected D/E: Not first line

A 48‑year‑old man has a firm, unilateral painless breast lump not fluctuating with hormones. Most likely diagnosis? A. Physiological gynaecomastia B. Male breast cancer C. Hyperprolactinaemia D. Bilateral gynaecomastia E. Benign lipoma

Correct answer: B – Male breast cancer Rule‑in: Firm, painless, unilateral Does not fluctuate with hormones Male breast cancer usually IDC Rule‑out: A & D: Gynaecomastia is rubbery and typically bilateral C: Would have nipple discharge E: Lipoma is soft, not subareolar

Which of the following is a cause of gynaecomastia? A. High testosterone B. Digoxin use C. Low prolactin D. Testicular torsion E. High vitamin D

Correct answer: B – Digoxin use Rule‑in: Listed drug causes: digoxin, spironolactone, goserelin, antipsychotics, chemotherapy, metronidazole, anabolic steroids Rule‑out: High testosterone → reduces gynaecomastia Torsion → acute pain, not hormonal imbalance

A man with known Klinefelter’s presents with gradual bilateral breast swelling. Primary mechanism? A. Androgen excess B. Oestrogen dominance due to low testosterone C. Elevated progesterone D. Increased DHT E. Growth hormone excess

Correct answer: B – Oestrogen dominance due to low testosterone Rule‑in: Klinefelter → testicular failure → low testosterone → relative ↑ oestrogen Classic cause of pathological gynaecomastia

Which feature most strongly suggests male breast cancer, not gynaecomastia? A. Tender subareolar thickening B. Bilateral enlargement C. Lump >2 cm D. Nipple ulceration E. Rubber‑like mass beneath nipple

Correct answer: D – Nipple ulceration Rule‑in: Cancer causes: nipple inversion, ulceration, Paget’s‑like eczema, bloody discharge, axillary lymphadenopathy Gynaecomastia → rubbery subareolar swelling

A 45‑year‑old man has an unexplained palpable mass. He is referred under the 2‑week rule. What is the preferred initial imaging? A. CT B. MRI C. Ultrasound D. Mammogram E. PET‑CT

Correct answer: C – Ultrasound Rule‑in: USS is preferred in men (dense pectoral muscles; smaller breast tissue) Mammogram can be added but USS is 1st line

A 70‑year‑old man has ER‑positive invasive ductal carcinoma. Surgery complete. What is the first‑line endocrine therapy? A. Aromatase inhibitor alone B. Tamoxifen C. Goserelin only D. Testosterone supplementation E. None required

Correct answer: B – Tamoxifen Rule‑in: Men with ER+ tumours → tamoxifen 5–10 years Aromatase inhibitors require GnRH analogue to suppress testicular testosterone

A 39‑year‑old man has severe gynaecomastia with nipple ptosis and significant breast tissue enlargement. Most appropriate management? A. Reassurance only B. Stop all medications C. Tamoxifen D. Surgical management (nipple‑sparing mastectomy/liposuction) E. Radiotherapy

Correct answer: D – Surgical management Rule‑in: Grades 3–4 gynaecomastia → consider surgery Liposuction or nipple‑sparing mastectomy Rule‑out: A/B/C useful for mild/moderate, not grade 4 E not used in benign gynaecomastia

Breast week Flashcards

(48 cards)