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  • Question 1 - A 50-year-old woman underwent a mammogram which showed a 2-cm lump in the...

    Correct

    • A 50-year-old woman underwent a mammogram which showed a 2-cm lump in the upper outer quadrant of her right breast. Assuming the primary tumor has spread to a nearby lymph node, where would the metastatic cells most likely be located?

      Your Answer: Axillary

      Explanation:

      Lymph Nodes and Their Drainage Areas

      Lymph nodes are small, bean-shaped structures that play a crucial role in the immune system. They filter lymphatic fluid and trap foreign substances, such as bacteria and cancer cells. Here are some of the major lymph nodes in the body and their drainage areas:

      Axillary lymph nodes: These nodes receive lymphatic drainage from the mammary glands and upper limb. They are important in breast cancer staging.

      Cervical lymph nodes: These nodes drain structures in the head and neck and can be enlarged in various cancers.

      Hilar lymph nodes: These nodes drain the lungs and can become enlarged in lung cancer and other conditions.

      Mediastinal lymph nodes: These nodes drain the trachea and oesophagus.

      Coeliac lymph nodes: These nodes drain the spleen and foregut, including the stomach, duodenum, liver, and pancreas.

      Understanding the drainage areas of lymph nodes is important in diagnosing and treating various diseases.

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  • Question 2 - A 48-year-old woman is referred for further evaluation after an abnormal routine mammogram....

    Incorrect

    • A 48-year-old woman is referred for further evaluation after an abnormal routine mammogram. Biopsy of a left breast mass shows high-grade malignant ductal epithelial cells with dark staining nuclei and several mitotic figures visible under high-power field. Necrosis and central calcification are noted and the basement membrane appears intact.
      Based on the biopsy findings, which one of the following is the most likely diagnosis?

      Your Answer: Lobular carcinoma in situ

      Correct Answer: Comedocarcinoma

      Explanation:

      Breast Cancer Subtypes and Histological Findings

      Breast cancer can present in various subtypes, each with unique histological findings and prognoses. Comedocarcinoma is a high-grade ductal carcinoma in situ that often presents with calcification and necrosis due to rapid cellular proliferation. Mucinous carcinoma is a subtype of invasive ductal carcinoma characterized by a large amount of mucin-producing cells and a slightly better prognosis than inflammatory carcinoma. Lobular carcinoma in situ is characterized by malignant cells in the terminal duct lobules that rarely progress to invasive lobular carcinoma. Anaplastic carcinoma is another subtype of invasive ductal carcinoma with a slightly better prognosis than inflammatory carcinoma. Inflammatory carcinoma is characterized by dermal lymphatic invasion of malignant cells and is associated with poor prognosis. Understanding the different subtypes and histological findings of breast cancer can aid in diagnosis and treatment planning.

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  • Question 3 - A 30-year-old single mother comes to you with a breast lump. She is...

    Correct

    • A 30-year-old single mother comes to you with a breast lump. She is concerned because her mother passed away from breast cancer at the age of 50. Upon examination, she appears healthy and the lump is smooth, about 2 cm in size, easily movable, and not attached to the skin or underlying muscle. You cannot feel any masses in the axilla. What is the most probable diagnosis?

      Your Answer: Fibroadenoma

      Explanation:

      Fibroadenoma is a benign tumor commonly found in the female breast, usually occurring during the reproductive period of life and peaking at 20-24 years of age. They are often multiple and can affect both breasts. Fibroadenomas develop in breast lobules and consist of fibrous and epithelial tissue. The epithelium of the fibroadenoma is sensitive to hormones and may slightly increase in size during the late phase of each menstrual cycle. During pregnancy, lactational changes or inflammation may cause an increase in size, leading to a fibroadenoma that mimics carcinoma. However, regression typically occurs after menopause.

      Fat necrosis can present as a painless, palpable mass with surrounding skin changes or as hyperdensity or calcifications on mammograms. It is more common in larger, fatty breasts in obese women and often occurs after trauma or surgery. It is a self-limiting condition and requires no further treatment once diagnosed.

      Fibrocystic change is a hormonal condition that affects women aged 20-50, causing nodularity and varying degrees of pain and tenderness in the breast. Symptoms are most severe about a week before menstruation and decrease when it starts. Treatment involves analgesia and a well-fitting bra.

      Carcinoma in situ is less likely in younger women, as breast cancer typically presents with irregular contours, skin changes, nipple discharge, and a family history of breast cancer or genetic mutations. However, any breast lump should undergo full triple assessment, including history and examination, imaging, and histological examination.

      Breast cysts are common in perimenopausal women aged 35-50 and often present as tender lumps. They cannot be reliably distinguished from solid tumors on clinical examination and may regress spontaneously or after aspiration. If the lump persists or the aspirate is blood stained, referral for triple assessment is recommended.

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  • Question 4 - A 70-year-old woman has been diagnosed with a malignant lesion in the medial...

    Incorrect

    • A 70-year-old woman has been diagnosed with a malignant lesion in the medial part of her left breast. To which one of the following lymph node groups is this site most likely to drain?

      Your Answer: Infraclavicular

      Correct Answer: Internal thoracic

      Explanation:

      Lymph Nodes and Their Locations in the Body

      Lymph nodes are small, bean-shaped structures that play a crucial role in the immune system. They filter lymphatic fluid and trap harmful substances, such as bacteria and cancer cells. Here are some of the lymph nodes found in the body and their locations:

      Internal Thoracic: These nodes are located parallel to the internal thoracic artery and vein, draining the medial part of the breast. Metastasis of breast cancer in these nodes can lead to reduced long-term survival.

      Coeliac: Found in the abdomen, these nodes drain the stomach, duodenum, spleen, pancreas, and biliary tract.

      Infraclavicular: Also known as the deltopectoral group, these nodes are located below the clavicle and receive lymph from the lateral side of the upper limb.

      Supraclavicular: These nodes are found above the clavicles and receive lymph from the chest and abdomen.

      Tracheobronchial: These nodes drain the trachea and bronchi and can be affected in lung malignancy and inflammatory conditions of the lung.

      Understanding the locations of lymph nodes can help in the diagnosis and treatment of various diseases.

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  • Question 5 - A 65-year-old retired post-office worker presents to his General Practitioner (GP) with a...

    Correct

    • A 65-year-old retired post-office worker presents to his General Practitioner (GP) with a two-week history of bleeding from the right nipple. He is otherwise well, with hypertension being the only medical history to note, which is well controlled on ramipril.
      On examination of the right breast, the doctor notes some oozing of blood from the right nipple, with an underlying 2 cm × 2 cm fixed mass on palpation of the right areola.
      With regard to breast cancer in men, which of the following statements is the most accurate?

      Your Answer: The is an increased risk of breast cancer in men with Klinefelter syndrome

      Explanation:

      Breast Cancer in Men: Risk Factors, Symptoms, and Prognosis

      Breast cancer is commonly associated with women, but it can also affect men. While the lifetime risk of developing breast cancer in men is low, certain factors can increase the likelihood of developing the disease. Men with Klinefelter syndrome, a genetic condition that affects the production of male hormones, have a significantly higher risk of breast cancer. Other risk factors include age, exposure to radiation, family history of breast cancer, high estrogen levels, and testicular damage or malfunction.

      The symptoms of breast cancer in men are similar to those in women, with the most common presentation being a painless lump in the breast tissue. Other symptoms may include nipple changes, discharge or bleeding, and skin changes. Unfortunately, the prognosis for breast cancer in men is often worse than in women due to a lack of awareness and delayed diagnosis.

      Treatment for breast cancer in men typically involves surgical removal of the tumor, chemotherapy, and radiation therapy. Tamoxifen, a medication that blocks the effects of estrogen, may also be used as part of the treatment plan. It is important for men to be aware of the risk factors and symptoms of breast cancer and to seek medical attention promptly if any changes are noticed.

      In conclusion, breast cancer is one of the top five most common cancers in men, and while the risk is low, it is important for men to be aware of the potential for the disease and to seek medical attention if any symptoms arise.

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  • Question 6 - A 40-year-old woman presents to the general practitioner (GP) with a painful, red...

    Correct

    • A 40-year-old woman presents to the general practitioner (GP) with a painful, red left breast for the past two days. Since the birth of her first daughter eight weeks ago, she has been exclusively breastfeeding. The patient has also experienced fever and chills over the last 24 hours. She does not have any other medical problems.
      Physical examination reveals a warm, erythematous and tender left breast without signs of masses or purulent discharge. There is a small fissure present. Her observations are shown below:
      Temperature 36.8 °C
      Blood pressure 126/59 mmHg
      Heart rate 67 beats per minute
      Respiratory rate 15 breaths per minute
      Sp(O2) 98% (room air)
      Which of the following is the most appropriate management for this patient?

      Your Answer: Oral antibiotics and continue breastfeeding

      Explanation:

      Treatment for Lactational Mastitis: Oral Antibiotics and Continued Breastfeeding

      Lactational mastitis is a common condition that affects breastfeeding women, typically within the first 12 weeks postpartum. It is caused by milk stasis and nipple trauma, leading to a superficial breast infection. Symptoms include breast pain, redness, fever, and chills. The most common cause is Staphylococcus aureus, and treatment involves prescribing oral antibiotics such as flucloxacillin. Breastfeeding should be continued, even on the affected breast. If the patient has a penicillin allergy, macrolides such as erythromycin or clarithromycin can be considered. Recurrent cases should have breast milk sent for cultures, and antibiotics should be adjusted accordingly. Non-steroidal anti-inflammatories can be used as adjunctive treatment, but should not be the sole treatment. Advising the patient to stop breastfeeding would be inappropriate, as breastfeeding has many benefits for both mother and child, and has not been shown to have adverse outcomes during mastitis. Referral for incision and drainage may be necessary if a breast abscess is present, which would present as a tender and fluctuant mass.

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  • Question 7 - A 52-year-old primary teacher is prescribed tamoxifen for the management of oestrogen receptor...

    Incorrect

    • A 52-year-old primary teacher is prescribed tamoxifen for the management of oestrogen receptor (ER)-positive breast cancer. What is a frequently encountered adverse effect of tamoxifen?

      Your Answer: Hirsutism

      Correct Answer: Hot flashes

      Explanation:

      Understanding the Side-Effects of Tamoxifen Therapy

      Tamoxifen is a medication used in the prevention and treatment of breast cancer. As a selective ER modulator, it has both oestrogenic and anti-oestrogenic actions depending on the target tissue. While it is effective in its intended use, tamoxifen therapy can also cause side-effects.

      One of the most common side-effects of tamoxifen therapy is hot flashes and sweats. Other side-effects include changes in menstrual patterns, loss of sex drive, nausea, visual problems, muscle ache, and fatigue. However, hirsutism (abnormal or excessive hair growth) is not a commonly occurring side-effect of tamoxifen. Thinning of the hair may occur, but this usually resolves on cessation of treatment.

      Contrary to popular belief, weight gain and not weight loss is a commonly associated side-effect of tamoxifen treatment. Additionally, there is a risk of hypercoagulability and thromboembolic events with tamoxifen therapy, as opposed to bleeding. Haematuria (blood in urine) is not commonly associated with the use of tamoxifen.

      In conclusion, while tamoxifen is an effective medication for the prevention and treatment of breast cancer, it is important to be aware of its potential side-effects. Patients should discuss any concerns with their healthcare provider and report any unusual symptoms experienced during treatment.

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  • Question 8 - A 38-year-old woman visits her GP to discuss the possibility of starting tamoxifen...

    Correct

    • A 38-year-old woman visits her GP to discuss the possibility of starting tamoxifen treatment to prevent breast cancer. Although the patient is healthy and has no personal history of breast disease, she is worried because her mother was diagnosed with the condition at a young age. The patient has heard that taking tamoxifen can help lower the risk of developing breast cancer. What is the mode of action of tamoxifen?

      Your Answer: Selective oestrogen receptor modulator

      Explanation:

      Tamoxifen: A Selective Oestrogen Receptor Modulator

      Tamoxifen is a medication that acts as a selective oestrogen receptor modulator. It has the ability to exhibit both oestrogenic and anti-oestrogenic actions, depending on the target tissue. In mammary epithelium, it has a strongly anti-oestrogenic action, making it useful in both the prevention and treatment of breast cancer. Tamoxifen is indicated for the treatment of oestrogen receptor-positive tumours in pre- and perimenopausal women. It may also be used as a prophylactic in women who are at moderate to high risk of developing breast cancer, such as those with a significant family history of breast and ovarian cancer. However, tamoxifen does not act on progesterone receptors, nor is it an aromatase inhibitor or a progesterone receptor agonist. Tamoxifen is a mixed oestrogen receptor antagonist and partial agonist, making it a unique and valuable medication in the treatment and prevention of breast cancer.

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  • Question 9 - A 28-year-old teaching assistant presents with a lump that she discovered in her...

    Incorrect

    • A 28-year-old teaching assistant presents with a lump that she discovered in her right breast. She performed a breast check after reading an article about breast cancer and was worried to find a lump in the right breast.
      The lump is painless, and she has no other accompanying symptoms. She has no family history of breast cancer.
      Upon examination, there is a smooth 2 cm × 2 cm lump in the upper quadrant of the right breast. There are no skin changes overlying the lump.
      What is the most appropriate course of action for this patient?

      Your Answer: Reassurance and discharge

      Correct Answer: Refer to the Breast Clinic for further investigation

      Explanation:

      Breast Lump Referral and Assessment Guidelines

      The following guidelines should be followed when assessing and referring patients with breast lumps:

      1. Refer patients aged 30 or over with an unexplained breast lump to the Breast Clinic using a Suspected Cancer Pathway referral (for an appointment within two weeks).

      2. Patients aged 50 or over should also be referred if they have either discharge or retraction in one nipple only, or if they have any other changes of concern.

      3. Non-urgent referral should be considered in patients under 30 who present with an unexplained breast lump.

      4. The patient needs to be assessed further by a breast surgeon, who will decide if any further action is indicated.

      5. Although the diagnosis may be a fibroadenoma, patients over 30 with an unexplained lump should be referred to the Breast Clinic for further investigation.

      6. If a patient over 30 has an unexplained lump in the breast, they should be referred for further assessment on a two-week pathway.

      7. Patients should be asked to return if they become symptomatic, regardless of whether they are having associated symptoms.

      Breast Lump Referral and Assessment Guidelines

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  • Question 10 - A 32-year-old woman is diagnosed with mastitis by her General Practitioner (GP) and...

    Incorrect

    • A 32-year-old woman is diagnosed with mastitis by her General Practitioner (GP) and prescribed antibiotics. Which of the following descriptions is most consistent with this diagnosis?

      Your Answer:

      Correct Answer: A wedge-shaped distribution of erythema

      Explanation:

      Understanding Mastitis: Symptoms and Differential Diagnosis

      Mastitis is a painful inflammatory condition of the breast that commonly affects lactating women but can also occur in non-lactating women. The condition is characterized by a painful breast, tenderness, swelling, and erythema of the affected area, often in a wedge-shaped distribution. Other symptoms include fever, general malaise, and rapid onset, usually unilateral.

      Diagnosis is based on physical examination, and the presence of erythema is a classical symptom of inflammation. A firm, round, non-tender lump in the breast is more suggestive of a fibroadenoma or malignancy, while painless swelling of the breast tissue is not typical of mastitis.

      Peau d’orange, a term used to describe the characteristic appearance of skin changes associated with an underlying carcinoma of the breast or inflammatory breast cancer, is not a symptom of mastitis. It represents cutaneous lymphatic edema secondary to obstruction of lymphatic outflow by an underlying malignancy.

      In lactating patients, mastitis is often secondary to milk stasis and may be managed conservatively or with antibiotics. In non-lactating women, the condition is always secondary to infection and requires treatment with antibiotics. Understanding the symptoms and differential diagnosis of mastitis is crucial for prompt and effective management of this painful condition.

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SESSION STATS - PERFORMANCE PER SPECIALTY

Breast (5/9) 56%
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