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  • Question 1 - 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 2 - A 45-year-old lady receives an invitation to attend for breast screening at her...

    Incorrect

    • A 45-year-old lady receives an invitation to attend for breast screening at her local hospital.
      Which one of the following statements with regard to breast screening is most accurate?

      Your Answer: Recall is on a yearly basis

      Correct Answer: Two mammogram views are routinely taken

      Explanation:

      Breast Cancer Screening in the UK: What You Need to Know

      Breast cancer screening in the United Kingdom is a three-yearly service offered to women aged between 50-70, with options for those in an at-risk category. The screening involves taking two views of the breast by mammography, a specialised form of plain radiography used exclusively for breast imaging. Recall is on a yearly basis, and triple assessment is performed for any women found to have a breast lump, comprising imaging, clinical assessment, and histopathology. It is important to note that triple assessment is not used in screening, and inclusion criteria for screening currently does not focus on the status of menopause.

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  • Question 3 - A 40-year-old woman presents to the general practitioner (GP) with a painful, red...

    Incorrect

    • 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: Non-steroidal anti-inflammatories

      Correct 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 4 - 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 5 - A patient visits her General Practitioner (GP) with some questions about the Breast...

    Correct

    • A patient visits her General Practitioner (GP) with some questions about the Breast Cancer Screening Programme, regarding which she has recently received a letter.

      Which of the following most accurately describes the components of breast cancer screening for a patient who is in her 50s?

      Your Answer: Mammogram every three years

      Explanation:

      Breast Cancer Screening and Assessment: What to Expect Every Three Years

      The NHS offers routine breast cancer screening every three years for patients aged 50 to 70. This involves a mammogram, an X-ray of the breast tissue. If a suspicious lesion is found, the patient will be referred for triple assessment, which includes history taking, examination, imaging (mammography or ultrasound), and biopsy.

      Ultrasound scans are not used for screening but may be used as an alternative to mammography in younger patients or men. A breast examination by a doctor is not part of the screening program but is performed as part of the triple assessment.

      MRI scans are not used for screening but may be used for further assessment after a lesion has been identified. Knowing what to expect every three years can help patients feel more prepared and informed about their breast health.

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  • Question 6 - A 38-year-old woman visits her GP to discuss the possibility of starting tamoxifen...

    Incorrect

    • 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: Oestrogen receptor agonist

      Correct 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 7 - 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 8 - A 52-year-old primary teacher is prescribed tamoxifen for the management of oestrogen receptor...

    Correct

    • 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: 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 9 - A 32-year-old woman comes to the breast clinic with a firm lump in...

    Incorrect

    • A 32-year-old woman comes to the breast clinic with a firm lump in her breast. She has never been pregnant and is a smoker.
      What should be the next appropriate step?

      Your Answer: Mammogram and return to clinic if appropriate for further tests

      Correct Answer: Triple test of clinical examination, ultrasound and fine-needle aspiration

      Explanation:

      Triple Testing for Breast Lumps: A Comprehensive Approach

      Breast lumps require further investigation through a process called triple testing. This involves a full clinical examination, imaging (mammography or ultrasound), and tissue biopsy (core needle biopsy or fine-needle aspiration). The results of each component are graded on a scale from E1 to E5 for examination, M1/U1 to M5/U5 for imaging, and C1 to C5 for aetiology.

      If the lump is obviously a fibroadenoma, which is common in younger patients, it may not require further investigation. However, it is important to be confident in this diagnosis. If further investigation is necessary, a mammogram and return to the clinic for additional tests may be appropriate. In some cases, a lumpectomy may be necessary, but this is typically determined after the triple test has been completed.

      Overall, triple testing is a comprehensive approach to investigating breast lumps and can provide valuable information for diagnosis and treatment.

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  • Question 10 - A 32-year-old woman comes to the GP with a 3-week history of a...

    Incorrect

    • A 32-year-old woman comes to the GP with a 3-week history of a painful left breast. The pain has been getting worse over the last seven days, despite following her midwife's advice. She is exclusively breastfeeding her first baby but had some attachment issues in the first few days. During the examination, you notice that she is sweating, her temperature is 38.5 °C, her heart rate is 110 bpm, and there is a tender, palpable, fluctuant lump in the left outer lower quadrant, with erythema and oedema of the overlying skin. What is the best course of action for this patient?

      Your Answer: Commence oral antibiotics and review in three days

      Correct Answer: Admit to hospital for intravenous antibiotics and aspiration

      Explanation:

      Management of Breast Abscess and Lactational Mastitis: Guidelines and Treatment Options

      Breast abscess and lactational mastitis are common conditions affecting lactating women. While lactational mastitis is a self-limiting condition, breast abscess requires immediate medical attention. In this article, we will discuss the risk factors, symptoms, and treatment options for these conditions.

      Risk factors for breast abscess include previous mastitis, immunosuppression, poor hygiene, poor socio-economic status, and Staphylococcus aureus colonization. Mastitis can lead to breast abscess if left untreated. Symptoms of breast abscess include fever, malaise, painful, swollen lump in the breast with overlying erythema, heat, and edema. The lump is usually described as fluctuant.

      Treatment of breast abscess involves four principles: treating the infection with appropriate intravenous antibiotics, managing the pain with analgesia, emptying the breast and continuing the milk flow, and emptying the abscess. Antibiotics alone are not as effective in treating an abscess as combination treatment. Aspiration under ultrasound guidance is attempted in a first instance. If the abscess refills and the patient fails to improve, then surgical incision and drainage is usually advised.

      In cases of lactational mastitis, where there are no indications for admission or any signs of infection, the woman should be reassured that symptoms will settle and given advice to continue breastfeeding from both breasts (affected and unaffected) and to take regular analgesia. Antibiotics are reserved for women with a nipple fissure, symptoms that are not settling with initial conservative treatment, or where a culture has been positive.

      In conclusion, breast abscess and lactational mastitis are common conditions affecting lactating women. Early diagnosis and appropriate treatment are essential to prevent complications. Women should be advised to continue breastfeeding from both breasts and seek medical attention if symptoms persist or worsen.

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SESSION STATS - PERFORMANCE PER SPECIALTY

Breast (5/10) 50%
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