🤔 MEDIUM

Here you will find some questions on breast lumps. Be sure to read the stem carefully as it contains important information. Good luck! 

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Breast Lumps

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Question 1

Stem 1. Question 1 of 4

A 48 year-old woman presents with a breast lump to GP. She noticed this lump a week ago and her breasts were painful and swollen when she noticed the lump.
What are fibrocystic breast lumps characterised by?
A
Inflammation of the breast with or without infection
B
Necrosis of fatty tissue leading to an ill defined mass
C
Slow growing non-cancerous fatty tissue beneath the skin
D
Stromal and ductal proliferation that results in cyst formation, diffuse thickening, cyclic pain and tenderness
E
Malignant neoplasm of the breast tissue
Question 1 Explanation: 
Fibrocystic breast lumps are the most common cause of breast lumps occurring in 60-75% of all women and are due to stroll and ductal proliferation which is thought to be form an exaggerated response to hormones. All other answers are definitions of other breast lumps: Mastitis, fat necrosis, lipomata and breast cancer respectively
Question 2

Stem 1. Question 2 of 4

When are symptoms of fibrocystic breast changes often worst?
A
During menses
B
Shortly prior to menses
C
At ovulation
D
Post menses
E
No cyclical pattern
Question 2 Explanation: 
Fibrocystic breast changes are asymptomatic in 50% of people but those who experience symptoms will find the bilateral pain and engorgement to be worst just prior to menses.
Question 3

Stem 1. Question 3 of 4

What are the examination findings of fibrocystic breast lumps?
A
Smooth, rubbery, mobile mass that is firm but painless
B
Palpable mass with axillary masses in addition
C
Breast fluctuant, tenderness, skin erythema and hot to touch
D
Well circumcised, lobulated lesion
E
Multiple cysts and nodules intermixed with scattered bilateral nodularity, especially in upper outer quadrants
Question 3 Explanation: 
Fibrocystic breast changes or lumps, as the name suggests, contain cysts and fibrous nodules scattered throughout the breast. The other answers describe other breast lumps. A smooth and rubbery lump is fibroadenoma. A palpable mass with axillary masses can be used to describe breast cancer. A fluctuant breast lump which is red and hot describes a breast abscess and a well circumcised, lobulated lesion describes a lipomata.
Question 4

Stem 1. Question 4 of 4

Which of the following is NOT a management option for fibrocystic breast lumps?
A
Excision biopsy
B
Mechanical support
C
Diuretics prior to menses
D
NSAIDs
E
Oral contraceptives
Question 4 Explanation: 
An excision biopsy is not appropriate to treat fibrocystic breast lumps as the management is conservative in nature.
Question 5

Stem 2. Question 1 of 4.

A 32 year old women with her 8 week old baby, presents  to GP. She explains that she is feeling very flu-like and has a very painful and "angry" left breast that started 2 days ago. The pain is making it difficult to breastfeed and her temperature at home was 38.3C.
Which of the following is the most likely diagnosis?
 
A
Fat necrosis
B
Breast cancer
C
Lipomata
D
Mastitis
E
Epidermoid cyst
Question 5 Explanation: 
This women is providing a clear infective history on a background of breastfeeding. Lactation is a risk factor for the development of mastitis
Question 6

Stem 2. Question 2 of 4

What is the difference between a breast abscess and mastitis?
A
Mastitis is dependent on infection but an abscess is a walled off collection of pus
B
An abscess contains fat necrosis but mastitis is a localised area of infection with a walled-off collection of pus
C
A breast abscess is as a result of trauma to the breast but mastitis is inflammation of the breast
D
Mastitis is caused by bacteria colonising the skin but an abscess will always result in bacteraemia
E
Mastitis is inflammation of the breast with or without infection but an abscess is a localised area of infection with a walled-off collection of pus
Question 6 Explanation: 
Mastitis is not dependent on infection, but is the presence of inflammation in the breast. An abscess is a walled off collection of infection.
Question 7

Stem 2. Question 3 of 4

The women wonders what bacteria can cause a breast abscess. Which of the follow is the most common cause of breast abscesses?
A
Neisseria mengitidis
B
Cryptococcus neoformans
C
Staphylococcus aureus
D
Streptococcus pyogenes
E
Streptococcus mutants
Question 7 Explanation: 
Most commonly breast abscesses are caused by bacteria colonising the skin, and many people have Staphylococcus aureus on the skin, hence S. aureus is the correct answer here.
Question 8

Stem 2. Question 4 of 4.

What would be the appropriate treatment for a breast abscess? Pick all the apply
A
Tamoxifen
B
Needle aspiration of the abscess
C
Bromocriptine
D
Flucloxacillin
E
Excision biopsy
Question 8 Explanation: 
Drainage of the abscess and the antibiotics would be the most appropriate treatment in this case. The others are not appropriate as they do not treat the infection.
Question 9

Stem 3. Question 1 of 1.

A 55 year old woman presents to GP very concerned about a lump in her right breast. On examination a solitary, irregular, ill-defined tender mass is felt with some skin retraction. The rest of her history is unremarkable apart from a car accident 9 months ago in which she sustained extensive seatbelt ecchymoses across her chest.
What is the most likely diagnosis?
A
Epidermoid cyst
B
Breast malignancy
C
Fibrocystic breast changes
D
Fibroadenoma
E
Fat necrosis
Question 9 Explanation: 
Fat necrosis is the correct answer. Fat necrosis is often confused with breast cancer as both can cause a solitary, irregular, ill-defined mass with skin retraction, however, the key to differentiating is most cases of fat necrosis will have prior trauma, surgery or augmentation to the breast. In the stem it states that this lady had trauma 9 months ago from a seatbelt
Question 10

Stem 4. Question 1 of 1

A 58 year old man presents with a painless lump in his right breast. The lump has appeared very slowly and he has other similar lumps across his back and his body that he believes are fat deposits. He is completely well otherwise and would like assurance.
What is the most likely diagnosis?
A
Breast cancer
B
Lipomata
C
Fibroadenoma
D
Epidermoid cyst
E
Ligament of Cooper
Question 10 Explanation: 
Remember that people without uteruses can have breast lumps too! Breast lumps can also be caused by lumps that occur all over the body and so this is a lipomata! Lipomata grow very slowly and as the name suggests are fat tissue. They most commonly first appear between 40-60 years of age, meaning that this gentlemen fits the demographic well.
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