AKT revision: breast conditions

1.A 28 year old develops a tender red quadrant on her right breast 10 days following the birth of her first child. Her temperature is 37.5 degrees, there is no fluctuance and she is breast feeding. Which one of the options below represents the single most appropriate management plan?

A. Avoid antibiotics since she is breast feeding
B. Co-amoxiclav and temporary cessation of breast feeding
C. Co-amoxiclav and continue breast feeding
D. Doxycycline temporary cessation of breast feeding
E. Doxycycline and continue breast feeding

Answer: C

Co-amoxiclav and continue feeding. Tetracyclines should generally be avoided if breast feeding (and in any case are unlikely to be helpful) and it is important that breast feeding continues.

2. Which one of the following female patients with a three day history requires urgent referral? They are all on day 24 of their menstrual cycles

A. A non pregnant 35 year old with tender lumpy breasts who presents with worsening tenderness on the right side.
B. A 28 year old woman with a non tender 2cm mobile lump. She is on the combined oral contraceptive pill and her grandmother developed breast cancer aged 60
C. A 30 year old with an eczematous eruption on both breasts
D. A non pregnant 35 year old with nodularity in her right breast. Her left breast is normal
E. A nulliparous 30 year old with bilateral serous discharge from both nipples.

Answer: D

Solitary asymmetrical nodularity should be triple assessed. All the other options require careful discussion with the patient and review - Option 1 probably has Benign Fibrocystic Change but should be reviewed after menstruation. Option 2 is most likely to have a fibroadenoma and although most GPs would refer her there is no clinical urgency unless there are additional risk factors (e.g. strong family history). Options 3 and 5 are unlikely to have serious pathology. It is however important not to mistake a unilateral eczematous eruption (which does not respond to topical treatment) for eczema since it may be a marker for an underlying carcinoma.

3. Which one of the following variables is the most important determinant of prognosis in Invasive ductal breast cancer?

A. Age of patient
B. Axillary lymph node positivity
C. Oestrogen receptor status
D. Site of tumour
E. Size of tumour

Answer: B