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SU25.1-5 | Breast Surgery — Practice Quiz
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A 30-year-old woman presents with a discrete, painless breast lump. What is the correct framework for evaluating any breast lump?
Correct. Every breast lump is evaluated by triple assessment: clinical assessment (history and examination), imaging (ultrasound and/or mammography), and tissue diagnosis (core biopsy). Concordance of all three maximises diagnostic accuracy and minimises missed cancers.
Triple assessment = clinical examination + imaging + tissue biopsy; the standard for evaluating any breast lump.
The cornerstone of breast lump evaluation is triple assessment — clinical, imaging, and pathology combined. No single modality is sufficient.
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Within triple assessment, which imaging modality is the most appropriate FIRST-line choice for a breast lump in a woman under 35 years of age?
Correct. In younger women (typically under 35) the breast tissue is dense, which reduces mammographic sensitivity, so ultrasound is the preferred first-line imaging. Mammography is the first-line imaging in older women (over 35-40). MRI and CT are not first-line for a routine lump.
Imaging by age: ultrasound first-line if <35 (dense breasts), mammography if >35-40.
Younger (<35) dense breasts are better imaged with ultrasound; mammography is preferred over 35-40 years. Choosing by age is the key principle.
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A mammogram is reported using a standardised scoring system that communicates the likelihood of malignancy and the recommended action. What is the name of this system?
Correct. BI-RADS is the standardised reporting lexicon for breast imaging that categorises findings (e.g. BI-RADS 1-5) by their likelihood of malignancy and links each category to a recommended management action.
BI-RADS standardises breast imaging reports, linking each category to malignancy risk and recommended action.
Breast imaging is reported with BI-RADS, which standardises the assessment category and recommended action. TNM stages cancer; Gleason is prostate; Bethesda is thyroid cytology.
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A 22-year-old woman has a smooth, firm, highly mobile, painless breast lump that slips under the examining fingers ('breast mouse'). What is the most likely diagnosis?
Correct. A fibroadenoma is the classic benign lump of young women: smooth, firm, well-defined, and very mobile (the 'breast mouse'). It is confirmed on triple assessment and many can be managed conservatively.
Fibroadenoma: smooth, firm, very mobile painless lump in young women ('breast mouse').
A highly mobile, smooth, firm, painless lump in a young woman is the textbook fibroadenoma. Carcinoma is typically hard, irregular and fixed.
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A 28-year-old breastfeeding mother presents with a tender, erythematous, fluctuant swelling in one breast, with fever. Which organism is most commonly responsible and what is the key management principle once an abscess has formed?
Correct. A lactational breast abscess is most often caused by Staphylococcus aureus. Once an abscess (fluctuant collection) has formed, antibiotics alone are insufficient — it requires drainage (ultrasound-guided aspiration or incision and drainage) together with antibiotics; breastfeeding is usually continued.
Lactational abscess: S. aureus; established abscess needs drainage plus antibiotics (not antibiotics alone).
Lactational abscess is typically Staphylococcus aureus and, once pus has collected, needs drainage in addition to antibiotics. Antibiotics alone do not clear an established abscess.
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A 40-year-old woman has a rapidly enlarging, large but well-circumscribed breast lump that has grown noticeably over a few months. Core biopsy suggests a phyllodes tumour. What is the recommended surgical management?
Correct. Phyllodes tumours are managed by wide local excision with an adequate clear margin because simple enucleation leaves a high local recurrence rate. They typically spread haematogenously rather than to nodes, so routine axillary clearance is not indicated.
Phyllodes tumour: wide local excision with a clear margin (enucleation recurs); axillary clearance not routine.
Phyllodes tumours require wide local excision with a clear margin to prevent recurrence; enucleation is inadequate and routine axillary surgery is not warranted.
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A 58-year-old woman has an early invasive breast cancer. She asks whether breast-conserving surgery with radiotherapy is as safe as removing the whole breast. Which statement best reflects the evidence on survival?
Correct. For suitable early breast cancers, breast-conserving surgery (wide local excision) combined with radiotherapy provides equivalent overall survival to mastectomy. Radiotherapy is integral to conservation to control local recurrence. This is central to counselling.
BCS + radiotherapy = mastectomy in overall survival for suitable early breast cancer; radiotherapy is integral to conservation.
The established evidence is that breast conservation PLUS radiotherapy gives equivalent survival to mastectomy in appropriately selected early breast cancer. Radiotherapy is an essential part of the conservation package.
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A breast cancer is reported as oestrogen-receptor (ER) and progesterone-receptor (PR) positive and HER2-negative in a postmenopausal woman. Which adjuvant systemic therapy is most appropriate to target the tumour biology?
Correct. ER/PR-positive disease is hormone-driven, so endocrine (anti-oestrogen) therapy is the targeted adjuvant treatment: an aromatase inhibitor is commonly used in postmenopausal women, and tamoxifen is the classic option (especially premenopausal). Trastuzumab targets HER2, which is negative here.
ER/PR-positive cancer: endocrine therapy (aromatase inhibitor postmenopausal, tamoxifen premenopausal). Trastuzumab is for HER2-positive disease.
Hormone-receptor-positive (ER/PR+) cancer is treated with endocrine therapy (aromatase inhibitor or tamoxifen). Trastuzumab targets HER2, which is negative in this tumour.
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