Questions

A worried 23-year-old woman, who started taking the combined contraceptive pill 3 months ago, presents with a 1-day history of discovering a painless lump in the right breast. The patient states that the lump was not there a month ago. On examination, a slightly mobile, discrete, well-defined, non-tender, firm 1 cm diameter lump is found. There is no lymphadenopathy. The most likely diagnosis here is:

A. Breast cyst B. Lipoma C. Fibroadenoma D. Sebaceous cyst E. Carcinoma of the breast

2. Breast pain (1)

A 36-year-old nulliparous woman attends your clinic with a 7-day history of left breast pain after being involved in a car accident. On examining her breast, you notice a hard, irregular 3cm, immobile, tender lump. You also notice some skin tethering and overlying bruising in the region of the lump. The most likely diagnosis is:

A. Breast carcinoma B. Breast cyst C. Fat necrosis D. Breast abscess E. Fibroadenosis

3. Breast infection

A 33-year-old, non-smoking, breastfeeding woman is 10 days postpartum. She has a 4-day history of a slight crack on the surface of her left nipple. She presents with a 2-day history of severe continuous pain in the left breast which has prevented her from sleeping. On examination, you find the outer quadrants of the left breast to be red, warm and tender with a hard 3 cm lump at the edge of the left nipple. The most likely diagnosis is:

A. Acute mastitis B. Breast cyst C. Fat necrosis D. Breast abscess E. Periductal mastitis

4. Breast lumps (2)

A 65-year-old nulliparous woman presents to your clinic with a lump in her left breast, which was discovered 7 months ago. On examination you find a hard, illdefined, non-tender, 3.5 cm lump behind the left nipple. The patient has also had bloody, non-purulent discharge from the left nipple for over 3 months. The most likely diagnosis here is:

A. Mammary duct ectasia B. Breast carcinoma C. Duct papilloma D. Periductal mastitis E. Acute mastitis

5. Breast pain (2)

A 43-year-old woman presents to your clinic with a 2-month history of localized dull pain in the right breast. The pain intensifies just before her period. On examination, you find a discrete 2.5 cm mobile, tense, tender, fluctuant lump in the lower inner quadrant of the right breast. The most likely diagnosis here is:

A. Fibroadenosis B. Periductal mastitis C. Breast cyst D. Fat necrosis E. Fibroadenoma

6. Nipple discharge

A 47-year-old perimenopausal woman presents with a 3-week history of green discharge from the right nipple. On examination, the right nipple is non-tender, has a ‘slit-like’ appearance and is retracted. The most likely diagnosis is:

A. Galactorrhoea B. Duct papilloma C. Breast carcinoma D. Mammary duct ectasia E. Periductal mastitis

7. Breast lumps (3)

A 31-year-old woman presents after having noticed multiple lumps in both breasts which become very painful before the onset of her menses. On examination, you find bilateral diffuse lumpy areas in the upper outer quadrants of both breasts with some areas of tenderness. There is no lymphadenopathy. The most likely diagnosis is:

A. Breast cysts B. Fibroadenosis C. Fibroadenoma D. Breast carcinoma E. Fat necrosis

8. Pathological breast enlargement

A 67-year-old woman, with a 25-year smoking history, on hormone replacement therapy, presents to clinic expressing concerns regarding a recent increase in size of her right breast. On examination, you find a non-tender, mobile, nodular 3 cm mass in the left breast. The right breast is significantly larger than the left and has a ‘teardrop’ appearance. The most likely diagnosis here is:

A. Paget’s disease of the nipple B. Inflammatory breast carcinoma C. Breast abscess D. Malignant phyllodes tumour E. Fibroadenoma

9. Rash

A worried 59-year-old city worker arrives at your clinic with a 1-month history of having noticed a non-itchy, persistent, burning rash in the region of her right breast. On examination you find the right nipple and the skin overlying the areola to be red and eczematous. Axillary lymphadenopathy is present. The most likely cause is:

A. Breast abscess B. Malignant phyllodes tumour C. Paget’s disease of the nipple D. Basal cell carcinoma E. Mastitis

10. Breast pain (3)

A 21-year-old nulliparous woman presents to your clinic with a 1-month history of bilateral breast pain. The pain, which is dull and achy in nature, is poorly localized and widespread across both breasts. The pain gradually increases in severity and is worse just before her menses. The pain usually starts to get better once her menses start. On examination, both breasts are tender. There are no lumps, skin changes or obvious swellings. The most likely diagnosis here is:

A. Non-cyclical mastalgia B. Tietze’s syndrome C. Cyclical mastalgia D. Acute bacterial mastitis E. Traumatic fat necrosis

11. Management of breast pathology (1)

A 25-year-old woman presents to your clinic after discovering, for the first time, two lumps in the inner lower quadrant of her left breast. On examination you find these lumps to be 2 cm in size, solid, discrete, mobile and non-tender. The right breast is normal and there is no lymphadenopathy. The most appropriate course of management is:

A. Request a mammogram B. Reassure the patient and discharge her C. Request an ultrasound of the left breast D. Request fine needle aspiration E. Request a core biopsy

12. Management of fat necrosis of the breast

A 25-year-old woman is diagnosed with fat necrosis of the left breast following a traumatic injury 14 days earlier. She has slight bruising of the lower outer quadrant of the left breast with moderate tenderness. What would be the most appropriate course of management?