001.breastrevision

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BREAST DISORDER

BY DR.WAEL METWALY

Clinical Operative

- Chronic Breast Abscess - Radical Mastectomy - Fibroadenosis - Treatment of Mastitis - Hard Fibroadenoma & Acute Breast Abscess.

- Breast Cancer - Management of Cancer.

Jars X-rays

- Breast Cancer - Soft tissue Mammography

EXAMSA. AnatomyB. Written QuestionsC. ExplanationsD. Cases

A. ANATOMY

1994 - Anatomy ofLymphatic Drainage of Female Breast (15 Marks)

1999 - Describe Lymphatic Drainage of the Breast (10 Marks)

2001 - Anatomy ofLymphatic Drainage of Female Breast (10 Marks)

2004 - Discuss Anatomy of Female Breast- Discuss Lymphatic Drainage of the Breast

(20 Marks)

(10 Marks)

REVISION 1


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B. WRITTEN QUESTIONS1995

Discuss Path., C/P & ttt of Acute Breast Abscess (15 Marks) Discuss Skin Manifestations of Female Cancer Breast. (10 Marks)

1996

Discuss Path., C/P & ttt of Acute Breast Abscess (10 Marks)

1997

Discuss C/P of Lactational Mastitis & Breast Abscess. (10 Marks) Enumerate pathological Types of Breast Carcinoma (5 Marks) Discuss 2 systems of staging of Cancer Breast (10 Marks)

1998

Discuss Path., C/P & ttt ofFibroadenoma of Breast. (15 Marks) Discuss management of Early Cancer Breast. (15 Marks)

1999

Discuss aetiology, diagnosis & ttt of Nipple Discharge (10 Marks) Discuss DD of Breast lump. (25 Marks)

2000

Discuss C/P & treatment of Acute Lactational Mastitis& Breast Abscess

(15 Marks)

Discuss causes & diagnosis of Nipple Discharge (10 Marks)

2001

Discuss Skin Manifestations of Female Cancer Breast. (10 Marks) Mention Aetiology, pathology, C/P of Acute Breast Abscess (10 Marks)

2002

Mention DD of Breast lump (15 Marks) Discuss, causes & management of Nipple Discharge (12 Mark) Discuss DD between Paget's & Eczema (12 Mark)

2003

Enumerate causes & investigations of Discharge per Nipple (12 Marks) Discuss Paget's disease of nipple (12 Marks) Discuss DD of Mass of the Breast. (12 Marks)

2004

A 55 years old women presented with a hard lump in the breast.Discuss the necessary investigations.

(10 Marks)

2005

Enumerate 5 Risk factors of cancer breast (5 Marks) Discuss management of Discharge per Nipple. (15 Marks)

2006

Discuss C/P & Management of Acute Breast Abscess Discuss Aetiology & Management of Bleeding per Nipple.

(10 Marks)

(10 Marks)


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C. EXPLAIN

THE FOLLOWING STATEMENTS

1. Early vertebral metastasis with cancer breast Because venous drainage of breast carrying the malignant cells passing directly to

valveless vertebral veins

2. Fever with mastitis from milk engorgement Because of absorption of milk protein which acts as antigen so leading to pyrogenic

(Ag ^ F=~=

3. Acute bacterial mastitis is common when baby is at 6 months_ ~ == === ===~== ==K

5. Firm & Tender L.Ns associated with Fibroadenosis_ ~ == ~=~==~ ~== =~=

6. Fibroadenosis & Cancer breast is common at upper outerquadrant of breast

_ ~ ===

7. Encephalloid (Medullary) carcinoma is better than scirrhous carcinoma

_ ~ ==i ~= = ~==K=

8. Atrophic Scirrhous carcinoma is better than scirrhous carcinoma

_ ~ =~= = ==~=~=== =EKK= =F======= == = =C=~== =~K

9. Soft Tissue Mammography is of less Value with young female_ ~ == ~=======~K

10. Routine screening mammography is recommended for femaleafter the age of 40 years ( 2006 J==S=K) q===~~= ~=~= = ~= ==~K=

11. Limitation of movement of abduction after Radical Mastectomy_ ~ ==_ =~= ==~== ~== ~=K

12. It is not advisable to give Radiotherapy to Axilla after axillaryevacuation of breast cancer ( OMMR=? J==h~) q= ==== ~= ~K= ==o ~~= ~= K=

13. Arm edema after Radical MastectomyA. Early (few days)

a ==NK=o ~=== ~OK=q == ~


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B. Late (few months)a ==NK=o == ~=i Kk

OK= ~=~~=E FPK=f=Ei ~F

14. It is recommended to give Hydrocortisone with Amino- glutethemide in hormonal treatment of cancer breast

^ = = = = ~~=

15. Patient with breast cancer & +ve axillary L.Ns should be treated byChemotherapy (Post-operative) ( OMMS=? J==h~) q=h =~=~=~= J ~~=~=~ =~=J~ =

16. The patient is warned to avoid minor trauma to the Ipsilateralhand & should wear gloves after Radical mastectomy. q=~ ==C= ~

D. CASES

Case [1] ( Bacterial Mastitis )

A 25-years-old- lactating female presented with pain at her left breast.

Associated with fever. Which becomes worse at night. By examinationthere were tender axillary L.Ns & no nipple discharge .

a. What is the provisional diagnosis .

b. What is Aetiology

c. What is the treatment

Case [2] ( Acute Abscess )

A young lactating female presented with painful mass at her left breast.Associated with fever & bad odour discharge at her brace .


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a. What is the provisional diagnosis .

b. What is the usual mode of presentation

c. What is the treatment

Case [3] ( Chronic Abscess )

A 30-years-old female presented with painless hard mass at Rt. breast.There was past history of purulent discharge & was advised medicaltreatment

- Discuss the diagnosis

Case [4] ( Mammary Duct Ectazia )

A 35-years-old lady presented by toothpaste like discharge from herright nipple


Case [5] ( Fibroadenosis )

A 40-years-old women presented to the outpatient department withmultiple lumps in both breasts.

a. What is your provisional diagnosis?

b. What are investigations would you order?

c. What is the treatment?


A 25-years-old girl presented by pain in her left breast which increasejust before each menses.


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a. What is the provisional diagnosis?

b. What is the aetiology of this condition?

c. What is the management?


A middle aged female presented with tender symmetrical enlargement ofher breasts.

a. What is the diagnosis?

b. What is the pathology?

c. How is the condition treated?

Case [8] ( Duct Papilloma or Duct Carcinoma )

A 40-years-old lady presented to the breast clinic with a bloody dischargefrom her right nipple

a. What is the differential diagnosis?

b. What is the causes of bleeding?

c. How can you manage this condition?

Case [9] ( Paget's Disease )

A 50-years-old women presented with an erosion of her left nipple andareola not associating with itching.


Case [10] ( Chronic Breast Abscess or Cancer )

A female patient 50-years-old presented with a hard painless lump in theright breast.

EOMMQ=? J S=l F


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Case [11] (Cancer Breast - Operable)

A 55-years-old women presented with a hard lump in the breast

EOMMQ=? ? h~F- Discuss the necessary investigations.

Case [12] (Cancer Breast - Inoperable)

A 70-years-old women presented to the breast clinic with a lesion in theLt. breast & pain in the right hypo-chondrium & Jaundice

a. What is the diagnosis ?

b. What are investigations would you order?

c. What is the treatment?

GOOD LUCK

Dr. WAEL METWAL

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