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REVISION 1

BREAST DISORDER
BY DR.WAEL METWALY
Clinical

Operative

- Chronic Breast Abscess


- Fibroadenosis
- Hard Fibroadenoma
- Breast Cancer

Jars

- Radical Mastectomy
- Treatment of Mastitis
& Acute Breast Abscess.
- Management of Cancer.

X-rays

- Breast Cancer

- Soft tissue Mammography

EXAMS
A. Anatomy
B. Written Questions
C. Explanations
D. Cases

A. ANATOMY
1994 - Anatomy of Lymphatic Drainage of Female Breast

(15 Marks)

1999 - Describe Lymphatic Drainage of the Breast

(10 Marks)

2001 - Anatomy of Lymphatic Drainage of Female Breast

(10 Marks)

2004 - Discuss Anatomy of Female Breast


- Discuss Lymphatic Drainage of the Breast

(20 Marks)
(10 Marks)

B. WRITTEN QUESTIONS
1995
Discuss Path., C/P & ttt of Acute Breast Abscess
Discuss Skin Manifestations of Female Cancer Breast.

(15 Marks)
(10 Marks)

1996
Discuss Path., C/P & ttt of Acute Breast Abscess

(10 Marks)

1997
Discuss C/P of Lactational Mastitis & Breast Abscess.
Enumerate pathological Types of Breast Carcinoma
Discuss 2 systems of staging of Cancer Breast

(10 Marks)
(5 Marks)
(10 Marks)

1998
Discuss Path., C/P & ttt of Fibroadenoma of Breast.
Discuss management of Early Cancer Breast.

(15 Marks)
(15 Marks)

1999
Discuss aetiology, diagnosis & ttt of Nipple Discharge
Discuss DD of Breast lump.

(10 Marks)
(25 Marks)

(15 Marks)

2000
Discuss C/P & treatment of Acute Lactational Mastitis
& Breast Abscess
Discuss causes & diagnosis of Nipple Discharge

(10 Marks)

2001
Discuss Skin Manifestations of Female Cancer Breast.
Mention Aetiology, pathology, C/P of Acute Breast Abscess

(10 Marks)
(10 Marks)

2002
Mention DD of Breast lump
Discuss, causes & management of Nipple Discharge
Discuss DD between Paget's & Eczema

(15 Marks)
(12 Mark)
(12 Mark)

2003
Enumerate causes & investigations of Discharge per Nipple
Discuss Paget's disease of nipple
Discuss DD of Mass of the Breast.

(12 Marks)
(12 Marks)
(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
Discuss management of Discharge per Nipple.

(5 Marks)
(15 Marks)

2006
Discuss C/P & Management of Acute Breast Abscess
Discuss Aetiology & Management of Bleeding per Nipple.

(10 Marks)
(10 Marks)

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 outer


quadrant 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 female


after 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 axillary


evacuation of breast cancer ( OMMR=? J==h~ )

q = ==== ~= ~K=^ ==o ~~= ~= K=

13. Arm edema after Radical Mastectomy


A. Early (few days)
a ==NK=o ~=== ~
OK=q ==^ ~

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B. Late (few months)
a ==NK=o ==^ ~=i Kk
OK=^ ~=~~=E F
PK=f=Ei ~F

14. It is recommended to give Hydrocortisone with Aminoglutethemide in hormonal treatment of cancer breast
^ =^ = = = ~~=

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

16. The patient is warned to avoid minor trauma to the Ipsilateral


hand & 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 examination
there 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 medical
treatment
- Discuss the diagnosis

Case [4] ( Mammary Duct Ectazia )


A 35-years-old lady presented by toothpaste like discharge from her
right nipple
- Discuss the diagnosis

Case [5] ( Fibroadenosis )


A 40-years-old women presented to the outpatient department with
multiple lumps in both breasts.
a. What is your provisional diagnosis?
b. What are investigations would you order?
c. What is the treatment?

Case [6] ( Fibroadenosis )


A 25-years-old girl presented by pain in her left breast which increase
just 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?

Case [7] ( Fibroadenosis )


A middle aged female presented with tender symmetrical enlargement of
her 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 discharge
from 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 and
areola not associating with itching.
- Discuss the diagnosis

Case [10] ( Chronic Breast Abscess or Cancer )


A female patient 50-years-old presented with a hard painless lump in the
right breast.
EOMMQ=? J S=l F

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- Discuss the diagnosis

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 the
Lt. 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 METWALY