Skip to main content
MMedVellum
MCQsExamsAtlas
DashboardPricing
MMedVellum

The exam atlas that feels like a flagship product — evidence-graded topics and exam tools for MBBS and fellowship preparation. Built to scale to fifty specialties. Educational content only — not medical advice.

llms.txt·psychiatry LLM catalog · sitemap

Atlas

  • Specialty atlas
  • MBBS / Core medicine
  • Dermatology
  • ICU Fellowship (CICM)
  • Anaesthesia
  • Emergency Medicine
  • Psychiatry Fellowship

Study & account

  • MCQ practice
  • Practice alias
  • Exam tools
  • Dashboard
  • Pricing
  • Sign in

© 2026 MedVellum. For education only — not a substitute for clinical judgement.

Clinical Atlas Prestige · Evidence-first

LibraryMBBS

MBBS SAQ

Breast Cancer — SAQ

10 marks10 min
On this page & tools
Question
10 marks10 min

Stem

A 52-year-old postmenopausal woman presents with a 3cm hard, irregular, painless lump in the upper outer quadrant of the left breast. There is a 1cm hard mobile lymph node in the left axilla. No skin changes or nipple discharge.

[1]

Questions

[1]

a) Describe the diagnostic approach (triple assessment) and what each component evaluates. (3 marks)

[1]

Triple assessment (98% accurate when all three agree):

  1. Clinical examination: inspect (symmetry, skin, nipple) + palpate (all quadrants + axillary tail + axillary nodes)
  2. Imaging: mammography (looking for microcalcifications, spiculated mass, architectural distortion — BI-RADS classification) ± ultrasound (solid vs cystic, guide biopsy)
  3. Tissue sampling: core needle biopsy (gold standard — histology type, grade, ER/PR/HER2 receptor status)
[1]

b) The core biopsy shows invasive ductal carcinoma, grade 2, ER+/PR+, HER2-. What adjuvant systemic therapy is indicated? (2 marks)

[1]

This is a Luminal subtype (ER+/PR+, HER2-). Adjuvant systemic therapy:

  • Endocrine therapy: Since she is POSTMENOPAUSAL, an aromatase inhibitor (anastrozole or letrozole) for 5-10 years (superior to tamoxifen in postmenopausal women — ATAC trial).
  • Chemotherapy may be added depending on tumour size, nodal status, grade, and genomic profiling (Oncotype DX).
[1]

c) What is the role of sentinel lymph node biopsy, and how is it performed? (3 marks)

[1]

Sentinel lymph node biopsy (SLNB) is the standard for axillary staging in clinically node-negative breast cancer:

  • Technique: Blue dye (methylene blue/patent blue V) and/or radioisotope (technetium-99) injected at the tumour/areola. The first draining node(s) are identified intraoperatively and excised.
  • If negative: No further axillary surgery (avoids morbidity of clearance — lymphoedema, nerve injury).
  • If positive (1-2 nodes): Axillary radiotherapy or clearance (ACOSOG Z0011: no benefit of clearance for 1-2 positive nodes in selected patients with BCT).
  • If positive (3+ nodes): Formal axillary node clearance (levels I-III).
[1]

d) Name two significant side effects of aromatase inhibitor therapy. (2 marks)

[1]
  1. Osteoporosis (reduced bone mineral density — due to complete oestrogen deprivation. Monitor with DEXA, give bisphosphonates if needed.)
  2. Arthralgia (joint pain — common, affects adherence). Also: hot flushes, vaginal dryness, increased cholesterol.
[1]

References

  1. [1]Waks AG, Winer EP. Breast Cancer Treatment: A Review. JAMA, 2019.PMID 30667505
  2. [2]Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death. Lancet, 2011.PMID 22019144
  3. [3]Robson M, Im SA, Senkus E, et al. Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation. New England Journal of Medicine, 2017.PMID 28578601