MLA Domain 5 · Presentation

Gynaecomastia

8 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 3

Gynaecomastia

Hard, fixed, eccentric, rapidly growing mass with nipple change → male breast CANCER (refer)

Klinefelter syndrome

Increased risk of breast cancer (gynaecomastia), osteoporosis, venous thromboembolism

Male breast cancer

A firm, fixed, eccentric breast mass with nipple change in a man → suspected-cancer pathway (not 'just gynaecomastia')

recognised feature · 3

Alcohol-related liver disease

Severe alcoholic hepatitis (Maddrey discriminant function ≥32) → consider corticosteroids; high mortality

Cirrhosis & chronic liver disease

Decompensation (ascites/SBP, variceal bleed, encephalopathy) → admit/treat

Hyperprolactinaemia / prolactinoma

Visual field loss from a macroprolactinoma → urgent

differential of the above · 2

Lipoma

Rapid growth, size >5 cm, fixation, pain, or deep/retroperitoneal location → exclude liposarcoma (imaging ± biopsy)

Marfan syndrome

Aortic root dilatation/dissection — the cause of premature death; acute chest/back pain