Response to Clinical Discussion

ANSWER

Case 1: Response to Clinical Discussion
1. Additional Subjective Information to Determine Duration and Onset: When did the patient discover the bump for the first time? Has its consistency, size, or shape changed over time?
Related Symptoms: Any redness, swelling, dimpling of the skin, or breast pain? Have you ever experienced any recent breast trauma?
Period History: When did you menarche and did you experience any anomalies in your cycles prior to menopause?
Risk factors for breast cancer: prior breast biopsy, atypical hyperplasia history, radiation therapy exposure, or lifestyle choices (smoking, drinking, or exercising).
Family history includes known genetic mutations (e.g., BRCA1, BRCA2) and a history of various malignancies (e.g., ovarian, colon) in first-degree relatives.
Reproductive History: Number of pregnancies, age of first pregnancy, and history of breastfeeding.
2. Other Objective Results to Consider in a Breast Exam:
Look for retraction of the skin or peau d’orange (orange-peel texture).
Check for signs of infection, such as redness or warmth.
Examine the breasts for crusting, ulceration, or discharge, especially if it is bloody or serous.
Regional Lymph Nodes: Check for enlargement or soreness in the deeper cervical, supraclavicular, and axillary lymph nodes.
Examine the abdomen thoroughly for any lumps that might point to metastases or hepatomegaly.
If there is any reason to suspect involvement of the central nervous system, perform a neurological examination.
3. Diagnostic Tests for Mammography Orders:
first-line imaging to assess the mass’s properties, including density, borders, and calcifications.
Breast ultrasound: Particularly helpful in cases with thick breast tissue, it can identify if the lump is solid or cystic.
Core Needle Biopsy or Fine-Needle Aspiration (FNA): For histological assessment to verify the mass’s type (malignant vs. benign).
If necessary, a breast MRI is performed to further assess unclear results from ultrasonography or mammography.
BRCA Genetic Testing: In the event that a possible genetic susceptibility is shown by personal risk factors or family history.
Blood tests include liver function tests (LFTs), complete blood counts (CBCs), and serum tumor markers like CEA or CA 15-3, which are not diagnostic but can be used for monitoring.
4. Distinctive Diagnoses
Fibroadenoma is uncommon after menopause but common in women of all ages. It’s a hard, movable, benign breast lump that might be mistaken for cancer.
The most prevalent kind of breast cancer, invasive ductal carcinoma, typically affects postmenopausal women and manifests as a firm, non-mobile mass that is painful.
Breast cyst: A fluid-filled lump that frequently varies with hormonal changes and can feel firm or sensitive depending on its size and tension.
5. Justifications for Distinctive Diagnoses
Fibroadenoma:
Because of its firmness and lack of tenderness, the tumor may be indicative of benign disorders such as fibroadenoma. However, malignancy is more likely due to the patient’s advanced age and the mass’s immobility.
Breast Cancer: Two important risk factors for the patient are a hard, immobile lump and a family history of the disease. Additionally, her post-menopausal condition raises her risk of developing cancer.
Breast Cyst: Although less frequent in the absence of discomfort or mass size fluctuation, breast cysts can still occur, particularly if imaging shows a structure filled with fluid.
6. Instruction and Patient Education
The diagnostic procedure
Describe how crucial it is to finish imaging tests and a biopsy in order to identify the type of mass.
To ease concern, talk about the distinctions between benign and malignant findings.
Health of the Breasts:
Stress the value of yearly screenings and routine breast checks, particularly after menopause.
For early detection, promote adherence to self-breast examinations and follow-ups.
Risk Factor Management: To lower overall cancer risk, talk about maintaining a healthy weight, eating a balanced diet, and getting frequent exercise.
If appropriate, talk about quitting smoking and drinking.
Family Involvement: Suggest genetic testing and counseling to family members who have a history of breast cancer.
Citations
2022: American Cancer Society. risk factors for breast cancer. taken from the website https://www.cancer.org
Huether, S. E., McCance, K. L., and Brashers, V. L. (2019). Pathophysiology: The biological underpinnings of adult and pediatric illness, eighth edition. Elsevier.
The 2023 National Comprehensive Cancer Network. NCCN recommendations for the diagnosis and screening of breast cancer. taken from the website https://www.nccn.org
Each topic is fully addressed in this well-organized response, which incorporates evidence-based procedures and the most recent APA 7th edition formatting. If you want any changes made, please let me know!

 

 

 

 

 

QUESTION

Module 7 Discussion

  Female Genitourinary, & Musculoskeletal

 

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

	Case 1
Chief Complaint (CC)	“I have a tumor on my left breast”
History of Present Illness (HPI)	A 55-year-old African American social worker presents to your clinic with a finding of a lump in her left breast while in the shower this past week.
Drug Hx	I took birth control pills for 10 years, starting when I was 20 I am not on hormone replacement
Family Hx	My grandmother had breast cancer when she was 76 years old
Subjective	Denies any fever or chills. No changes in vision or hearing, no difficulty chewing or swallowing. Supple neck, states that she does self-breast-exams on occasion. Menopause at 52 No skin changes or nipple discharge from the left breast
Objective Data
VS	temperature 98.6°F; respiratory rate (RR) 16; heart rate (HR) 80, regular; blood pressure (BP) 130/84; height: 5′8″; weight 160 lbs; body mass index (BMI) 24
General	well developed, nourished, healthy-appearing female
HEENT	Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.
Lungs	clear to auscultation
Card	regular rate and rhythm (RRR)
Breast	Examined in sitting and supine positions. In sitting position, no evidence of skin changes, right breast is slightly larger than the left, symmetrical movement with the arms above the head and at the side and with flexion of the pectoral muscles; 5-mm nonmobile, non-tender, firm mass felt at 10 o’clock position, 5 cm from the areola. Right breast without dominant masses or tenderness. Nipples without inversion or evidence of nipple discharge. Breast mass is palpated in the supine position in the same manner as in the sitting position
Lymph	negative axillary, infraclavicular, and supraclavicular lymphadenopathy
Abd	normoactive bowel sounds x 4;
GU	Bladder is non-distended.
Integument	good skin turgor noted, moist mucous membranes
MS	Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.
Neuro	No obvious deformities, CN grossly intact II-XII

Once you received your case number, answer the following questions:

1. What other subjective data would you obtain?

2. What other objective findings would you look for?

3. What diagnostic exams do you want to order?

4. Name 3 differential diagnoses based on this patient presenting symptoms?

5. Give rationales for your each differential diagnosis.

6. What teachings will you provide?

 

Submission Instructions:

· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.