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1. A 44-year-old female mathematician presents to clinic c. This patient
was in
with a complaint of a mass in the right breast. Her compliance with
the U.S.
partner noticed this mass 2 days ago, and the patient Preventive
Services Task
feels guilty because she has only had one mammo- Force (USPSTF)
recom-
gram and does not engage in breast self-examination mendations
for her age
(BSE) on any regular basis. She has no family group and risk factors
history of breast cancer, and her prior pri- or to her current
mammogram was or- com-
dered as a routine screening test at age 43 years after plaint.
a brief discussion with her primary care provider.
After a thorough investigation reveals a
benign cyst, what advice should be given to
this patient about screening for breast cancer
in her age group?
a. BSE is well evidenced, and all recommending
agen- cies agree that it should be taught and
reinforced.
b. Clinical breast examination (CBE) is superior to
BSE and should be a routine part of annual
examinations starting at age 30 years.
c.This patient was in compliance with the U.S.
Preven- tive Services Task Force (USPSTF)
recommendations for her age group and risk
factors prior to her current complaint.
d. Mammography is most sensitive and
specific for women in their 40s, when breast
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tissue is still dense enough to image
accurately.
e. Breast cancer screening is extremely well
stud- ied, and no controversy exists on the
recommended norms for screening and
follow-up.
2. A 42-year-old female website developer b. Sensitivity of
presents for an annual preventive screening for breast
examination with questions about breast cancer increas-
cancer screening. She is concerned
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about the radiation exposure associated with irregular
mam- mography and is interested in magnetic periods
resonance imaging (MRI) as a possible over the
alternative for routine screening. She is last few
otherwise healthy with no family his- tory of months.
breast, ovarian, or colon cancer. Which of the On
following is true about MRI as a screening examinatio
modality for breast cancer in the general n, she is
population? able to
express a
a. Breast cancer screening by MRI has been small
well stud- ied in the general population. amount of
b. Sensitivity of screening for breast cancer discharge,
increases with breast MRI at the expense of which is
specificity. sent to the
c. This patient is an ideal candidate for laboratory
screening via breast MRI based on current and found
evidence. to be
d. Women at low lifetime risk of breast cancer consistent
(<20%) are recommended to undergo with breast
screening MRI. milk but
e. Known BRCA1 or BRCA2 mutation is without
insufficient criteria to justify screening with any signs
breast MRI. of blood or
pus.
3. A 35-year-old G0P0 woman presents to clinic
Screen- ing
with a complaint of bilateral nipple discharge.
laboratorie
This discharge started several weeks ago and
s are also
has occurred at irregu- lar intervals since that
sent, which
time. She does not complain of local
reveal a
tenderness, redness, fever, or any other
nor- mal
systemic symptoms aside from slightly
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blood count, metabolic panel, thyroid- es with breast MRI at
stimulating hormone, and human chorionic the expense of
gonadotropin (HCG) specificity.
e. Prolactinoma