Family Medicine Aquifer Cases question n answers graded A+ 2023/2024

Family Medicine Aquifer CasesA 34-year-old woman who has no past medical problems nor is currently taking any medications comes into your office because she noticed a tender lump in her left breast starting approximately one month ago. She is worried because she has an aunt who had breast cancer that was BRCA positive, though her mother is BRCA negative. Her periods have been regular since they started at the age of 13 and occur every 32 days. She is currently menstruating. She has three children aged 12, 9, and 4. On exam, her BMI is 32, up from 28 three years ago and her other vital signs are stable. On breast exam, you note a mobile rubbery mass of approximately 1 x 1cm and with regular borders that is tender to palpation. You appreciate no axillary adenopathy. The rest of her physical exam is unremarkable. Of the information provided, which of the following places this patient at increased risk for breast cancer? A. Age B. Weight C. Parity - correct answer The correct answer is B. With a BMI of 32, obesity is the one risk factor for this patient based on the information given. Other risk factors for breast cancer include family history of breast cancer in a first degree relative (mother or sister - not aunt), prolonged estrogen exposure (menarche before age 12, menopause after 45, advanced age at first pregnancy), genetic predisposition (BRCA 1 or 2 mutation), advanced age (breast cancer risk increases with age, and this patient is relatively young), female sex, increased breast density and certain exposures (diethylstilbestrol, hormone or radiation therapy, heavy smoking). A 64-year-old woman who is overweight with well-controlled hypertension comes to your office complaining of a lump in her breast that she noticed while showering. She denies any pain, tenderness, or skin changes. A pertinent review of systems is negative. Menarche began at the age of 10. Her first child was born when she was 31 and she had her second and last child at the age of 33. She experienced menopause at the age of 44. Her mother died of colon cancer when she was 65 and her father passed away from metastatic prostate cancer at the age of 70. She has no history of tobacco use ever and occasionally drinks a glass of wine with dinner. Her BMI is 34. Which of the information provided thus far puts the patient at decreased risk for breast cancer? A. Age B. Weight C. Age at first birth D. Age at menarche E. Age at menopause - correct answer The correct answer is E. The patient experienced menopause at the age of 44, which shortens her time of estrogen exposure, a known risk factor for the development of breast cancer. Factors associated with decreased breast cancer risk include pregnancy at an early age, late menarche, early menopause, high parity and medications such as selective estrogen receptor modulators along with NSAIDs and aspirin. Risk factors for breast cancer include family history of breast cancer in a first degree relative (mother or sister), prolonged estrogen exposure (menarche before age 12, menopause after 55, advanced age at pregnancy, obesity after menopause), female sex, genetic predisposition (BRCA 1 or 2 mutation), advanced age (breast cancer risk increases with age), increased breast density and exposures (diethylstilbestrol, hormone or radiation therapy, smoking). A 63-year old woman comes into your office for her annual preventive exam. She has hypertension and type 2 diabetes. She is not sexually active. Her blood pressure is 125/80 and her physical exam otherwise is within normal limits. You recommend influenza and zoster vaccination. Her last colonoscopy was eight years ago and her last mammogram one year ago was normal. She has never had an abnormal Pap smear. At the age of 45 she had a total hysterectomy for fibroids. You tell her she does not require a Pap smear today because: A. She has never had an abnormal Pap smear B. She is not sexually active C. She had a total hysterectomy for fibroids D. She is 63 years old E. She experienced menopause more than 10 years ago - correct answer The correct answer is C. The patient described above underwent a total hysterectomy (total removal of the uterus and cervix with or without oophorectomy) for benign reasons (fibroids). USPSTF guidelines recommend against continued cervical cancer screening in patients whose uterus has been removed for benign disease and evidence showed cytologic screening to be very low yield and poor evidence that screening to detect vaginal cancers improves health outcomes in women after hysterectomy for benign disease. Cervical cancer screening should begin at the age of 21 and women between the ages of 65 and 70 who have had three or more normal Pap tests in the past ten years may choose to stop cervical cancer screening. Not being sexually active; age 63; only having had normal PAP smears and years since menopause are not reasons to stop screening for cervical cancer.