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Aquifer FMCases Quiz at the end of cases 1-10 With Complete Solutions
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Aquifer FMCases Quiz at the end ofcases 1-10 With Complete Solutions.
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,A 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. Parit - Answers: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 - Answers: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 - Answers: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.
A 47-year-old woman comes into your office for a health care maintenance exam. She
has hypertension and type 2 diabetes. She is not sexually active and has not yet
experienced menopause. There is no family history of cancer. Her blood pressure is
118/78, her BMI is 34 and the remainder of her physical exam is within normal limits.
Her vaccinations are up-to-date, she has a PAP smear today and will have labs drawn.
*According to USPSTF, which of the following is the best recommendation to give her
concerning mammography?*
A. Should have started at age 40 and every year thereafter
B. Should have started at age 40 and every 2 years thereafter
C. Start at age 50 and every year thereafter
D. Start at age 50 and every 2 years thereafter
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