Discuss the questions that would be important to include when interviewing a patient
with this issue.
This patient is a 42-year old female who came in
... [Show More] today for examination of two lumps she has
palpated on her right breast. She denies pain at the area of the lumps, denies nipple
drainage. She states that she had this condition approximately 3 years ago and a breast biopsy
was done and she was diagnosed with atypical ductal hyperplasia. She is also complaining of
not having an appetite and she has noticed a weight loss over the past couple of months. This
patient does have a first relative family history of breast cancer. According to a study that
was done at the University of San Diego California, Obtaining an accurate history is the
critical first step in determining the etiology of a patient's problem (University of San Diego,
California, 2018). I prefer to use the OLDCARTS acronym to obtain a history.
O: When did you first notice the lumps in your breast?
L: Where in your breasts are the lumps located?
D: How long have the lumps been there?
C: Are the lumps hard, soft, do they have rigid borders, are they movable?
A: Are the lumps painful? If they are does anything make the pain better?
R: Does anything make the lumps smaller or go away?
T: Is there a certain time of the month that they are larger?
S: Are they painful?
Additionally, I would like to know when her last mammogram was and if she has had a pap
smear done and were the results abnormal?
Discuss the clinical findings that may be present in a patient with this issue.
The clinical findings are positive for two lumps located in her right breast. The first mass is
located at the 12 o’clock location and it is 2cm in size, the second mass is located at the 2
o’clock location is about 2.5cm in size. There is also a hard, although mobile, nodule located
in the right axillary lymph node. This patient might have nipple discharge, and if so what
does it look like, i.e.: blood, green, yellow, white etc. She had any trauma to the breast for
example a car accident where the seat belt tightened against her breast. The breasts might be
a difference of appearance such as increase or decrease in size. The nipple may be everted,
pain may be present or absent and the mass may differ depending on the menstrual cycle
(Pruthi, 2014).
Are there any diagnostic studies that should be ordered on this patient? Why?
This patient should have several diagnostic studies. A mammogram will depict the density of
the soft tissue present. This study can detect a mass that is abnormal and may be suspicious
of breast cancer it cannot give a definitive diagnosis. Many women who are premenopausal
have breast tissue that appears dense.
A targeted ultrasound should be ordered, this will show if the mass is a solid mass, a mass of
cystic consistency or a mixture of both of them. This test will also depict information on
whether the margins of the mass are defined or not.
If a mass is suspected to be malignant the patient should have a magnetic resonance image
(MRI) which will enhance the image and show masses that may be present that are not
palpable. [Show Less]