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Join date : 2013-12-26

PostSubject: AMC Clinical exam preparation   Sat Dec 28, 2013 1:47 pm

amc clinical exam

A 40 year old woman presented with lumpy breast, cyclical pain. She has family history of breast cancer in her mother. You have just examined her and it showed lumpy breast and mobile tender mass over upper outer quadrant of left breast. She is not tolerated to OC pills.

Task- Management plan

Me- Hello X, I have just examined you. It is a good news. I believe it is a condition called fibroadnosis.
RP- Isn’t it cancer?

Me- No it is not. I really appreciate your concern and it is very good you came to see me today.
I can feel the mass in the upper outer part of your breast. It is sore obviously and very mobile and your whole breast has lumpy feeling. You don’t have any glands in your arm pit. You don’t have any signs of attachment of your mass to skin or underlying muscles. You have no nipple destruction and discharge. And you get cyclical pain relieved after your cycle. All those symptoms and signs are consistent with a benign mass. Benign means “ Not cancer”.

RP- Why does it happen?
Me- It is due to hormone related abnormal changes in the breast tissue and glands. It is a very common condition and usually associated with lumpy sore breast.

Me-Shall we talk about management plan for you now ?
RP- Yes. I really want to know.

Me- First of all, though I am strongly convinced that it is not cancer , as you have family history of breast cancer in your mom , I want to arrange USG and Mammogram for you so that you will feel less anxious about it too.
If the USG showed a definite mass, then we will proceed to USG guided needle biopsy.
Once you get those results , I will review you again.

In the mean time , we will start with some simple measures for your symptoms.
Take Panadol for pain as required before onset of your period. Take EPO daily too. ( RP says I have heard about that) .
And wear soft supportive bras of good quality.

Me- Can I ask few questions? Do you smoke ? Do you drink alcohol? Do you do exercise? What about your diet ?
RP- Smokes 5 cigarettes a day. Don’t drink alcohol. No exercise.

Me- I want to suggest you to gradually cut down your smoking and we can talk about that in another consultation.
It is good that you don’t drink alcohol.
Will you be interested in doing any sort of exercise ?
RP- I used to swim before. Can I do that ?
Me-Of course, you can. And eat nutritious healthy diet rather than fast food, sweet and fatty food. Have lots of fruits and vegetables.
All these will improve your general fitness too.

If you are not still improving, we can try some injection hormones ( progestrogen) after getting specialist opinion as you are not tolerated to OC pills.
It helps to shrink the lump but may not completely cure it.

Last resort which is very unlikely to be needed is surgery. And it is not usually performed cos it can recur and it doesn’t balance the hormonal imbalance.

I would like you to do good self breast examination every month even after normal USG and Mammogram.
Do you know how to do it ?

Me- Do you have any sisters? I want them to do self breast examination every month and to discuss a doctor immediately if they feel anything abnormal.

RP- What else can we do for all our sisters to know the risk as we have 3 sisters in the family.
Me- If it is familial breast cancer, BRCA genes can be positive . We can do that if you are concerned.
RP- By the way, you told me that I have slightly increased risk of breast cancer than others. What is that risk exactly?
Me- It is hard to say exactly and I can google it up if you want .
RP- Smiles

Me- Is there any other concerns ?
RP- No

Me- I will see you again with your results.
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