FM_CASES_QUESTIONS FM_Cases#01:---45 year old female annual exam

FM_CASES_QUESTIONS FM_Cases#01:---45 year old female annual exam QUESTION #1 (Case#1) 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. Her periods have been regular since they started at the age of 12 and occur every 32 days. She is currently menstruating. She has three children aged 12, 9, and 4. On exam, her BMI is 32 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 history D. Family history of cancer E. Age of menarche Correct Answer Q1C1 B. Weight has been selected by the expert. QUESTION #2 (Case#1) 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 29 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 of menarche E. Age of menopause 2 QUESTION #3 (Case#1) CORRECT ANSWER: “C” C has been selected by the expert. QUESTION #4 (Case#1) 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 E. Screening mammography is not recommended at this time CORRECT ANSWER: “D”—Start at age 50 and every 2 years thereafter Mammography has a sensitivity of 60-90% for detecting breast cancer and decreases breast cancer mortality. According to the most recent USPSTF guidelines, routine mammography is not indicated for women younger than 50 years old unless they fall into a high-risk category such as women with a BRCA mutation. The USPSTF recommends biennial testing for women between the ages of 50-74 years of age. There is insufficient evidence to assess the benefits versus risk of screenings in women after the age of 75. Other groups such as the American Cancer 3 Society (ACS) and American College of Obstetricians and Gynecologists (ACOG) recommend yearly mammograms starting at age 40, continuing as long as the woman is in good health. QUESTION #5 (Case#1) A 27-year-old woman comes into your office because she heard from her friend about a vaccination against cervical cancer and would like one. She has no medical problems and has had a Mirena IUD for three years. She has an allergy to latex and penicillin. She began having sex at the age of 18 and is currently sexually active with one partner. She occasionally uses condoms. She smokes half a pack of cigarettes per day. Her mother had endometrial cancer several years ago and had a total hysterectomy. Why is the patient not a good candidate for the Gardasil vaccination? A. Age B. Sexual activity C. Mirena IUD D. Allergy to penicillin E. Family history of endometrial cancer F. Tobacco use CORRECT ANSWER: “A”—Age Gardasil is a vaccination against HPV types 6, 11, 16, and 18 approved for females ages 9 to 26. Cervarix protects against serotypes 16, 18, 31 and 45 approved for ages 10 to 25. Both are a series of three shots and recommended for females ages 11-18, optimally before sexual debut or shortly thereafter. The patient above is too old to receive the vaccination. Though vaccination before sexual debut is preferred, sexual activity (choice b) is not a contraindication to Gardasil vaccination. The other choices are not contraindications to vaccinations. FM_Cases#02:---55 yo male annual exam A 55-year-old male with no significant past medical history presents for a routine physical exam. He last saw a doctor five years ago. Social history is remarkable for a 35- pack-year tobacco history since the age of 20. He indicates that his wife and children have urged him to quit smoking for the last few months. When you ask him if he has considered quitting, he replies, "I just don't see what the big deal is!" Which stage of change best describes this patient at this time? A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance ANSWER:--A Precontemplation Based on this man's response, it appears he has not actively considered quitting smoking despite his family's concern. All stems refer to a different stage in the