Case 1 - 45 yo female annual exam

Question 1

Risk factors for breast cancer

Answer 1

family history in first degree relative, menarche before 12 or menopause after 45, genetic predisposition, advanced age, female sex, obesity, hormone therapy, advanced age at first pregnancy, exposure to DES

Question 2

Decreased risk for breast cancer

Answer 2

pregnancy at early age, late menarche, early menopause, high parity, SERMs

Question 3

Is breast self-examination indicated?

Answer 3

Does not reduce mortality but increases biopsies performed, so not reommended

Question 4

How often should breast exam be done by PCP?

Answer 4

every 3 years in 20s and 30s, every year over 40

Question 5

Risk for cervical cancer

Answer 5

Early onset of intercourse, high number of partners, cigarette smoking, DES exposure, immunosuppression

Question 6

Cervical cancer vaccines

Answer 6

Gardasil or Cervarix, approved for ages 9-26, recommended for ages 11-18

Question 7

Definition of menopause

Answer 7

Missed periods for 12 straight months, usually 40-60 with avg age being 51, smokers earlier than non-smokers

Question 8

Perimenopause

Answer 8

Lasts 2-8 years, menstrual irregularity plus sx like vaginal dryness, hot flashes, change in libido, mood swings

Question 9

Risk factors for osteoporosis

Answer 9

Low estrogen states, lack of physical activity, fam hx, low calcium intake, cigarette smoking, caucasian race

Question 10

Osteoporosis screening recommendations

Answer 10

All women 65 and older plus women 60-64 who have increased fracture risk

Question 11

Immunizations for adult female

Answer 11

Td every ten years, Tdap if pt has not received full Tdap between 19 and 64 years

Question 12

Mammography recommendations

Answer 12

Every 1-2 years beginning between 40-50 on an individual basis, No evidence for starting younger than 40 unless patient is high risk

Question 13

Pap recommendations

Answer 13

Starting at 21, every two years, then every three years between 30-65. If greater than 65 and had normal paps, can stop screening.
Patients with HIV, DES, hx of cervical dysplasia or cancer or immunocompromised state should be screened more frequently

Question 14

Evaluation of breast lump

Answer 14

Take history
If cystic, needle aspiration can be performed
If solid, mammography is next step
Ultrasound can be helpful in distinguishing between cystic and solid

Question 15

Causes of nipple discharge

Answer 15

Pregnancy, prolactinoma, breast cancer, intraductal papilloma, Paget’s disease, breast abscess, breast trauma
Work up should include hx of breast discharge (color), imaging and hormonal testing

Question 16

Osteoporosis prevention

Answer 16

USPTF is currently recommending against calcium and vitamin D supplementation due to increased risk for atherosclerotic plaque and kidney stones but no clear fracture benefit. Recommendations: increase calcium intake in diet and increase weight bearing exercise