Discussion week 7

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Carolyn Cross 41 years old female came to the clinic for a wellness visit, She also like to discuss a few concerns, especially her risk for breast cancer. She stated that recently both her mother who's 63 and her first cousin on her mother's side were diagnosed with breast cancer, then now she wants to know whether that increases her risk and if so how much.

Provide a reference for your treatment plan (in APA format). The reference may come from a journal, a book, etc.
Cite all sources using APA format.
Include three differential diagnoses and support your diagnoses with supporting literature.

diagnosis:

1- hyperlipidemia

2- type 2 diabetes mellitus

differential diagnosis:

1- breast cancer risk (based on first degree family member, early menses and late pregnancies)

1- diabetes (based on the patient is considered a prediabetic beased on labs results)

3- cardiovascular disease (based on lipid panel results)

The patient had an encounter a year before, this was the history:

Chief complaint:

Yearly physical

HPI:

Carolyn is an almost 40 y/o married female, G2P2 here for her yearly physical exam. She has no complaints.

PMH (previous medical history)

Other active problems:

None

Medical, surgical, obstetric, hospitalizations:

Medical: none
Surgical: G2P2; Bilateral tubal ligation following last delivery at age 35
OB/Gyn: NSVD x two; breast fed both for 3 months; premenopausal; menses regular since age 10.5

Allergies:

None

Medications:

None
Ibuprophen occasionally for headaches

Preventive Health:

Pap smears in the past are negative; last one 3-4 years ago
Diet: tries to eat a well-balanced diet
Exercise: Walks to and from the train 5 days a week; weekend gardening

Immunizations:

Up-to-date

FHx:

Father: hypertension, hyperlipidemia
Mother: Hx of type 2 diabetes
Sisters: no sisters
Brothers: healthy and very physically active

SHx:

Ethnicity: Hispanic-American
Occupation: Middle-school learning specialist
Marital status: married x ~13 years
Children: 2 sons (5ish and 7ish)
Tobacco: never
Recreational drugs: never
Alcohol: wine (one glass at dinner most days)

ROS (review of systems)

General/ Constitutional:

Normal energy level
No sleep concerns
Weight stable

Skin/Breast:

Negative except for lumpy breasts

HEENT & Neck:

Negative

Cardiovascular:

Negative

Respiratory:

Negative

Abdomen/ Gastrointestinal:

Negative

Genitourinary:

Negative

Musculoskeletal:

Negative

Allergic/Immunologic:

Negative

Lymphatic/Endocrine:

Negative

Hematologic:

Negative

Neurological:

Negative

Psychological:

Negative

Vitals

Temp:	98.6 F
Pulse:	72, rhythm: regular
BP:	left: 130/72
Respiration:	14, effort: normal

Physical Exam

Weight:

148.0 pounds

Skin/Breast:

No pallor, jaundice, ecchymoses, or rash
Normal, symmetrical breast contour
No visible skin or nipple abnormalities
No spontaneous or expressed nipple discharge or blood
Irregular "lumpy bumpy" consistency through both breasts; no suspicious, discrete palpable lesions
Slight tenderness to exam reported

HEENT & Neck:

Good dentition
Thyroid within normal limits for size and consistency
No cervical lymphadenopathy or mass

Cardiovascular:

Regular rhythm and rate
No murmur or gallop
No peripheral edema

Respiratory:

Thorax normal to percussion
Breath sounds equal/clear bilaterally

Abdomen/ Gastrointestinal:

Abdomen mildly obese, nondistended
No hepatosplenomegaly, mass, or herniation
Soft, nontender throughout

Genitourinary:

Normal external genitalia
Parous introitus
Normal vaginal mucosa
Slight cervical eversion without friability; samples collected for Pap smear completed
No abnormal discharge

Musculoskeletal:

Normal muscle tone and bulk bilaterally

Allergic/Immunologic:

Normal

Lymphatic/Endocrine:

No adenopathy
Thyroid normal, no nodules

Hematologic:

No ecchymosis, no petechiae

Neurological:

Reflexes 2+ bilaterally throughout
CN II-XII intact

Management Plan

Ms. Cross is a healthy 40ish woman with no acute medical issues.

1) Preventative Health

Mammogram ordered
lipid panel ordered
Pap smear - pending results
Fasting blood sugar ordered

Then for this encounter this are the labs results, the ROS and PE are the same from the previous visit.

pap smear negative

mammogram pending

Name	Value	Units	Reference Range
Hemoglobin A1c	6.4	%	normal 4-5.6, elevated risk 5.7-6.4, diabetes >6.7

Name	Value	Units	Reference Range
Glucose, 8 hour fasting	122	mg/dL	<126

Name	Value	Units	Reference Range
Cholesterol	239	mg/dL	low risk <200, moderate 200-239, high >239
High-density lipoprotein (HDL)	45	mg/dL	maj risk <40, neg risk >59
Low-density lipoprotein (LDL)	159	units/L	low risk <130, moderate 130-159, high >159
Triglycerides	40	mg/dL	(♀) 35-135, (♂) 40-160