OS XXX LEC 0X: TITLE

OS 210LEC 0X: TITLE

OS 217: Systemic Diseases (Oncology)LEC 0X:LECTURE TITLEExam 02| Lecturer | Date

TransersUPCM 2016: XVI, WalangKapantay!3of 2

\\Patti, Leonard, Jasper JerUPCM 2016X: XVI, WalangKapantay!1of 3

OUTLINE

PART 1: GRAND ROUNDS CASEI. HistoryII. Physical ExaminationIII. Differential DiagnosisIV. Labs and other DiagnosticsV. Final Diagnosis

VI. First Degree Header 1A. Second Degree Header 1 B. Second Degree Header 2VII. First Degree Header 2A. Second Degree Header 1 B. Second Degree Header 2VIII. First Degree Header 3A. Second Degree Header 1 B. Second Degree Header 2

PART 1: GRAND ROUNDS CASEI. HISTORY

A. General Data

AM 58 year old female from Calamba, Laguna

B. Chief Complaint

Lump in right breast

C. History of Present Illness

4 mos PTA: patient palpated a small lump on her right breast without any associated pain or skin changes. No consult was done at that time 2 mos PTA: patient noted an increase in the size of the breast mass. She consulted at the local clinic. She was advised to consult at PGH Breast Clinic with impression of a possible breast tumor. Date of Admission: at the breast clinic, biopsy and other labs were done.

D. Review of Systems

(-) headaches, seizures, nausea and vomiting, blurring of vision (-) difficulty of breathing, cough, chest pain (-) abdominal pain, changes in bowel habits, GI bleeding, dysuria (-) weakness or musculoskeletal pains

E. Past Medical History

Controlled hypertension for 5 years maintained on Losartan (100mg PO 1x a day) Myomectomy (at 42 y/o) No known allergies to food or drugs

F. Family History

Father died of acute MI at 56y/o No other disease noted in family Has three children, all adults

G. Personal Social History

No vices reported High school teacher since she was 25 years old Only one sexual partner (-) history of STD Menopause at age 56

H. Additional Info to be Asked

Other symptoms Nipple discharge Weight loss Location of mass Menstrual and menopausal history Tenderness, warmth, signs of inflammation Previous history of benign breast disease Gynecologic/Obstetric History Age at menarche Age at full term pregnancy Use of oral contraceptives Personal/Social History Diet and physical activity Exposure to radiation

II. PHYSICAL EXAMINATION

A. Vital Signs

Awake, not in distress HR 88, RR 20 Temp 36.7C, BP130/70B. Physical Exam Findings

Pink conjunctivae, anicteric sclera, no tonsillopharyngeal congestion or exudates, no CLAD Symmetric chest expansion, clear breath sounds, distinct heart sounds, regular rhythm, no murmurs (+) 3x2cm movable hard mass on the right breast, no nipple and skin changes noted (+) 1x1 cm movable nodule on the right axilla. No other nodes palpated in left axilla and supraclavicular areas.

III. DIFFERENTIAL DIAGNOSIS

A. Primary Working Impression

Table 1. PWI of PatientBreast Cancer

Rule In: (+) firm movable mass(+) movable nodules(+) rapid increase in sizeageRule Out:Need biopsy

B. Differential Diagnoses

Table 2. DDx of Patient Fibroadenoma

Rule in: (+) firm movable mass(-) nipple or skin changesRule Out:Usually in younger patientsTo rule out using biopsy

Fibrocystic Breast Disease

Rule In:(+) firm movable mass(-) nipple or skin changesRule Out:MenopauseTo rule out With biopsy

Benign Phyllodes Tumor

Rule in:(+) firm movable massAge of the patientRule Out:(+) palpable lymph nodesTo rule out With biopsy

Intraductal Papilloma

Rule in:(+) firm movable massAge of the patientRule Out:(+) palpable lymph nodes(-) nipple dischargeTo rule out With biopsy

IV. LABS and DIAGNOSTICS

A. Laboratory Tests

Table 3. Lab Tests done on the patient Diagnostic TestResultInterpretation

CBCHgb: 120 (NV 120-160)Hct: 0.3 (NV 0.36-0.4)WBC: 9 (NV 4.5-11)Plt: 350 (NV 150-400)Low hematocritAll else within normal range

Blood ChemNa: 142K: 3.6Crea: 71Alb: 38Ca: 2.34All within normal range

PT/PTTPT: 99% activityINR1.4, PTT normalNormal

B. Diagnostics Used

Table 4. Diagnostics done on the patient Diagnostic TestResultInterpretation

Chest X-ray(-) cardiomegaly(-) pulmonary opacitiesunremarkable

MammographyBI-RADS 1 Left Breast

Routine screening recommended

Core Needle BiopsyInvasive Ductal Carcinoma, Right Breast

IV. FINAL DIAGNOSIS

Biopsy revealed Invasive Ductal Carcinoma of the Right Breast, Stage IIB (cT2N1M0) Patient was then admitted and prepared for surgery

1. Third Degree Header 1

Text Text Text Text Text Text Text Text

2. Third Degree Header 2

Text Text Text Text Text Text Text Text Text

Table X. Table Title COLUMN 1COLUMN 2COLUMN3

ROW 1Field FieldField

ROW 2FieldFieldField

ROW 3FieldFieldField

ROW 4FieldFieldField

ROW 5FieldFieldField

Note: Additional Information or explanation

II. FIRST DEGREE HEADER 2

A. Second Degree Header 1

Text Text Text Text Text Text Text Text

Figure X. Figure Title (Additional Information or explanation)

END

Greetings

TransersUPCM 2016: XVI, WalangKapantay!3of 2

\\