MM, a 54-year old female presents to the Family Medicine Clinic due to a 2-week history of increasing shortness of breath and cough and mild/moderate pain in left side.
She was diagnosed with infiltrating intraductal adenocarcinoma of the left breast 5 years ago; at that time, ER(-)/ PR(-); her-2/neu(+); p53(+); staged as having T3N1M0, stage IIIA, high-risk breast cancer. She underwent a modified radical mastectomy with axillary node dissection followed by 6 cycles of CMF chemotherapy. Her mother and sister also had a history of breast cancer.
Past Medical History
Gravida 4, para 4; menses onset age 13; HTN x 10 years; Type 2 DM x 8 years; breast CA described above; remained disease free until present follow up.
Past Surgical History:
Left modified radical mastectomy 5 years ago; cholecystectomy 14 years ago.
Medications:
Glyburide, 5mg PO BID
Verapamil SR, 240mg PO daily
Furosemide, 40mg PO daily
Allergies: NKDA
Physical Examination:
GEN: Well-developed, obese woman in no acute distress
VS: BP 120/88, HR 80, RR 20, T 370C, Ht167.6 cm, Wt 92 kg
HEENT: PERRLA, no JVD, no lymphadenopathy
COR: Normal S1 and S2, no murmurs, rubs, or gallops
CHEST: Well-healed scar left breast area; dullness of percussion over left lung bases, decreased breath sounds
ABD: Obese, soft, nontender, no masses or organomegaly
GU: WNL
RECT: External hemorrhoids noted
EXT: No clubbing, cyanosis, or edema
NEURO: A and O X 3; cranial nerves intact, normal deep tendon reflexes
Laboratory Examination Results in SI units (Conventional unit):
|
Na |
143 (143) |
Lkcs |
6.8 x 109 |
Plts |
372 x 109 |
|
K |
4.5 (4.5) |
LDH |
204 (204) |
Glu |
7.7 (138) |
|
Cl |
100 (100) |
Alk Phos |
1.5 (90) |
Ca |
2.35 (9.4) |
|
HCO3 |
22 (22) |
AST |
0.62 (37) |
Mg |
1.1 (2.2) |
|
BUN |
3.9 (11) |
ALT |
0.5 (30) |
Uric Acid |
286 (4.8) |
|
Cr |
106 (1.2) |
PO4 |
1.32 (4.1) |
T Bili |
5.1 (0.5) |
|
Hct |
0.426 (42.6) |
Alb |
40 (4.0) |
PTT |
22.0 |
|
Hgb |
130 (13) |
T Prot |
68 (6.8) |
INR |
1.0 |
Differential test: Neut 0.7 (70%}, lymph 0.20 (20%), mono 0.055 (6.5%), baso 0.013 (1.3%), eos 0.022 (2.2%)
Urinalysis: WNL
ECG: Normal sinus rhythm
CXR: Effusion in left lower lobe. Fluid layers out on lateral x-ray
Bone scan: Multiple metastases to left lower ribs.
Pleural fluid: Thoracentesis: Glucose 5.3 (95), LDH 234 (234), pH 7.5, specific gravity 1.025, protein 50 g/L (5.0 g/dl), Lkcs 2.6 x 109, RBC 110 x 1012 (110 x 106); cytology: adenocarcinoma breast
QUESTION:
1. What is the importance of determining the patient's onset of menses and the number of pregnancies?
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