Laura Wood ihuman answers

Laura Wood ihuman answers – Case: Key Findings

Key Findings

Most significant active concern: risk of breast cancer

Cystic breast disease

Overweight (BMI=27.5) with recent weight gain

American fast food diet 2 x per week

FH breast cancer mother and maternal cousin

FH of hyperlipidemia

FH of type 2 diabetes

Due for pap smear

Elevated BP 134/74

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Laura Wood ihuman answers Case: Key Findings Feedback

The medical problem list you have compiled should be a list that includes everything that is out of the ordinary about this patient, even when it is not a “problem” in the true sense of the word.

In a wellness visit, there may be points) of discussion raised by the patient, but by definition, there is no chief complaint, instead there may be a chief issue of concern. So the next question may be how to define the most significant active problem (MSAP)? The answer might vary, but in general the MSAP is either an issue raised by the patient or an item in health prevention that needs to be urgently addressed, for example; a 55 y/o woman who has never had a screening mammogram.

For this patient, the most significant active problem (MSAP) or issue is the patient’s risk of breast cancer and by default, the effectiveness of mammographic screening. She presents with a first degree relative (mother) diagnosed with invasive breast cancer at age 63. How does this affect the patient’s risk? How does her cousin’s diagnosis at age 44 affect her risk? How does having cystic breast disease affect her breast cancer risk or the ability of mammography to detect cancer? Does she need additional screening approaches? Does she need a genetic analysis? Finally, breast cancer risk is increased with increased exposure to estrogen. How does her age of menarche, age of first pregnancy and breast feeding affect her risk of breast cancer?

The second major medical issue is her elevated blood pressure (134/74) The AHA guidlines have changed to now classify this into the Stage 1 Hypertension category. Thus, this should be something discussed. In addition, how would her hypertension related to other FH risk factors or her body weight?

A wellness visit is also done to complete the recommended disease screening(s) so that medical problems can be identified early and addressed prior to the development of sequelae. Recommendations for screening come from; local health care systems, medical societies as well as the federal government (Centers for Disease Control, CDC) and Medicare. These guidelines are specific for the person’s gender, age, ethnicity, genetic background and family history. the patient is a 41 y/o female of Hispanic ethnicity. What medical issues are found more frequently in Hispanic women? How does her weight or body habitus affect these risks? How does her diet affect these risks?

Finally, it is important to look at her entire family history, lifestyle, diet and living location. Look at the medical problems of the patient’s parents, level of exercise, type of diet and even consider total lifetime sun exposure. What malignancies are linked to diet or sun exposure?

For the hypothesis or differential diagnosis section, instead of picking the diagnosis or medical condition (we are not diagnosing a condition, but rather we are…

Laura Wood ihuman answers Case: Problem Statement

The patient is a healthy 41-year-old G2P2 Hispanic-American female who presents for a well-woman examination. She has no active medical complaints, but is concerned about her risk of breast cancer as both her mother (age 63) and maternal first cousin (age 44) have been recently diagnosed with intraductal breast cancer. Additional risk factors include menarche age 10.5; first pregnancy age 33; she breast fed each of her two infants for only four months each. The patient, reports a normal baseline mammogram at age 40, (report not available) and a history of fibrocystic breast disease. Physical exam reveals elevated Blood pressure (134/74), increased body weight (BMI 27.5) with a FH of hypertension, hyperlipidemia (father) and type 2 diabetes (mother).

Management Plan – Laura Wood ihuman answers

The patient will be counseled regarding her. Hypertension

Repeat the BP measurement in a week
Reduce salt intake and try to reduce stress
Discuss a healthy potassium rich diet and possible weight loss
II-BP remains elevated, consider starting a low dose ACE inhibitor.

Breast Cancer Risk

Patient has an increased breast cancer risk due to first-degree family member and early menses and late pregnancies-increased estrogen exposure to the breast tissue
Alcohol has been associated with an increased risk of breast cancer, therefore, she is counseled to reduce her alcohol consumption as an intervention she can do to reduce her risk as well as her concern for developing this disease
Fibrocystic disease will make self-breast examination less reliable, however, she is counseled to undergo yearly mammograms (tomosynthesis should be done if possible because of her cystic breast disease)

Cardiovascular Disease

Screening test showed that the patient’s lipids are in the high-moderate to high range for the risk of heart disease.

This would be the time to discuss diet intervention with weight reduction and increasing vegetables and reducing fats Prediabetes

Patient’s fasting blood glucose and hemoglobin A1C levels categorize her as a prediabetic. An improved healthy diet and weight reduction to a normal BMI can reduce her risk of progressing to diabetes. This provides an opportunity to prevent neuropathy and accelerated CAD

Lifestyle/Diet

Increased exercise would assist in maintaining a normal BMI and would help in stress reduction

Cervical neoplasm risk

Negative pap smear means she only needs continued screening