PART 2
Belinda is now 30 years old.
CC: breast lump
Hx of CC: Partner found lump in her left breast two weeks ago.
Allergies: none.
Medications: none.
Immunizations UTD.
LMP 10 days ago. G0P0
FHx:
Mother: Type 2 DM, hypertension, dyslipidemia, gout
Father: Died from metastatic colon cancer, aged 59
Brother: A&W
Sister: Celiac Disease

FHP:
Diet: No restrictions.
Exercise: walks occasionally
Occupation: High School Teacher
Sleep: 7-8 hours a night; naps on weekends
Relationships: Same-sex, in stable relationship x 5 years. Thinking of marriage.
Substance use: cigarette smoker: ½ ppd for 7 years, occ alcohol binges, no recreational drugs.
Regular dental care and eye exams.

ROS:
No concerns.
Denies headache, weight loss or gain in last 3 months, cough, mastalgia, nipple discharge, bra size changes, trauma to breast.

Physical Exam:
Anxious but in no acute distress.

B/P 140/85 HR 72 regular RR 18 T 36.8C BMI: 30.

HEENT: No lymphadenopathy. Thyroid not palpable.
CNS: Grossly normal.
CVS: Normal exam.
Chest: Clear to auscultation, respirations quiet and easy
Breasts: Firm, non-tender, fixed nodule approx. 2cm x 1cm in left breast at 11 o’clock position above the nipple. New tattoo noted to left breast positioned at 2’oclock above the nipple; slight erythema, no induration, slightly tender, warm to touch, non-suppurative. No axillary nodes or supraclavicular nodes palpable. Nipples normal, no drainage. No other skin changes.
GI: Normal exam: truncal obesity noted.
GU: Not examined.
Skin: Multiple tattoos. No lesions or rashes seen. Caucasian.

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Address the following questions and be sure to include evidence-based rationale:
1a) List a maximum of 3 differential diagnoses, including the likely/working diagnosis. Provide rationale for only the likely/working diagnosis.
1b) Are there any Red flags? If so, please list.
2) Identify any risk factors pertinent to her chief concern.
3) Identify any risk factors that you would like to discuss both today and at a follow-up visit.
4) Based on your likely/working diagnosis, list relevant screening test or inquiries, lab work or diagnostic imaging you will order today. Explain.
5) Based on your likely/working diagnosis, what medication(s) will you recommend today, if any? What are the therapeutic objective(s)?