PBL 4 session 2

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PBL 4 session 2 by Mind Map: PBL 4 session 2

1. Step 8

1.1. Diagnostic decision

1.1.1. Breast cancer (T1 N1 M0)

1.2. Mechanism

1.2.1. family history

1.2.2. late onset

1.2.3. Famililal

1.3. Presentation

1.3.1. upper left outer breast mass,

1.4. Supporting data

1.4.1. History

1.4.2. Physical Exam

1.4.3. Core biopsy

1.4.4. Surgical Pathological Report

1.5. 10 minutes

2. Step 7

2.1. Inquiry plan and info gathering

2.1.1. History of presenting complaint

2.1.1.1. 58 yr old blue mountains saw her GP about a limp, which she first found 4 months ago, sister ago on tamoxifen, wants sentinel node biopsy

2.1.1.2. noticed the lump after a seat belt injury 4 mo ago

2.1.1.3. no history of discharge, pain, discomfort

2.1.1.4. husband encourages her to see GP, GP referred her to core biopsy

2.1.1.5. sister had mastectomy at 65

2.1.2. Previous medical / surgical history

2.1.2.1. no history of breast lumps

2.1.2.2. hypertensive

2.1.2.3. no surgeries

2.1.2.4. menarche at age 14, menopause at 53, still has flushes

2.1.2.5. did a mammography 2 yrs ago, nothing was detected

2.1.3. Drug history / allergy

2.1.3.1. lisenopril

2.1.3.2. 40-45 OCT

2.1.4. Family history

2.1.4.1. 2 sisters, 1 brother

2.1.4.2. 1 sister developed breast cancer at age 65, she's doing well on tamoxifen, mastectomy 6 months ago

2.1.4.3. other sister died of liver cancer at 55 yrs old

2.1.4.4. brother is healthy and well

2.1.4.5. father died of old age at 72

2.1.4.6. mother is alive and well

2.1.5. Social / occupational history

2.1.5.1. 60 yr old chinese husband

2.1.5.2. she immigrated from Hong Kong

2.1.5.3. 2 daughters, 35,40. both married

2.1.5.4. breastfed children for 6 mo

2.1.5.5. Not smoker, 20 g per day of alcohol

2.1.6. Systemic review

2.1.7. Physical examination

2.1.7.1. Vital signs

2.1.7.1.1. pulse 72

2.1.7.1.2. BP 110/70

2.1.7.1.3. Temp 36

2.1.7.1.4. RR 18

2.1.7.1.5. Weight 55

2.1.7.1.6. Height 160

2.1.7.2. Palpation

2.1.7.2.1. 2cm mass upper outer left quadrant (breast) mass

2.1.7.2.2. 10 o'clock 6 cm from nipples

2.1.8. tests results

2.1.8.1. Biochemistry and CBC is normal

2.1.8.2. Mammography

2.1.8.2.1. 1-1.5 cm lesion if upper outer quadrant of left breast

2.1.8.2.2. lesion does NOT COMPRESS

2.1.8.3. Surgical Pathology report

2.1.8.3.1. llocal exicision of left breast, lampectomy and central node biopsy

2.1.8.3.2. 18 mm breast lesion, grade 2, ER ++. HER 2 -.

2.1.8.3.3. core biopsy positive for cancer

2.1.8.3.4. Lymph nodes 3 mm focused in one of two sentinel nodes

2.1.8.3.5. Axillary CLEAR (0/15)

2.2. 50 minutes

3. Step 6

3.1. Review session 1

3.2. Report new knowledge

3.3. 30 minutes

3.3.1. The scribe does not have to write in this step!