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Family Medicine Aquifer Cases Exam Questions and Answers 100% Solved
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Family Medicine Aquifer Cases Exam Questions and Answers 100% Solved A 34-year-old woman who has no past medical problems nor is currently taking any medications comes into your office because she noticed a tender lump in her left breast starting approximately one month ago. She is worried bec...

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  • November 15, 2024
  • 72
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • Family medicine
  • Family medicine

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©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Family Medicine Aquifer Cases Exam

Questions and Answers 100% Solved


A 34-year-old woman who has no past medical problems nor is currently

taking any medications comes into your office because she noticed a

tender lump in her left breast starting approximately one month ago. She is

worried because she has an aunt who had breast cancer that was BRCA

positive, though her mother is BRCA negative. Her periods have been

regular since they started at the age of 13 and occur every 32 days. She is

currently menstruating. She has three children aged 12, 9, and 4. On exam,

her BMI is 32, up from 28 three years ago and her other vital signs are

stable. On breast exam, you note a mobile rubbery mass of approximately

1 x 1cm and with regular borders that is tender to palpation. You appreciate

no axillary adenopathy. The rest of her physical exam is unremarkable. Of

the information provided, which of the following places this patient at

increased risk for breast cancer?



A. Age

,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
B. Weight

C. Parity - ✔✔The correct answer is B.



With a BMI of 32, obesity is the one risk factor for this patient based on the

information given. Other risk factors for breast cancer include family history

of breast cancer in a first degree relative (mother or sister - not aunt),

prolonged estrogen exposure (menarche before age 12, menopause after

45, advanced age at first pregnancy), genetic predisposition (BRCA 1 or 2

mutation), advanced age (breast cancer risk increases with age, and this

patient is relatively young), female sex, increased breast density and

certain exposures (diethylstilbestrol, hormone or radiation therapy, heavy

smoking).

A 64-year-old woman who is overweight with well-controlled hypertension

comes to your office complaining of a lump in her breast that she noticed

while showering. She denies any pain, tenderness, or skin changes. A

pertinent review of systems is negative. Menarche began at the age of 10.

Her first child was born when she was 31 and she had her second and last

child at the age of 33. She experienced menopause at the age of 44. Her

mother died of colon cancer when she was 65 and her father passed away

from metastatic prostate cancer at the age of 70. She has no history of

,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
tobacco use ever and occasionally drinks a glass of wine with dinner. Her

BMI is 34. Which of the information provided thus far puts the patient at

decreased risk for breast cancer?



A. Age

B. Weight

C. Age at first birth

D. Age at menarche

E. Age at menopause - ✔✔The correct answer is E.



The patient experienced menopause at the age of 44, which shortens her

time of estrogen exposure, a known risk factor for the development of

breast cancer. Factors associated with decreased breast cancer risk

include pregnancy at an early age, late menarche, early menopause, high

parity and medications such as selective estrogen receptor modulators

along with NSAIDs and aspirin. Risk factors for breast cancer include family

history of breast cancer in a first degree relative (mother or sister),

prolonged estrogen exposure (menarche before age 12, menopause after

55, advanced age at pregnancy, obesity after menopause), female sex,

genetic predisposition (BRCA 1 or 2 mutation), advanced age (breast

, ©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
cancer risk increases with age), increased breast density and exposures

(diethylstilbestrol, hormone or radiation therapy, smoking).

A 63-year old woman comes into your office for her annual preventive

exam. She has hypertension and type 2 diabetes. She is not sexually

active. Her blood pressure is 125/80 and her physical exam otherwise is

within normal limits. You recommend influenza and zoster vaccination. Her

last colonoscopy was eight years ago and her last mammogram one year

ago was normal. She has never had an abnormal Pap smear. At the age of

45 she had a total hysterectomy for fibroids. You tell her she does not

require a Pap smear today because:



A. She has never had an abnormal Pap smear

B. She is not sexually active

C. She had a total hysterectomy for fibroids

D. She is 63 years old

E. She experienced menopause more than 10 years ago - ✔✔The correct

answer is C.



The patient described above underwent a total hysterectomy (total removal

of the uterus and cervix with or without oophorectomy) for benign reasons

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