Reference no: EM133749061

Question

Patient is a healthy 41-year-old Hispanic-American woman who present for a well-woman examination. There is no major health issues but patient reports her concerns about her increased risk of breast cancer. Patient is married with two boys ages 6 and 8. Patient had a normal mammogram age age 40. Patient reports a history of fibrocystic breast disease and as a result, she is concerned that she may be unable to identify abnormal lump on her breasts. She has no significant medical history, but her major concern is her risk of developing breast cancer because her mother (63 years old) and her cousin (44 years old) were recently diagnosed with intraductal breast cancer. Patient denies taking a prescribed medications but reported taking daily Vitamin E and ibuprofen as needed for headaches. Patient is unable to remember her last physical exam date, her immunizations are up-to-date, last gynecological examination was about 18 months ago. Patient reported that her first menses was at age 10.5, first pregnancy was 35 years old and second pregnancy was 25 years old. Patient reported further that she breast-fed her infants for only four months each. She reports that her mammogram was normal as a baseline, she has history of fibrocystic breast disease, she drinks a glass of wine every night with supper. She gardens and performs house chores as a form of exercise, she likes cooking, gardening and reading. Patient reported that her diet is mostly her traditional Hispanic regular meals with occasional fast food at least once a week. On examination, both breasts are "lumpy bumpy" bilaterally with slightly diffused tenderness. Patient lives at home with her husband and two boys. Medications: Daily Vitamin E and Ibuprofen as needed for headaches. PMH: Patient reported bilateral fibrocystic breast changes Diagnostic Test results: Fasting blood glucose is 122 mg/dL, Hemoglobin A1c is 6.4%, Cholesterol is 239 mg/dL, High-density lipoprotein (HDL) is 45 mg/dL, Low-density lipoprotein (LDL) is 159, Triglycerides is 40 mg/dL, Pap smear result is normal, and mammography screening is pending. What are the diagnoses? What are the differential diagnosis? What is the management plan? Please provide references.