A 37-year-old woman G2P2 presents with a lump in her left breast. Her husband noticed it recently and she is concerned, especially as she had an aunt that had breast cancer and thinks that a great-grandmother or some other ancestor may have died of breast cancer as well. Both of her children (9 and 7) were delivered without complication and she breastfed “for well over a year” with each. She has no other significant PMH or allergies. She is 5’ 6” tall, weighs 144 lb and has a BMI of 22 and works as an office manager. She is a non-smoker, considers herself to be an “almost” vegetarian and has a glass of wine many evenings with dinner. She has regular physicals and is up-to-date on pap smears which have always been normal. Meds include a daily multi-vitamin and occasional acetaminophen for tension headache or ibuprofen during her period. Upon examination, the lump is discovered. It is firm and near the surface and no other masses are discovered. The lump is aspirated and an opaque liquid is removed. Following this procedure, the lump has vanished.
What is the differential diagnosis?
What would be any further screening or treatment options?
What is her risk of developing breast cancer?
A generally healthy 59-year old post-menopausal woman has had incrementally increasing LDL levels in blood test results over the past few years. You had warned her of the need to get this under control as she had been on HRT for severe vasomotor complications during menopause which could have increased her overall risk for cardiovascular complications. At her last visit, you recommended diet changes and increased exercise as a means to naturally bring her hyperlipidemia under control. Being a diligent patient, she has made these changes, e.g., cutting back to 1% milk and increasing the length of her evening walk. But today, with her LDL still high, you have suggested she add a low-dose statin. She accepts your recommendation, puts the prescription in her pocketbook but just before leaving, she says “what about avocados?” She goes on to say that she was at a Mexican restaurant recently and overheard a group of women at the table behind her talking about cholesterol. One of the women said “I saw on the Internet that avocado can help lower cholesterol so I am going to eat a lot more guacamole!” Your patients asks “is this for real?”
Is there any indication that avocado can be effective for lowering cholesterol?
What, if any, is the strength of evidence supporting this?
Is the efficacy clinically significant?
How much avocado would one need to take to attain a therapeutic level?
In what form, e.g., raw fruit, extract, guacamole with nachos, is the appropriate mechanism for action?
A 21-year old woman presents for prenatal visit, her 1st even though she is well into her third trimester and her EDC is predicted to be within a month or so. He boyfriend, the father of the child, has not been supportive to date of the pregnancy and is also not on good terms with her own parents. At first, she denies alcohol or drug use but after a while, she opens up and talks about an ongoing opioid addictions. Most of the time, she takes Percocet bought on the street but due to cost, she has recently begun using heroin. It becomes clear that she will not be “clean” prior to her deliver and that her child will be born also addicted to narcotics. And as she has almost no external support, you know that after she delivers, she will be the primary caregiver of the infant and also hopefully working a detox program.
What is the accepted name of the condition with which the child will be born?
What are the peri-natal risks to the infant?
What are the post-natal risks to the infant?
What are the post-natal risks to the mother?
Is there an evidence on the long-term risk to the child?
You recently delivered a healthy child to a 26-year old woman (G1P1) who had no pre-natal complications and was very knowledgeable and proactive in her pregnancy taking her folic acid, stopping her social alcohol intake and digesting all information she could find on becoming a new parent. Today, you receive a telephone call from your patient’s husband. He says that after being at home for about a week, “something changed” in his wife. She seems sad, feels tired all of the time and most concerning to him, seems to at times be uninterested in their infant. Case in point; he says he came home from running some errands yesterday and found the baby crying in her crib with a wet diaper and behind on her feeding. Mom was lying on the couch watching TV and said “she didn’t think anything was wrong and could he please just give her some space!” You suspect postpartum depression and ask that the family come in for a consultation ASAP.
What is the prevalence of post-partum depression?
What are the criteria for making the diagnosis?
Are there any validated screening tools that can be used prenatally?
What treatments have the highest level of evidence-based efficacy?
What is the prognosis for women with postpartum depression?
These Case Studies were created by Len Levin - Head, Education and Clinical Services at the University of Massachusetts, Lamar Soutter Library. For more information and resources to incorporate into education and the curriculum, visit the Library's Evidence Based Medicine LibGuide and the Curriculum Resources on this guide.