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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Read the following scenario. Discuss the essential issues that arise with Katrina and suggest appropriate management. If you are considering anything that you do not wish to discuss with the patient at this stage, you should inform the observing examiner.

No physical examination is required and no further investigations are available.

Scenario

Katrina Carroll, a long-term patient of yours, is attending for an urgent appointment after scheduled routine follow-up with her breast surgeon. Your receptionist has obtained Dr Fisher’s report from her recent review as follows:

Dear Doctor,

Re: Mrs Katrina Carroll, I saw Katrina for routine annual review following her T2 N1 M0 receptor negative left breast cancer four years ago. She has been well and had no specific complaints, but clinical examination revealed an enlarged, firm node in the left supraclavicular area. I organised an excision biopsy, which unfortunately returned results consistent with metastatic breast cancer. I organised staging scans which suggested she has metastasis in her T7 and L1 vertebrae, as well as two lesions in her liver.

We discussed her results today and I outlined that her condition is not operable. I have organised for her to see the oncologist next week.

Regards

The following information is on her summary sheet:

  • Past medical history

  • Mild episodic asthma

  • Left breast cancer—mastectomy, radiotherapy and chemotherapy four years ago

  • Medication

  • Nil regular

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Non-smoker

  • Married to Paul

  • Six children

  • Works as a librarian.

INSTRUCTIONS FOR THE PATIENT, KATRINA CARROLL

You are Katrina Carroll, a 54-year-old woman who has been coming to this GP for several years. You are married to Paul (a high school English teacher) and you have six children. The youngest of your children is 17 and is the only one still at home. Your oldest two are married with children of their own.

You present to the doctor today following a visit to your surgeon, Dr Fisher, last week.

You came to this doctor with a breast lump four years ago and ended up having your left breast surgically removed because of breast cancer. Following this, you had radiotherapy to the left armpit and shoulder area and a course of chemotherapy. All this went pretty well and you’ve been healthy since then—back at work and feeling well.

About three weeks ago you went to see Dr Fisher for your annual check-up.

You weren’t bothered by anything, but he found a lump around your left collarbone and cut it out a couple of days later. It came back as cancer in a lymph node and he then sent you for more tests—mostly scans. You saw him for the results of these last week, and he explained that your breast cancer has ...

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