Scenario 1:

Mrs. Smith is a 50 year old Caucasian woman who has 4 children ages 17, 15, 13, and 10. She was 33 with the birth of her first child. Her BMI is 25. She has no personal or family history of breast cancer. She lives with her husband in a suburban community. She is an elementary school teacher who is working part-time as a substitute so she can be home with her children. She has been healthy with no previous medical history. One year ago she noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy she assumed it was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her health insurance would be expiring in the next month so she reluctantly decided to have a mammogram. She called for an appointment and they were unable to see her for another 2 months.

After waiting 2 months, her mammogram confirmed a 5 cm mass. She then had an ultrasound guided biopsy. This biopsy confirmed the presence of cancer cells. An additional biopsy confirmed the presence of cancer cells in 3 of her lymph nodes most proximal to the tumor.

What are the primary concerns for the patient right now?
What is the rationale for these concerns?
What are some of the expected medical surgical interventions?
What is the worst possible complication to anticipate?
What further assessment will be needed if complications develop?

Scenario 2:

A 44-year-old obese female is admitted to the emergency room with fever and severe abdominal pain on the upper right side that radiates to the scapula. She states that she feels nauseated. She states that the pain began at a friend's house during a party and is becoming more severe. You can see that she is quite uncomfortable.

What could be the underlying cause of these symptoms?
What examinations would you perform? Why?
What laboratory tests would be needed to confirm possible differential diagnoses?