PHYSICAL

IMPRESSION
REVIEW OF
FEATURES
PERSONAL &
EXAMINATION
FAMILY MEDICAL
SYSTEMS
HISTORY
SOCIAL OF
HISTORY
HISTORY
PRESENT ILLNESS

Level III
2020

Dr. James Belgira Tamayo

Department of Internal Medicine
TUMOR BOARDS
  Among Asian countries, the Philippines has the
No.1 incidence of breast cancer.

 Three out of 100 (Filipino) women will get breast

HISTORY
FAMILY MEDICAL
MEDICAL

INTRODUCTION
EXAMINATION

cancer before age 75 and one out of 100 will die

IMPRESSION

&
REVIEW OF
FEATURES

HISTORY
PHYSICAL
SYSTEMS
HISTORY
PERSONAL

before reaching 75

 Breast cancer accounts for 15 percent of all

SOCIAL
PAST

new cancer cases in the country for both sexes and

8 percent of all cancer deaths.

 Most Filipino patients consult a doctor only when

their cancer is already in its advanced stage.
  To discuss general overview of Breast Cancer
HISTORY
FAMILY MEDICAL
MEDICAL
EXAMINATION

OBJECTIVES
IMPRESSION

&

 To identify diagnostic measures for diagnosing

REVIEW OF
FEATURES

HISTORY
PHYSICAL
SYSTEMS
HISTORY
PERSONAL

Breast Cancer
SOCIAL
PAST

 To evaluate available chemo and targeted

therapies for management of Breast Cancer
 IMPRESSION
PHYSICAL
FEATURES
REVIEW OF
EXAMINATION
PERSONAL &
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FAMILY MEDICAL
SOCIAL
PAST HISTORY
MEDICAL
HISTORY
HISTORY
GE
45/F

Filipino
Married

Methodist
Bagong, Silang Caloocan
Admitted: February 10, 2020

GENERAL
DATA
 IMPRESSION
PHYSICAL
FEATURES
REVIEW OF
EXAMINATION
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SYSTEMS
FAMILY MEDICAL
SOCIAL
PAST HISTORY
MEDICAL
HISTORY
HISTORY

RIGHT BREAST MASS

CHIEF COMPLAINT
 IMPRESSION
PHYSICAL
FEATURES
REVIEW OF
EXAMINATION
PERSONAL &
SYSTEMS
FAMILY MEDICAL
SOCIAL
PAST HISTORY
MEDICAL
HISTORY
HISTORY

Outer Lower Portion

 Firm
Jolen
3 years PTA: (+) Palpable Mass Right

 No Skin
 Size of a

Dimpling
 Moveable
 Non Tender

HISTORY OF
PRESENT ILLNESS
 2 years PTA: (+) Increase in Mass

PRESENT ILLNESS
HISTORY
FAMILY MEDICAL
MEDICAL

 Size of a Jolen to an EGG

EXAMINATION

 Nodular Surface
IMPRESSION

&

HISTORY OF
REVIEW OF
FEATURES

HISTORY
PHYSICAL

Firm
SYSTEMS


HISTORY
PERSONAL

 Moveable
 Non Tender
 No Skin Dimpling
SOCIAL
PAST

 No Nipple Retraction

 Sought Consult at a Private

Physician, Breast Ultrasound was
Requested and done but Patient
was lost to follow up and
unrecalled results.
 14 months PTA:

 (+) Continuous increase in the mass and

PRESENT ILLNESS
HISTORY
FAMILY MEDICAL
MEDICAL
EXAMINATION

affected surface area.

IMPRESSION

HISTORY OF
&
REVIEW OF
FEATURES

HISTORY
PHYSICAL
SYSTEMS
HISTORY

 Multiple nodular mass, firm, moveable, non

PERSONAL

tender, no skin dimpling, no nipple retraction

SOCIAL
PAST

 Some nodules started to erupt notable pustular

lesion and bloody discharge.
 Patient sought consult to a private doctor
unrecalled antibiotics and started herbal
medications.
 14 months PTA:

 (+) Continuous increase in the mass and

PRESENT ILLNESS
HISTORY
FAMILY MEDICAL
MEDICAL
EXAMINATION

affected surface area.

IMPRESSION

HISTORY OF
&
REVIEW OF
FEATURES

HISTORY
PHYSICAL
SYSTEMS
HISTORY

 Multiple nodular mass, firm, moveable, non

PERSONAL

tender, no skin dimpling, no nipple retraction

SOCIAL
PAST

 Some nodules started to erupt notable pustular

lesion and bloody discharge.
 Patient sought consult to a private doctor
unrecalled antibiotics and started herbal
medications.
 12 months PTA:

 Growth of mass at the right axillary area and

PRESENT ILLNESS
HISTORY
FAMILY MEDICAL
MEDICAL
EXAMINATION

started to palpated mass on her right supra

IMPRESSION

HISTORY OF
&
REVIEW OF
FEATURES

HISTORY
PHYSICAL
SYSTEMS
HISTORY

clavicular area.
PERSONAL

 Continuous growth of multiple nodular mass, firm,

SOCIAL
PAST

moveable, non tender, no skin dimpling, no nipple

retraction with pustular lesion and bloody
discharge. No consult was done no medications
were taken she still opted Herbal treatment.
 3 months PTA:

 Persistence Growth of mass at the right axillary

PRESENT ILLNESS
HISTORY
FAMILY MEDICAL
MEDICAL
EXAMINATION

area and increase number of mass on her right

IMPRESSION

HISTORY OF
&
REVIEW OF
FEATURES

HISTORY
PHYSICAL
SYSTEMS
HISTORY

supra clavicular area that extended above her

PERSONAL

right anterior neck.

SOCIAL
PAST

 Continuous growth of multiple nodular mass, firm,

moveable, non tender, with more frequent
nodular eruptions with pustular and bloody
discharge.
 (+) Weight loss 60 kg to 50 kg for the past 3
months
 IMPRESSION
PHYSICAL
FEATURES
REVIEW OF
EXAMINATION
PERSONAL &
SYSTEMS
FAMILY MEDICAL
SOCIAL
PAST HISTORY
MEDICAL
HISTORY
HISTORY

HISTORY OF
PRESENT ILLNESS
 ILLNESS
(+)Hypertension (2018)
SOCIAL HISTORY
FAMILY MEDICAL

MEDICAL
EXAMINATION

(-) Allergy (-) CVA

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OF
REVIEW OF
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PHYSICAL
SYSTEMS

HISTORY
HISTORY

(-) Heart disease (-) Asthma

PERSONAL

HISTORY
(-) Diabetes mellitus (-) Tuberculosis

PRESENT
(-) Thyroid disease (-) Blood dyscrasias

PAST
(-) Cancer (-) Seizures

Atenolol 50 mg/tab Once a day

Amlodipine 5 mg/tab Once a day
 ILLNESS
(+)Hypertension (2018)
SOCIAL HISTORY
FAMILY MEDICAL
EXAMINATION

(-) Allergy (-) CVA

IMPRESSION

&

OF
REVIEW OF
FEATURES
PHYSICAL
SYSTEMS

HISTORY
OBGYNE
HISTORY

(-) Heart disease (-) Asthma

PERSONAL

HISTORY
(-) Diabetes mellitus (-) Tuberculosis

PRESENT
(-) Thyroid disease (-) Blood dyscrasias
(-) Cancer (-) Seizures

Atenolol 50 mg/tab Once a day

Amlodipine 5 mg/tab Once a day
 (-)Hypertension (-) Allergy (-) Stroke

ILLNESS
SOCIAL HISTORY

FAMILY MEDICAL
MEDICAL
(-) Heart disease (-) Asthma (-) Seizures
EXAMINATION
IMPRESSION

SYSTEMS&

OF
REVIEW OF
FEATURES
PHYSICAL

HISTORY
HISTORY
(-) Diabetes mellitus (-) Tuberculosis
PERSONAL

HISTORY
(-) Thyroid disease (-) Blood dyscrasias

PRESENT
(-) Cancer

PAST
 IMPRESSION
PHYSICAL
FEATURES
REVIEW OF
EXAMINATION
SYSTEMS

Non Smoker

(-) Substance use/abuse

Non Alcoholic Beverage Drinker

PERSONAL &
FAMILY MEDICAL
SOCIAL
PAST HISTORY
MEDICAL
HISTORY OF
HISTORY
HISTORY
PRESENT ILLNESS
 GENERAL:(-) weakness, (-) fatigue, (-) febrile (-) weight gain/loss
SKIN: (-) pruritus, (-) dry skin, (-) bruises, (-) rash, (-) photosensitivity
EAR: (-) deafness, (-) tinnitus, (-) discharge

ILLNESS
MEDICAL
HISTORY
MEDICAL
EXAMINATION

NOSE: (-) epistaxis, (-)discharge, (-) obstruction, (-) post-nasal drip,

IMPRESSION

OF
REVIEW OF &
FEATURES
PHYSICAL

HISTORY
SYSTEMS
(-) sinusitis

HISTORY
PERSONAL
HISTORY
MOUTH: (-) bleeding gums, (-) sores, (-) fissures,(-) tongue

PRESENT
abnormalities, (-) dental caries

SOCIAL
FAMILY
PAST
THROAT: (-) soreness, (-)tonsillitis
NECK: No stiffness, limitation of motion, masses, (-) sensation of
lump in throat
PULMONARY: (-) dyspnea, no cough, sputum production,
hemoptysis, wheezing, chest wall abnormality
 •CARDIOVASCULAR: No chest pain, (-) PND, (-) orthopnea, (-)
syncope, (-) edema, (-) phlebitis, no varicosities, claudication

ILLNESS
•GENITOURINARY: (-) hematuria, dysuria, bubbly urine, flank pain

MEDICAL
HISTORY
MEDICAL
EXAMINATION
IMPRESSION

OF
REVIEW OF &
FEATURES
PHYSICAL

HISTORY
SYSTEMS
HISTORY
•Musculoskeletal: (-)pain, (-) weakness in lower extremities,

PERSONAL
HISTORY
wasting, trauma, abnormal posture

PRESENT
•Endocrine: No heat or cold intolerance, voice change, polyuria,

SOCIAL
FAMILY
PAST
polyphagia, polydypsia
•Hematopoietic:(-) Easy bruisability, pallor, no adenopathy, no
gum bleeding
•Neurologic: No headache, seizure, sensory perversion, motor
dysfunction, speech disturbance, mental changes, head trauma,
CN I-XII intact
•Psychiatry: No anxiety, depression, interpersonal relationship
difficulties, illusion, delusion, hallucination, paranoia
 Vital Signs:

ILLNESS
BP: 130/80 RR: 20 O2: 98%

MEDICAL
HISTORY
MEDICAL
EXAMINATION
IMPRESSION

OF
HR: 85 Temp: 36.6 C

REVIEW OF &
FEATURES

PHYSICAL

HISTORY
SYSTEMS
HISTORY
PERSONAL
HISTORY
PRESENT
General Survey:

SOCIAL
FAMILY
PAST
Conscious, Coherent, Not In Acute Respiratory Distress.
Fair Colored Skin, Moist, Good Turgor, Generalized
Warmth, Oriented to 3 spheres (Date, Time, Place).
 HEENT: Anicteric Sclera, Pink Palpebral
Conjunctiva, Pink Oral Mucosa

ILLNESS
MEDICAL
HISTORY
MEDICAL
EXAMINATION
IMPRESSION

OF
REVIEW OF &
FEATURES

PHYSICAL

HISTORY
SYSTEMS
HISTORY
PERSONAL
HISTORY
PRESENT
SOCIAL
FAMILY
PAST
Cervical Mass Right, 4 x 6 cm, Firm, Smooth None Moveable and None Tender
 CHEST: Right Axillary Mass 9 x 18 cm, firm, nodular, non
moveable and non tender, irregular border

ILLNESS
MEDICAL
HISTORY
MEDICAL
fixed.

EXAMINATION
IMPRESSION

OF
REVIEW OF &
FEATURES

PHYSICAL

HISTORY
SYSTEMS
HISTORY
Symmetrical Chest Expansion, (-) Retractions,

PERSONAL
HISTORY
Clear breath sounds

PRESENT
SOCIAL
FAMILY
PAST
BREAST: (+) Breast Mass noted 5x10 cm firm, nodular
none moveable, nontender, irregular border,
fixed with 2 open wounds noted with pus and
bloody discharge
 IMPRESSION
FEATURES

PHYSICAL
REVIEW OF
PERSONAL &
EXAMINATION
FAMILY MEDICAL
SYSTEMS
SOCIAL HISTORY
PAST MEDICAL
HISTORY
HISTORY OF
HISTORY
PRESENT ILLNESS
 IMPRESSION
FEATURES

PHYSICAL
REVIEW OF
PERSONAL &
EXAMINATION
FAMILY MEDICAL
SYSTEMS
SOCIAL HISTORY
PAST MEDICAL
HISTORY
HISTORY OF
HISTORY
PRESENT ILLNESS
 IMPRESSION
FEATURES

PHYSICAL
REVIEW OF
PERSONAL &
EXAMINATION
FAMILY MEDICAL
SYSTEMS
SOCIAL HISTORY
PAST MEDICAL
HISTORY
HISTORY OF
HISTORY
PRESENT ILLNESS
 CHEST: Right Axillary Mass 9 x 14 cm, firm, nodular, non
moveable and non tender, irregular border

ILLNESS
MEDICAL
HISTORY
MEDICAL
fixed.

EXAMINATION
IMPRESSION

OF
REVIEW OF &
FEATURES

PHYSICAL

HISTORY
SYSTEMS
HISTORY
Symmetrical Chest Expansion, (-) Retractions,

PERSONAL
HISTORY
Clear breath sounds

PRESENT
SOCIAL
FAMILY
PAST
BREAST: (+) Breast Mass noted 5x10 cm firm, nodular
none moveable, nontender, irregular border,
fixed with 2 open wounds noted with pus and
bloody discharge
 IMPRESSION

CHEST: Symmetrical Chest Expansion,

(-) Retractions, Clear breath sounds

SALIENT
PHYSICAL
FEATURES
REVIEW OF
PERSONAL &
EXAMINATION
FAMILY MEDICAL
SYSTEMS
SOCIAL HISTORY
PAST MEDICAL
HISTORY
HISTORY OF
HISTORY
PRESENT ILLNESS
 CLINICAL
SALIENT
IMPRESSION
PHYSICAL
FEATURES
REVIEW OF
PERSONAL
EXAMINATION &
FAMILY MEDICAL
SYSTEMS
SOCIAL
PAST HISTORY
MEDICAL
HISTORY OF
HISTORY
HISTORY
PRESENT ILLNESS