58 YO F presented to ER with tired and fatigue. She has hx o | Figure 1

Case:

58 YO F presented to ER with tired and fatigue. She has hx of met. Breast ca. She has the lowest hgb I saw.

Questions:

• 39yo F: she is not married, has bad feeling to her breasts. She said they are heavy and increased in size and feel fixed mass in one of them. She never let me examine them, will never go to do mammogram. I told her what's the danger that wait her if not hear my advice. So I am thinking to prescribe "Tamoxafin" for her as prophylaxis against breast cancer. Is this drug useful? What's the dose per day must she take, and the period she must continue using it?

Additional Cases:

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69yo Woman diagnosed with metastatic adenocarcinoma of mullerian origin 4 years ago. This was originally a 2x3x6cm palpable mass in left breast. She has declined and continues to decline all medical treatment.

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A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.

Patient in late teens presented after a collapse.