Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. 
Discussion
Discuss the questions that would be important to include when interviewing a patient with this issue, including any risk factors she may have.
While interviewing the patient presenting with this specific issue, it would be essential to ask her regarding the exact location and position of the masses within the patients breast. It would also be imperative to ask the patient about the duration or period regarding the symptoms, the absence, the presence of pain, and the course regarding the symptoms (Sethi, 2016). It would also be essential to determine whether she has ever experienced the same complaint before, the treatment administered given that is the case, and the outcome concerning the remedy. Besides, any other signs or symptoms the patient has experienced and the realization of the masses are equally essential to ascertain, such as nipple discharge, loss of weight, and fatigue. 
Describe the clinical findings that may be present in a patient with this issue.
The primary clinical findings that would be present are the two painless lumps located on the right breast and a significant loss in weight (Sethi, 2016). Patients with breast cancer are likely to develop concerns related to dimpling of the breasts and breast swelling. Breast dimpling and breast discharge are also remarkable clinical findings manifested in a person having this issue. 
Are there any diagnostic studies that should be ordered on this patient? Why?
To confirm the exact diagnosis, it would be pertinent to order further diagnostic studies for her. The first diagnostic tests that are recommended for CM in this scenario relates to the Magnetic Resonance Imaging (MRI) and a mammogram which would be deployed in providing detailed images about the breast, which in turn would indicate whether or not she has breast cancer (Shoko Vos et al., 2016). In addition, a primary needle biopsy would be used to remove or take some samples regarding the breast tissue. The biopsy will assist in determining if the patient has the issue of breast cancer.
List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
The primary diagnosis for this patient relates to breast cancer, and this is supported by the fact that the patient has two lumps located on the right breast. The presence of family history regarding breast cancer and the fact that the patient previously had atypical lobular hyperplasia also ate risk factors for the patients high likelihood of having breast cancer. The other three differential diagnoses which would be considered in this scenario encompass breast cysts, breast lipoma, and fibroadenoma (Shoko Vos et al., 2016). 
The presence of lumps typically characterizes breast cysts, and as such, they ought to be incorporated in this patients diagnosis. Also, patients presenting with breast fibroadenoma have painless nodes, making this a likely diagnosis for this patient.
Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.
The pharmacological treatment for breast cancer for this patient will encompass the administration of methotrexate, cyclophosphamide, and 5-fluorouracil (5-FU) since these drugs have the potential of inhibiting the progression of breast cancer (Shoko Vos et al., 2016). In regards to patient education, CM will be informed to take a diet rich in vegetables, fruits, fresh foods, and fish since this has the potentiality of reducing the risks associated with the development of breast cancer. The patient will also be informed to engage in regular physical activity and exercises (Shoko Vos et al., 2016). Finally, the patient will be advised to revisit the healthcare facility given that her symptoms worsen.
References
Sethi, S. (2016). MiRNAs and target genes in breast cancer metastasis (3rd ed., p. 78). New York: Springer.
Shoko Vos, S., Farhad Vesuna, F., Raman, V., van Diest, P., & Groep, P. (2016). miRNA expression patterns in normal breast tissue and invasive breast cancers of BRCA1 and BRCA2 germ-line mutation carriers. Oncotarget, 6(31). http://dx.doi.org/10.18632/oncotarget.5617