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4 Cards in this Set
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A 40 yo F presents with concern over a breast mass that she has identified in her left breast.
She has no PMH of breast pathology. She has no FMH of breast cancer either. In your exam of the mass, you find that it is non-fixed and feels fluctuant to palpation. Furthermore, the patient states that it might have gotten bigger just within the past few days. She is currently in day 5 of her menstrual cycle. A FNA aspirates no fluid. What do you do next? Reassure the pt that there is nothing to worry abou since no fluid was aspirated Reassure the pt and schedule a follow-up in one month, and monitor the breast lesion regularly after that Schedule her for a mammogram Schedule her to have a massectomy Repeat the FNA |
Schedule her for a mammogram
Per the algorithm on pg 185 of Boards and Wards, this is a nonsuspicious mass, therefore FNA is the 1st step FNA of no fluid and age >35 requires a core or excisional biopsy & mammography |
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A 51 yo F presents with complaints that one breast has begun to look like it is "pointing" in a different direction.
ON exam, you cannot detect any significant difference between the two, although there might be a slight difference. No skin changes are noted on the breasts. On palpation, no masses are appreciated. Her mammogram showed no masses or calcifications. What might you include in your differential diagnosis? Malingering Fibroadenoma Ductal carcinoma DCIS Invasive lobular carcinoma |
Invasive lobular carcinoma
Any suspicious finding which may be causing physical changes to the structure of the breast is due to a LOBULAR CARCINOMA Lobular carcinoma causes diffuse infiltrates, causing architectural distortion without producing distinct masses or calcifications, this is why it wouldn't show up on a PE or mammogram |
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In performing a DRE on a 60 yo M, a rock hard prostatic enlargement is noted.
The pt is asymptomatic and denies any urinary hesitancy or decreased force of urinary stream. What should be the next step in the diagnostic process? Radical prostatectomy Bone scan PSA measurement CT scan or MRI of the pelvis Transrectal ultrasound (TRU) |
PSA measurement
A rock hard enlargement of the prostate is a common finding on a DRE in prostatic cancer. BPH presents a spongy enlargement on DRE. Once an enlarged prostate is identified on DRE, the PSA is measured next. After PSA, a transrectal biopsy is performed. |
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A 69 yo moderately demented woman presents to the ER after having fallen on the ice outside.
She complains of severe right groin pain. Her right leg is shortened and externally rotated. Passive internal rotation of this limb causes severe pain. AN AP roentgenogram of the pelvis and a cross-table lateral roentgenogram of the hip are negative. What should be the next course of action? Send the pt. home, but arrange for outpatient consultation with an orthopedic surgeon Send the pt home and arrange for a family member or visiting nurse to care for her while her sprain resolves Hospital admission, followed by CT scan Hospital admission, followed by repeat X-ray studies Hospital admission, followed by MRI or bone scan |
Hospital admission followed by MRI or bone scan
The correct order for a pt with high-suspicion of a hip fracture is: PE, X-ray, MRI A roentgenogram is an X-ray, so therefore this pt. needs an MRI next |
