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A 45-year-old woman presents to her primary care physician for a general check up. She has not seen a primary care physician for the past 20 years but states she has been healthy during this time frame. She had breast implants placed when she was 29-years-old (which have been stable and without issue) but otherwise has not had any surgeries. She denies any family history of breast cancer. She is concerned about her risk for breast cancer given her friend was recently diagnosed. Her temperature is 97.0°F (36.1°C), blood pressure is 114/64 mmHg, pulse is 70/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is unremarkable. Which of the following is the most appropriate workup for breast cancer for this patient?
BRCA genetic testing
No intervention indicated at this time
Sentinel node biopsy
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A 35-year-old woman is presenting for a general wellness checkup. She is generally healthy and has no complaints. The patient does not smoke, drinks 1 alcoholic drink per day, and exercises 1 day per week. She recently had silicone breast implants placed 1 month ago. Her family history is notable for a heart attack in her mother and father at the age of 71 and 55 respectively. Her father had colon cancer at the age of 70. Her temperature is 99.0°F (37.2°C), blood pressure is 121/81 mmHg, pulse is 77/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is unremarkable. Which of the following is the most appropriate initial step in management?
Colonoscopy at age 60
Mammography at age 50
A 27-year-old woman presents to her primary care doctor with concern about a mass she felt in her left breast on a recent breast self-examination. She denies any nipple discharge and reports that her grandmother died of breast cancer at the age of 70. She is otherwise healthy, has a 5 pack-year smoking history, and drinks 3 to 4 alcoholic beverages daily. Her temperature is 99.0°F (37.2°C), blood pressure is 120/84 mmHg, pulse is 70/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical examination confirms the presence of a firm lump in the superolateral quadrant of the left breast. There are no evident overlying skin changes and there is no notable axillary lymphadenopathy on palpation. An ultrasound is performed as seen in Figure A. Which of the following is the most appropriate next step in management?
Fine needle aspiration