Posted by YP from IP 69.74.36.200 on February 28, 2006 at 14:21:12:
A 51-year-old woman comes to the office because of a "lump" in her left axilla. She says that she noticed it 3 months ago in the shower and it has been slowly increasing in size. She has not seen a physician in ages because her mother died from ovarian cancer at age 42 and she is angry at "all physicians" because they did not find it before it was too late. She is generally very healthy, exercises regularly, eats a low-fat diet, does not smoke cigarettes, lives alone with her dog, and has not traveled recently. She is allergic to flowers and cats. She denies fever, night sweats, or fatigue. Physical examination shows a 2.0 cm fixed round lesion in her axilla. The remainder of the examination, including a clinical breast examination and pelvic examination, are normal. A complete blood count is unremarkable. The most appropriate next step is to
A. obtain cultures for Epstein-Barr virus and Cytomegalovirus
B. order a complete biochemical profile and chest x-ray
C. reassure her and have her return in 2 weeks for reexamination
D. schedule a mammography
E. send her to a surgeon for a lymph node biopsy