MKSAP: 69-year-old woman with a lump under her arm

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 69-year-old woman is evaluated for a lump under her arm found on self-examination. She is otherwise healthy and has no other symptoms. Medical and family histories are unremarkable, and she takes no medications. On physical examination, temperature is 37.4 °C (99.3 °F), blood pressure is 110/70 mm Hg, pulse rate is 72/min, and respiration rate is 14/min. The patient has a hard, fixed, 2-cm mass palpable in the right axilla. The remainder of the examination, including breast examination, is normal. Complete blood count and serum creatinine, total bilirubin, and alkaline phosphatase levels are normal. A needle aspirate of the right axillary mass reveals adenocarcinoma. Bilateral mammography and breast MRI are normal. CT scan of the chest, abdomen, and pelvis demonstrates the enlarged axillary lymph node and no other abnormalities. Which of the following is the most appropriate initial treatment? A: Breast cancer chemotherapy regimen B: Excision of the axillary lymph node C: Mastectomy with axillary lymph dissection D: Radiation therapy to the right axilla Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs