doyoudig
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An otherwise healthy 65yr old woman comes to the physician because of bloody discharge from the right nipple for 2weeks. On examination , no retraction, erosion, or other abnormal change is present. Palpation reveals an ill-defined, 1cm nodule located deep in the right areola. Which of the following is the most appropriate next step in diagnosis?
a cytologic examination of nipple discharge
b mammography alone
c ultrasnography
d biopsy under mammographic localisation
e. mammography followed by fine needle cytology
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| faraym
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d.?
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| tanmaynator
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d..????
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| doyoudig
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ok, think about when u would need Mammagraphic help to localize the lesion in order to know where to biopsy??
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| Justice
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e. mammography followed by fine needle cytology, but even (A) seems to be appropriate
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| faraym
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ok I go with E.
A . wrong ,becoz absence of malignant cells will not rule out cancer.
B.Mammography alone is inconclusive.
D. when we can palpate the mass , no need for guided biopsy.
Hope Iam right. 
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| doyoudig
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good job faraym 
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| faraym
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Thank you .
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| arlete
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Good question!
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| robin082006
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E
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| mjl1717
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I would have gone for "most artillery" which is e.
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| ram3
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E big time
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| jamdoc
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A
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| sprint123
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As per kaplan lectures, isn't it the cytology of the discharge is the NSIM??!
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| Justice
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sprint123 wrote:
As per kaplan lectures, isn't it the cytology of the discharge is the NSIM??!
Totally agree... Sampling can be done right in the office... And I am sure this prep will be 80% positive provided that there is not inflammation and thus cellularity will be scant...
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| ansalshah
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Why not a?If its positive,then 100% diagnostoc.If negative then do invasive tests.
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| wywywy2006
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hi, this is intraductal papilloma. Mamagraphy is not useful. So, any options including mammagraphy should be ruled out first.
Then, A is the best answer and should be done before galactogram guided resection
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