A 23-year-old female presents with episodic bilateral breast tenderness. Upon palpation, there are multiple areas of nodularity with no dominant breast mass and no tenderness, nipple, or skin changes. It is best to recommend:
A. Ultrasound of the breasts
B. Mammogram of the breasts
C. Fine needle aspiration of one nodule within a breast
D. Diary of menstrual cycle and breast symptoms
ANS: D
Women who experience cyclic mastalgia usually have onset as a teen or young adult. It is important to determine menstrual and reproductive history and to identify all pharmacologic agents taken. A complete breast examination should be performed. The pain associated with hormonal fluctuation most commonly occurs during the second half of the woman's cycle. The variability of the signs and symptoms is identified with a symptom diary and record of the menstrual cycle. The pain is typically poorly localized, bilateral, and nonspecific. It may be accompanied by a sense of breast fullness. The examination may identify the multiple, bilateral nodularities associated with fibroadenomas or fibrocystic changes.
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