American Board of Internal Medicine (ABIM) Certification Practice Exam

If a palpable lump in a patient under 30 is found to be a simple cyst on ultrasound, what is the next appropriate step?

1. Refer for surgery

2. Aspirate and repeat breast exam in 4-6 weeks

3. Perform breast MRI

4. Order a CT scan

The correct answer is: Aspirate and repeat breast exam in 4-6 weeks

When a palpable lump in a patient under 30 is determined to be a simple cyst through ultrasound, the appropriate next step is to aspirate the cyst and perform a repeat breast examination in 4-6 weeks. This approach is guided by the understanding that simple cysts are benign and often resolve after aspiration. By aspirating the cyst, you can relieve any associated symptoms and confirm the diagnosis. Additionally, scheduling a follow-up exam allows for monitoring of any changes in the lump, ensuring that it remains stable. Aspiration serves both diagnostic and therapeutic purposes, as it can alleviate discomfort caused by the cyst and confirm that the fluid is clear. The follow-up examination serves to confirm that the cyst has resolved and to check for any new developments that might require further evaluation. In contrast, options such as referring for surgery, performing breast MRI, or ordering a CT scan are more aggressive interventions that may not be necessary given the benign nature of a simple cyst. These options typically pertain to cases where there are more concerning features on imaging or clinical examination, which is not the case here. Therefore, monitoring after aspiration is the most appropriate course of action in this scenario.