American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended managed follow-up if a patient under 30 years has a palpable mass that proves to be a solid mass?

1. Observation with regular ultrasound check

2. Mammography and core biopsy or surgical excision

3. Immediate surgery

4. Referral to a specialist without any imaging

The correct answer is: Mammography and core biopsy or surgical excision

In the case of a patient under 30 years who has a palpable mass that has been confirmed to be a solid mass, the recommended managed follow-up often involves mammography and core biopsy or surgical excision. Solid masses in younger patients are more often benign, but there is still a risk of malignancy that cannot be ruled out without further intervention. Mammography may not be the most effective imaging tool in younger women due to denser breast tissue, but it can still provide valuable information, especially when combined with ultrasound. Core biopsy allows for histological evaluation of the mass, providing definitive information about the nature of the mass. If the core biopsy indicates a malignancy or if there are characteristics suggesting a high risk for cancer, surgical excision may be necessary for both diagnosis and treatment. This approach ensures that any potentially malignant masses are identified and treated appropriately while also managing the patient’s health and anxiety regarding the mass. It lays the foundation for safety, as it allows for proper pathology evaluation, which is crucial in determining the next steps in management based on the findings. Other strategies, such as observation with regular ultrasound check, might not be adequate due to the risks associated with undiagnosed solid masses. Immediate surgery may be excessive without first