American Board of Internal Medicine (ABIM) Certification Practice Exam

When a breast ultrasound in a patient under 30 reveals a solid mass, what is the recommended next step?

1. Follow-up with ultrasound in 6 months

2. Mammography and core biopsy or surgical excision

3. Administer antibiotics

4. Refer to oncology

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

When a breast ultrasound in a patient under 30 reveals a solid mass, the recommended next step is often to proceed with mammography and a core biopsy or surgical excision. This approach is based on the need to characterize the solid mass further and to rule out any malignancy, as solid lesions in younger patients can sometimes be of concern despite the lower incidence of breast cancer in this age group. Mammography is useful to assess the characteristics of the mass and any associated findings, while a core biopsy allows for histological examination of the tissue. This is essential because solid masses can vary widely in etiology, from benign fibroadenomas to more serious conditions. Surgical excision may also be indicated, especially if the mass shows suspicious features on imaging or if the biopsy results are inconclusive. While follow-up with ultrasound may be considered in certain benign cases, it does not provide definitive information about the nature of the mass, which is critical for determining the appropriate management plan. Neither administering antibiotics nor referring to oncology addresses the immediate need to establish a diagnosis, which is why these options are not recommended as the next steps in this scenario.