American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition requires surgery if a palpable lump in a patient under 30 is found to have bloody fluid?

1. Mammography and biopsy

2. MRI and observation

3. Elective surgery

4. Forceful aspiration

The correct answer is: Mammography and biopsy

A palpable lump in a patient under 30 that presents with bloody fluid raises concern for potential malignancy, particularly in the breast. The appropriate management in this scenario involves conducting a mammogram followed by a biopsy if the imaging findings are suspicious. This approach is critical because the presence of bloody fluid can indicate various underlying conditions, including a rare but possible breast cancer, which necessitates histological examination to confirm the diagnosis. Mammography is often the first imaging study performed in women, while a biopsy allows for definitive diagnosis. In this age group, while many breast lumps may be benign, the possibility of a malignant etiology must be ruled out, particularly when bloody fluid is noted. Surgery is reserved for cases where malignancy is confirmed or suspected based on these investigations. In contrast, the other options do not align with the urgency and diagnostic requirements presented by a lump with bloody fluid. MRI and observation may not provide the immediate answers needed for a suspicious finding. Elective surgery would typically be considered only after a diagnosis is established. Forceful aspiration could temporarily relieve symptoms but does not address the underlying concern for potential malignancy or provide a definitive diagnostic histology. Thus, the best approach is to obtain imaging and perform a biopsy to ensure appropriate management and treatment