A 23-year-old woman is concerned about a mass she found on ...

[naturalchemist]

A 23-year-old woman is concerned about a mass she found on palpation. Upon examination of the patient, the mass feels cystic, round, and mobile with discrete borders. The diagnostic study that is recommended is:
 
  A. CT scan
  B. Mammogram
  C. Biopsy
  D. Ultrasound

Question 2

A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident.
 
  Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect:
  A. Pulmonary embolism
  B. Pleural effusion
  C. Pneumothorax
  D. Fracture of ribs

[bassamabas]

Answer to Question 1

ANS: D
The American College of Radiology (2012) recommends that women under 40 years of age should be assessed through ultrasound, and women who are older than 40 years should be assessed with a mammogram. Younger women have denser breasts, and ultrasound is, therefore, often more useful than a mammogram. Ultrasounds are helpful in determining whether or not a mass that feels potentially cystic is fluid filled or solid. It is crucial that the woman understand that the imaging procedure is a screening tool and is never diagnostic regarding the existence or absence of a malignancy.

Answer to Question 2

ANS: C
Pneumothorax involves air in the pleural cavity. A pneumothorax can occur spontaneously in otherwise healthy individuals or be secondary to trauma or intrinsic lung disease. There is history of sudden onset of shortness of breath associated with chest pain. The patient usually presents in great distress, with tachycardia and tachypnea, and is often splinting the chest. There is decreased fremitus and increased hyperresonance on the affected side. Lung sounds are diminished or absent. The trachea may shift away from the affected side if a large pneumothorax is present.