An 18 year-old female presents after completing her freshman year at college. Two months ago, she developed "bronchitis" which has persisted. She has become increasingly tired and has frequent night sweats. A chest x-ray today reveals a left mediastinal mass. What is the next step in her evaluation?
A. repeat the chest x-ray in six months
B. ultrasound of the left hemithorax
C. bone scan
D. CT scan of the chest
E. proceed directly to bronchoscopy with biopsy
Answer: D, CT scan of the chest
Any patient presenting with mediastinal nodes should have a CT. This patient may have sarcoid or Hodgkin's or another type of cancer - CT is indicated.
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If you are studying for the PANCE or the PANRE I recommend these Review Books.