Fatigue and general achiness Reviewed by Avan J. Armaghani, MD Author and Disclosure Information [Show] Avan J. Armaghani, MD, Assistant Member, Department of Breast Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL.Avan J. Armaghani, MD, has disclosed no relevant financial relationships. Question 1 of 3 A 47-year-old woman presents to her ob/gyn with reports of fatigue, headache, general achiness, bloating, and what she describes as brain fog. She believes that she is in perimenopause and is seeking treatment for her symptoms. Physical exam shows that she is pale, slightly jaundiced, and her abdomen is distended. Slight hepatomegaly is evident on palpation. There is an asymmetry between the left and right breasts, with the left one being larger and appearing swollen. It also feels somewhat denser than the other breast does, and the veins appear dilated. The patient does not find this remarkable because she breastfed all three of her children and said that she has experienced this asymmetry, along with calcifications in both breasts, for many years. Further examination reveals left axillary lymphadenopathy and a general swelling in the underarm area. The patient's medical history is otherwise unremarkable.What is the next step in the diagnostic process for this patient? Choose one PET Needle biopsy Breast MRI Diagnostic mammogram and ultrasound This quiz is not accredited for CME.