Near constant headache 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 67-year-old man presents to his doctor with reports of fatigue, nausea, loss of appetite, near-constant headache, and breathlessness for the past 3 months. He is slightly overweight, with a BMI of 28.4 (height is 6 ft and weight is 210 lb). He has ongoing hypertension and hyperlipidemia, both of which are medically controlled. He has a positive history of cancer. He was diagnosed with stage IIA Hodgkin lymphoma 8 years ago at age 59 years. He was treated with chemoradiation and went into remission. There is no history of cancer in his family.Physical exam reveals a lump in the left breast, with a pebble-like consistency, as well as axillary lymphadenopathy. The patient appears slightly jaundiced; abdominal distention is evident on palpation. There is also slight hepatosplenomegaly on palpation. Laboratory testing is performed. Complete blood count shows nothing remarkable; comprehensive metabolic panel reveals elevated liver function tests and alkaline phosphatase (ALP) = 500 IU/L.What is the immediate next step in the diagnostic process for this patient? Choose one Biopsy Mammography/ultrasound PET Bone scan This quiz is not accredited for CME.