A 43-Year-Old Man Undergoes Abdominal Ultrasonography for Dyspepsia

question 267

Multiple Choice

A 43-year-old man undergoes abdominal ultrasonography for dyspepsia.  Medical problems include gastroesophageal reflux disease.  He is not overweight and has no history of hypertension.  His father was diagnosed with colon cancer at age 65.
Temperature is 36.7 C (98.1 F) , blood pressure is 120/60 mm Hg, pulse is 68/min, and respirations are 18/min.  Physical examination is unremarkable.
Ultrasound of the abdomen reveals gallbladder sludge.  There is also a 2.4-cm right renal cyst that is round, has smooth walls, is anechoic, and demonstrates strong posterior wall enhancement.  Laboratory studies show hemoglobin of 14.5 g/dL and serum creatinine of 0.8 mg/dL.  Urinalysis is unremarkable.
Which of the following is the best next step in management of this patient's renal cyst?

• A)CT scan of the abdomen
• B)Genotyping for mismatch repair gene mutations
• C)Percutaneous needle aspiration of the cyst
• D)Reassurance and observation
• E)Repeat ultrasound in 6 months

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