Medicine at a Glance: Core Cases

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Oncology

Case 1: A Patient with Back Pain, Cough and Breathlessness

CASE

A 57‐year‐old woman presents with worsening health, back pain, cough and breathlessness. She has no significant past medical history. Her mother developed breast cancer in her 60 s. She has right‐sided, painless axillary lymphadenopathy, and clinical evidence of a right pleural effusion, but no breast mass. A chest radiograph demonstrates a right pleural effusion and lytic bone metastases.

QUESTION

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What is the best initial diagnostic strategy?