During an examination of a 57-year old man, you note gynecomastia. Your next best action is what?

A. Cyclic breast pain is related to the menstrual cycle and typically follows a pattern in relation to hormonal changes. It often starts in the luteal phase of the cycle and resolves with the onset of menstruation. Since the described pain is not associated with the menstrual cycle, this term is not appropriate for the given scenario.
B. Noncyclic breast pain is pain that is not related to the menstrual cycle and does not have a specific, cyclical pattern. It is often described as occurring independently of hormonal changes and can be associated with a variety of other factors, including infections, injuries, or other conditions affecting the breast tissue.
C. Fibrocystic breast changes refer to a condition characterized by lumpy, tender breasts with pain often related to hormonal changes. The pain and lumps can vary with the menstrual cycle, so it does not fit the description of noncyclic pain that is independent of the menstrual cycle.
D. While breast cancer can present with pain, particularly in advanced stages or in the presence of a mass, the term "breast cancer" is not used to describe the nature of the pain itself. It is a diagnosis rather than a descriptive term for pain characteristics.

A. While mammograms are commonly used to evaluate breast tissue in women, they are not typically used for men. In men, gynecomastia is usually evaluated with a physical exam and sometimes ultrasound rather than mammography. A mammogram might be ordered if there is a suspicion of breast cancer, but this is less common and not the first step in evaluating gynecomastia.
B. This is a prudent and effective next step. Certain medications can cause gynecomastia as a side effect, including some antipsychotics, antidepressants, antiandrogens, and calcium channel blockers. Reviewing the medication list can help identify if the gynecomastia might be related to a drug the client is taking.
C. A breast biopsy is an invasive procedure used to diagnose breast cancer or other conditions when there is a concern about a mass or abnormality. If gynecomastia is the only finding and there are no concerning features such as a palpable mass or other symptoms, a breast biopsy would not be the first step.
D. While gynecomastia can occur as a normal part of aging, especially in older men due to hormonal changes, it is important to evaluate it thoroughly to rule out other causes. Simply dismissing it as a normal part of aging without further investigation might overlook an underlying condition or medication side effect.