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140 questions
A 65-year-old woman presents to the physician's office for a second opinion on the management options for recently diagnosed breast cancer. She presents with a 2.5-cm mass in the upper outer quadrant of the left breast associated with a palpable axillary node suspicious for metastatic disease. The remainder of her examination is normal. Mammography demonstrates the cancer and shows no other suspicious lesions in either breast. Chest x-ray, bone scan, and blood test panel, including liver function tests, are normal. Family history is positive for breast cancer diagnosed in her sister at age 65. Past history is unremarkable. The first physician recommended modified radical mastectomy. The patient has read about SLN biopsy. She avidly wants to avoid the risk of lymphedema that her sister must endure. She asks the question "Am I a candidate for a SLN biopsy instead of a complete axillary dissection?" Which of the following is the most appropriate answer to her question? Yes, and if the SLN if positive, then a complete axillary dissection should be performed.
A54-year-old woman presents to her physician for an opinion regarding additional therapy following curative resection of recently diagnosed colon cancer. She underwent uncomplicated sigmoid resection for invasive colon cancer 4 weeks ago. The pathology revealed carcinoma invading into, but not through, the muscularis propria, with one of eight positive mesenteric nodes. There was no evidence of liver metastases at the time of operation. Preoperative chest x-ray and CT scan of the abdomen showed no evidence of distant disease. Preoperative carcinoembryonic antigen (CEA) level was normal. Past history is positive for diabetes and mild hypertension. Examination is unremarkable except for a healing abdominal incision. Which of the following is the most appropriate recommendation regarding adjuvant therapy?
A55-year-old man presents to the physician's office for his yearly physical examination. He is asymptomatic. Past history is pertinent for hypertension. Family history is positive for breast cancer in his mother at age 70 and colon cancer in his father at age 65. His examination is unremarkable except for guiac positive stool. Barium enema shows a sigmoid colon polyp. Colonoscopy confirms a 3-cm pedunculated polyp in the sigmoid colon, and snare polypectomy is performed. Pathologic examination reveals an adenomatous polyp with a focus of invasive carcinoma in the head, with a 4-mm resection margin and no tumor noted in the stalk. Which of the following is the most appropriate next step in management?
A 68-year-old man presents to the physician's office complaining of progressive dysphagia over the last 3 months associated with mild chest discomfort. He reports a 15-lb weight loss, a 30 pack-year smoking history, and occasional alcohol intake. The physical examination, including vital signs, is unremarkable. A chest x-ray was normal, and a barium esophagogram shows an irregular filling defect in the distal third of the esophagus with distortion and narrowing of the lumen. Which of the following is the most appropriate next step in management?
A 28-year-old man presents with vague complaints of fatigue, nausea, and dyspnea. He has had occasional episodes of hemoptysis and some burning with urination. Laboratory studies reveal a mild anemia and an elevation of both blood urea nitrogen (BUN) and creatinine. Urinalysis reveals the presence of blood, protein, and red cell casts. Antibodies against which of the following is the cause of this condition?
A 65-year-old man presents to the physician's office for his yearly physical examination. His only complaint relates to early fatigue while playing golf. Past history is pertinent for mild hypertension. Examination is unremarkable except for trace hematest-positive stool. Blood tests are normal except for a hematocrit of 32. A UGI series is performed and is normal. A barium enema is performed, and one view is shown in the figure below. Which of the following is the most appropriate therapy following colonoscopy?
Apreviously healthy 45-year-old man presents with a 9-month history of a slow-growing, painless right neck mass. He is a nonsmoker and has no significant past medical history. On examination, there is a nontender, discrete, 3-cm mass over the angle of the right mandible. Facial muscle function and sensation are normal. An oropharyngeal examination is normal. Which of the following is the best next step in the management of this patient?
A 28-year-old man with a past history of bilateral orchiopexy for cryptorchidism presents with a painless, unilateral right scrotal enlargement. On examination, there is a palpable right testicular mass and enlarged inguinal nodes. Scrotal ultrasonography demonstrates heterogeneity of the testis, with an associated hydrocele. A CT scan of the abdomen and pelvis demonstrated right-sided retroperitoneal adenopathy. CT scan of the chest is normal. Which of the following would help confirm the diagnosis?
A 57-year-old man complains of worsening headache, nausea, and vomiting for 2 months. On examination, he is lethargic, confused, and has right-sided weakness. While waiting for a computed tomography (CT) scan, he develops status epilepticus, suffers cardiorespiratory arrest, and dies. His brain at autopsy is shown in the figure below. Which of the following is the most likely diagnosis? glioma
A65-year-old female presents with ascites, multiple peritoneal implants, and a large abdominopelvic mass. At laparotomy, she is found to have omental disease, splenic metastases, retroperitoneal lymphadenopathy, and bilateral pelvic masses with rectosigmoid involvement posteriorly and bladder involvement anteriorly. The appropriate surgical management for this patient would be which of the following?
A 67-year-old female was admitted to the hospital because of chronic fatigue and low back pain. An x- ray of the vertebral column showed diffuse osteoporosis and compression fractures of L1 and L2 vertebral bodies. The complete blood count (CBC) was within normal limits. The peripheral blood smear showed rouleaux formation. The immunoelectrophoresis showed a monoclonal spike of more than 3 g. A bone marrow biopsy was performed and showed an increase of more than 20% in plasma cells see Figure below In this particular patient what would be the electrophoretical characteristic changes?
A 56-year-old woman presents to the physician's office with complaints of a new left breast mass. She denies any pain, nipple discharge, or skin dimpling. She has a prior history of breast cysts 5 years ago, treated by aspiration at that time. Her last mammogram was at age 53. Past history is pertinent for a 30 pack-year smoking history, prior total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAH-BSO) at age 54 for leiomyomas, and current use of hormone replacement therapy (HRT). Family history is negative for breast disease. Examination reveals a firm, welldefined, mobile, 1.5-cm nodule in the upper outer quadrant of the left breast without any regional lymphadenopathy. Which of the following is the most appropriate next step in management?
An 83-year-old woman presents to a mammographic facility for a screening mammogram. The technician notices a mass in the lateral right breast. The patient denies any breast pain, nipple discharge, skin changes, or breast trauma. A right breast CC view is shown in Which of the following is the most likely diagnosis?
An 83-year-old woman presents to a mammographic facility for a screening mammogram. The technician notices a mass in the lateral right breast. The patient denies any breast pain, nipple discharge, skin changes, or breast trauma. A right breast CC view is shown in Which of the following is the most appropriate next step in management?
A 17-year-old male is evaluated for a painless neck mass. You assess the mass as lymphadenopathy and arrange for a biopsy. The pathology report subsequently notes the presence of Reed-Sternberg cells. Which of the following is the most likely diagnosis?
Of the following, which is the best indicator of response to treatment or progression of disease in monitoring patients being treated for prostate cancer?
A 23-year-old female sought medical help because of a painless asymmetrical enlargement of the lower neck. The patient had no history of dyspnea, dysphagia, hoarseness, or previous radiation exposure. On physical examination, besides the enlarged asymmetrical thyroid gland, there was also a palpable lymphadenopathy. A lymph node biopsy (see Figure, was performed. Hematoxilin and eosin (H&E) stained slide shows the lesion. What is the most appropriate diagnosis?
A 72-year-old male presented with nonspecific symptoms of easy fatigability, weight loss, and anorexia. On physical examination, generalized lymphadenopathy and hepatosplenomegaly were present. On the peripheral blood, he was found to have a marked lymphocytosis and in the serum, a small monoclonal spike was present. What would be the most likely histology seen in a lymph node biopsy?
A 65-year-old woman presents to the physician's office for a second opinion on the management options for recently diagnosed breast cancer. She presents with a 2.5-cm mass in the upper outer quadrant of the left breast associated with a palpable axillary node suspicious for metastatic disease. The remainder of her examination is normal. Mammography demonstrates the cancer and shows no other suspicious lesions in either breast. Chest x-ray, bone scan, and blood test panel, including liver function tests, are normal. Family history is positive for breast cancer diagnosed in her sister at age 65. Past history is unremarkable. The first physician recommended modified radical mastectomy. Which of the following is the most appropriate management option for locoregional control yielding results equally effective as mastectomy?
A 59-year-old woman had a left modified radical mastectomy for intraductal carcinoma 2 years previously. She presents with confusion, lethargy, and thigh pain. X-rays reveal a lytic lesion in the shaft of the femur. Which of the following blood abnormalities is most likely?