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140 questions
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 45-year-old woman presents with a slowly growing mass near the right jaw. You palpate a firm nodule in the parotid gland but find no adenopathy and no other abnormality on examination. A biopsy reveals both epithelial and stromal elements. What is the appropriate treatment for this lesion?
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.
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 is the most appropriate initial therapy?
A15-month-old African American male, who is otherwise healthy, is found to have an emoglobin level of 8 g/dL on routine screening. The mean corpuscular volume (MCV) is decreased. His lead screen is within normal limits. You obtain a diet history, which reveals that he drinks about 3040 oz of whole cow's milk a day. He eats no meat and some fruits and vegetables. Which of the following is the most likely cause? sickle cell anemia
A15-month-old African American male, who is otherwise healthy, is found to have an emoglobin level of 8 g/dL on routine screening. The mean corpuscular volume (MCV) is decreased. His lead screen is within normal limits. You obtain a diet history, which reveals that he drinks about 3040 oz of whole cow's milk a day. He eats no meat and some fruits and vegetables. The most effective next step in management would be to obtain which of the following?
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 42-year-old woman returns to the clinic following an uneventful biopsy for a welldefined, mobile mass. The pathology report describes the mass as a fibroadenoma, but LCIS is identified in the breast parenchyma adjacent to the fibroadenoma and extending to the margin of resection. She has no current illnesses, is on no medications, and her family history is negative for breast cancer. Breast imaging studies show fatty breasts with no abnormal findings except for the fibroadenoma. Which of the following is the most appropriate management option? re-excision of the biopsy cavity to gain negative margins of resection
The most likely cause of the pathologic findings in the spleen shown in Figure below is which of the following?
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. This disease is most prevalent in which age group?
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 64-year-old White female presents to your office with complaints of vulvar pruritis and pain. You examine her and find an ulcerated lesion in the medial aspect of the left labia majora, 3.0 1.5 cm, that is thickened and indurated. You biopsy this lesion and the findings confirm a squamous cell carcinoma of the vulva. The groin nodes are palpably normal bilaterally. The next step in the patient's management would be which of the following?
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?
A 37-year-old female presented to your office with an ultrasound report suggestive of bilateral ovarian masses. You take her to the operating room for an exploratory laparotomy and note the left ovary to be replaced by an 8 9 cm neoplastic process. The right ovary appears to have a small 2 x 2 cm cystic process, similar in appearance to the left ovary, involving only a small portion of the right ovary. After obtaining pelvic and upper abdominal washings, you remove the left ovary and then perform a cystectomy on the right ovary, removing all visible disease without rupture. The frozen section on both resected specimens reveals a serous tumor of low malignant potential (LMP). The best procedure for the patient at this point is which of the following?
A 65-year-old woman presents to the physician's office for evaluation of an abnormal screening mammogram. She denies any breast masses, nipple discharge, pain, or skin changes. Past history is pertinent for hypertension. Family history is positive for postmenopausal breast cancer in a sister. She has a normal breast examination and no axillary adenopathy. The remainder of her examination is unremarkable. An MLO view of the right breast is shown in Figure along with a magnification view of the craniocaudal (CC) film Which of the following is the most likely diagnosis?
A 45-year-old man presents to the physician's office complaining of dysphagia and retrosternal pressure and pain of 2-year duration. The symptoms have worsened over the last 3 months. He has a 30 packyear smoking history and drinks beer on weekends. Vital signs include a BP of 150/90 mmHg, pulse rate of 90/ min, and respiratory rate of 12/min, with a normal temperature. Examination reveals a thin man with a normal heart, lung, and abdomen examination. An esophagogram reveals a 6-cm, smooth, concave defect in the midesophagus with sharp borders. Esophagoscopy reveals intact overlying mucosa and a mobile tumor. Which of the following is the most likely diagnosis?
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?
A 65-year-old woman presents to the physician's office for evaluation of an abnormal screening mammogram. She denies any breast masses, nipple discharge, pain, or skin changes. Past history is pertinent for hypertension. Family history is positive for postmenopausal breast cancer in a sister. She has a normal breast examination and no axillary adenopathy. The remainder of her examination is unremarkable. An MLO view of the right breast is shown in Figure along with a magnification view of the craniocaudal (CC) film Which of the following is the most appropriate next step in management?
A 45-year-old man presents to the physician's office complaining of dysphagia and retrosternal pressure and pain of 2-year duration. The symptoms have worsened over the last 3 months. He has a 30 packyear smoking history and drinks beer on weekends. Vital signs include a BP of 150/90 mmHg, pulse rate of 90/ min, and respiratory rate of 12/min, with a normal temperature. Examination reveals a thin man with a normal heart, lung, and abdomen examination. An esophagogram reveals a 6-cm, smooth, concave defect in the midesophagus with sharp borders. Esophagoscopy reveals intact overlying mucosa and a mobile tumor. Which of the following is the most appropriate next step?
A14-year-old male is evaluated for thigh pain. He has no history of injury. An x-ray of the leg shows a mass in the distal femur that extends into the soft tissue. Abiopsy is performed and cytogenetic studies show translocation of chromosomes 11 and 22. What is this patient's diagnosis?