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140 questions
Routine screening is advocated by numerous authorities for many different types of cancer. These screening programs have resulted in various degrees of success in terms of reduction in mortality. Cytologic screening for cancer of which of the following organs has successfully produced a marked reduction in mortality?
A 63-year-old woman with a grade 2 endometrioid adenocarcinoma of the uterus diagnosed by endometrial biopsy is taken to the operating room for surgical treatment with a total abdominal hysterectomy, bilateral salpingooophorectomy, and pelvic and paraaortic lymphadenectomy. No complications are noted intraoperatively. On postoperative day 1, the patient complains of numbness in her medial thigh. Your neurologic examination suggests absence of cutaneous sensation to the medial thigh and an inability to adduct her hip. Which of the following is the most likely etiology for this clinical presentation?
A41-year-old woman, recently diagnosed with a 2-cm, stage IB1 cervical cancer, undergoes a radical hysterectomy, bilateral salpingooophorectomy, and retroperitoneal pelvic lymph node dissection. Her surgery and postoperative course are uncomplicated. Four weeks postoperatively, she presents to the ER complaining of left leg swelling and left lower quadrant abdominal pain. On physical examination, she is afebrile, has a normal WBC count, and you palpate a 5 4 cm mass in the left lower quadrant. You order a pelvic ultrasound that shows a 5 5 cm simple cyst in the left lower quadrant.
Biopsy of a 4-cm sessile polyp of the cecum during a routine screening colonoscopy reveals it to be a villous adenoma with atypia. Attempt at piecemeal snare polypectomy through the colonoscope is unsuccessful. Which of the following is the most appropriate management?
Apatient with a known family history of multiple endocrine neoplasia (MEN) I, now presents with intractable ulcer disease. Which of the following statements about his condition is most accurate?
A 60-year-old Asian male presents with early satiety and 40-lb weight loss over 3 months.Upper endoscopy shows an irregular mass in the antrum of the stomach. What can you tell him and his family about his situation?
A 56-year-old thin, White woman, who has recently undergone a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy for a stage IB, grade 1, endometrioid tumor of the uterus, presents to your office complaining of hot flashes and vaginal dryness. She wants advice about the use of estrogen replacement in women treated for endometrial cancer. Which of the following is the best treatment for this woman?
Match the below medication with the potential blood dyscrasia side effect it can be associated with. Carbamazepine
A 60-year-old Asian male presents with early satiety and 40-lb weight loss over 3 months.Upper endoscopy shows an irregular mass in the antrum of the stomach. He follows up in the clinic a few days later, and you see that the results of the endoscopic biopsies are suggestive of a gastric lymphoma. Which of the following is true regarding this condition?
A mobile mass is found on rectal examination in a 77-year-old male with complaints of blood in his stool. On workup, he is found to have a stage I (Dukes' A), well-differentiated adenocarcinoma. The most appropriate intervention is which of the following?
A 55-year-old-woman presents to the physician's office for evaluation of mammographic findings on a screening mammogram. She denies any breast masses, nipple discharge, pain, or skin changes. Past history is pertinent for insulin-dependent diabetes. Family history is positive for postmenopausal breast cancer in her mother. She has a normal breast examination and no axillary adenopathy. A mediolateral oblique (MLO) view of the right breast is shown in the figure below. Which of the following is the most likely diagnosis?
A 51-year-old woman presents to the physician's office with a 2-month history of a right breast bloodtinged nipple discharge. Past history is unremarkable. Family history is positive for postmenopausal breast cancer in a maternal grandmother. Examination reveals no palpable masses or regional adenopathy, but a serous discharge is easily elicited from a single duct in the right breast. Bilateral mammograms show no abnormalities. Cytology from the discharge was not diagnostic. A ductogram was ordered, and the results are shown in the figure below. Which of the following is the most appropriate next step in management?
A27-year-old female whose father had a colon resection for adenocarcinoma undergoes her first colonoscopy. Over 100 small polyps are seen distributed mainly in her sigmoid and rectum. Multiple polyps are removed and histologic review reveals tubular adenomas with no evidence of atypia or dysplasia. The most appropriate next step in her management is which of the following?
You perform an upper endoscopy on a patient and find changes suggestive of Barrett's esophagus. How do you explain this to the patient and his family?
A patient with dyspepsia has a positive serologic test for Helicobacter pylori and is concerned that he could have an ulcer. Which of the following statements about H. pylori and ulcer disease would be most accurate?
A 19-year-old female presents to the ED complaining of swelling in her left lower extremity. She reports that she had arthroscopy of the right knee about a week ago for a torn meniscus. The swelling started last night and is uncomfortable. Which of the following statements most accurately describes the situation?
A 49-year-old male underwent his last chemotherapy session for testicular cancer 3 weeks ago and now is complaining of shortness of breath. Which of the following drugs is most probably causing his problems?
A38-year-old woman presents to the ER with heavy vaginal bleeding. A pelvic examination using a speculum to visualize the cervix reveals a large, friable, fungating cervical mass. On bimanual examination, the mass extends to the right pelvic sidewall. A biopsy from a recent gynecologic visit reveals invasive squamous cell carcinoma of the cervix. An abdominal/pelvic CT scan shows enlarged pelvic lymph nodes and right hydronephrosis. Her hematocrit (HCT) in the ER is 24%, but she is hemodynamically stable with a BP of 124/70 and a pulse of 73. The cervical mass is actively bleeding. Your initial treatment of the vaginal bleeding in the ER only partially controls the bleeding, and she is requiring frequent retreatment. The best definitive treatment to control the bleeding at this time is which of the following?
A38-year-old woman presents to the ER with heavy vaginal bleeding. A pelvic examination using a speculum to visualize the cervix reveals a large, friable, fungating cervical mass. On bimanual examination, the mass extends to the right pelvic sidewall. A biopsy from a recent gynecologic visit reveals invasive squamous cell carcinoma of the cervix. An abdominal/pelvic CT scan shows enlarged pelvic lymph nodes and right hydronephrosis. Her hematocrit (HCT) in the ER is 24%, but she is hemodynamically stable with a BP of 124/70 and a pulse of 73. The cervical mass is actively bleeding. Which of the following is the most appropriate immediate management of the vaginal bleeding in the ER?
A 42-year-old woman who previously underwent a vaginal hysterectomy for persistent cervical dysplasia presents to your office for vaginal cytology. Her vaginal cytology is shown in Figure. Which of the following is the most appropriate next step in management?