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140 questions
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. On speculum examination, you visualize a 1 × 1 cm lesion at the left vaginal fornix. The lesion is acetowhite, slightly raised, with coarse punctation and bizarre branching vessels. You take a biopsy of the lesion and the pathology returns consistent with vaginal intraepithelial neoplasia (VAIN) 3, suspicious for invasion. Which of the following is your next step in management?
A 46-year-old female presents to your office with rectal bleeding, itching, and irritation. On examination, a 3-cm ulcerating lesion is seen in the anal canal. Biopsy of the lesion reveals squamous cell carcinoma (SCC). Which of the following is the most appropriate treatment?
A 25-year-old male presents to your office for evaluation of a testicular mass that he found in the shower. On examination, his left testicle is larger than his right with a firm palpable mass. Ascrotal ultrasound confirms the presence of a solitary intraparenchymal testicular mass. The most likely diagnosis in this patient is which of the following?
You are seeing a 48-year-old female in followup in your clinic. She originally presented for evaluation of a suspicious nonpalpable lesion in her right breast that was seen on her annual mammogram. A stereotactic core biopsy was done. She now returns to your office to review the results of the pathology report that confirms the presence of lobular carcinoma in situ (LCIS). How do you counsel her at this time?
A 25-year-old male presents to your office for evaluation of a testicular mass that he found in the shower. On examination, his left testicle is larger than his right with a firm palpable mass. Ascrotal ultrasound confirms the presence of a solitary intraparenchymal testicular mass. Further management of his condition would include which of the following?
Match the below medication with the potential blood dyscrasia side effect it can be associated with. Clozaril
Match the below medication with the potential blood dyscrasia side effect it can be associated with. Valproate.
A 50-year-old male presents with difficulty swallowing. Esophageal manometry demonstrates absence of peristaltic waves and a nonrelaxing lower esophageal sphincter (LES). Which of the following is the most likely diagnosis?
A 52-year-old female has been referred to you for consultation following a core biopsy of an area of calcifications seen on a screening mammogram. She has no family history of breast or ovarian cancer. She has not been taking hormone replacement therapy and has no reproductive risk factors. On physical examination, there is no palpable mass. The core biopsy results demonstrate atypical ductal hyperplasia. What should be the next step in her treatment?
Match the below medication with the potential blood dyscrasia side effect it can be associated with. Lithium
A 63-year-old Native American male, with a 6-year history of DM, hypertension, and hyperlipidemia, comes to your office as a new patient for a routine examination. He has been experiencing frequent lower back pain and headaches for which he is taking ibuprofen daily for the past 5 weeks. Moreover, he is complaining of mild fatigue. In addition, he is taking aspirin, atorvastatin, verapamil, and glipizide. His physical examination shows a blood pressure of 165/80 and heart rate of 90 bpm. In general, he was not in any distress. His funduscopic examination reveals no signs of diabetic retinopathy. Cardiac examination reveals a regular rate and rhythm with an S4 gallop. His lungs are clear and abdominal examination is unremarkable without any bruit auscultated. He also has 2+ lower extremity pitting edema. Rectal examination reveals brown stool, negative for occult blood. His laboratory results are as follows: Which of the following is a typical finding in this patient's condition?
A64-year-old man with a long history of smoking but no significant past medical history presents to his physician's office complaining of a 12 week history of worsening dyspnea, facial swelling, and discoloration. He has also had swelling and discomfort of his right arm. Physical examination reveals edema with plethora of the face and right arm, with prominent collateral veins over the chest wall. What test is most likely to establish the cause of the patient's symptoms?
A32-year-old female presents for her first pap smear in more than 10 years. She has a history of heavy alcohol use and IV drug use and has performed sexual acts for drugs on numerous occasions. Testing performed today reveals her to have chlamydia cervicitis and trichomonas vaginalis and to be seropositive for hepatitis B and hepatitis C. HIV testing is negative. Her pap smear subsequently returns with carcinoma in-situ of the cervix. Infection with which of the following agents is most likely to have resulted in her cancer?
A72-year-old African American male presents for a routine health examination. He states that he would like to have a "screening for cancer." In the United States, based on his sex, race, and age, what is the most likely malignancy for this patient?
A 63-year-old Native American male, with a 6-year history of DM, hypertension, and hyperlipidemia, comes to your office as a new patient for a routine examination. He has been experiencing frequent lower back pain and headaches for which he is taking ibuprofen daily for the past 5 weeks. Moreover, he is complaining of mild fatigue. In addition, he is taking aspirin, atorvastatin, verapamil, and glipizide. His physical examination shows a blood pressure of 165/80 and heart rate of 90 bpm. In general, he was not in any distress. His funduscopic examination reveals no signs of diabetic retinopathy. Cardiac examination reveals a regular rate and rhythm with an S4 gallop. His lungs are clear and abdominal examination is unremarkable without any bruit auscultated. He also has 2+ lower extremity pitting edema. Rectal examination reveals brown stool, negative for occult blood. His laboratory results are as follows: Which additional of the following would best help in the determination of the etiology of this patient's nephrotic syndrome?
A 63-year-old Native American male, with a 6-year history of DM, hypertension, and hyperlipidemia, comes to your office as a new patient for a routine examination. He has been experiencing frequent lower back pain and headaches for which he is taking ibuprofen daily for the past 5 weeks. Moreover, he is complaining of mild fatigue. In addition, he is taking aspirin, atorvastatin, verapamil, and glipizide. His physical examination shows a blood pressure of 165/80 and heart rate of 90 bpm. In general, he was not in any distress. His funduscopic examination reveals no signs of diabetic retinopathy. Cardiac examination reveals a regular rate and rhythm with an S4 gallop. His lungs are clear and abdominal examination is unremarkable without any bruit auscultated. He also has 2+ lower extremity pitting edema. Rectal examination reveals brown stool, negative for occult blood. His laboratory results are as follows: Which of the following antihypertensive medications would be best implemented in patients with diabetic nephropathy?
A 63-year-old Native American male, with a 6-year history of DM, hypertension, and hyperlipidemia, comes to your office as a new patient for a routine examination. He has been experiencing frequent lower back pain and headaches for which he is taking ibuprofen daily for the past 5 weeks. Moreover, he is complaining of mild fatigue. In addition, he is taking aspirin, atorvastatin, verapamil, and glipizide. His physical examination shows a blood pressure of 165/80 and heart rate of 90 bpm. In general, he was not in any distress. His funduscopic examination reveals no signs of diabetic retinopathy. Cardiac examination reveals a regular rate and rhythm with an S4 gallop. His lungs are clear and abdominal examination is unremarkable without any bruit auscultated. He also has 2+ lower extremity pitting edema. Rectal examination reveals brown stool, negative for occult blood. His laboratory results are as follows: Which of the following microscopic findings on kidney biopsy is most usually associated with HIV infection?
A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor?
A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor? What is the most common cell type in testicular cancer?
A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor? What serum marker can be used to monitor therapy?