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140 questions
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 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?
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?
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?
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 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 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 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 appropriate next step in management?
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.
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 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?
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 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 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 Microscopically, the bone marrow examination will reveal which of the following?
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?
A54-year-old woman has a dilation and curettage procedure for the evaluation of postmenopausal bleeding. Which of the following pathologic diagnoses would carry the most favorable prognosis for the patient?
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?
A70-year-old man presents with back pain and increasing difficulty with initiating a urinary stream. On rectal examination, he is found to have a hard, irregularly enlarged prostate. He has an elevated prostate-specific antigen (PSA), and osteoblastic lesions in the vertebral column and bones of the pelvis. Aneedle biopsy of the prostate shows well-differentiated adenocarcinoma. Which of the following is the treatment of choice?