Internal-Medicine

Questions: 3–13 121
9. A 52-year-old man presents with abdominal
pain and weight loss. He describes a dull
“gnawing” pain located in the epigastric region
radiating to the back. The abdominal examination
is normal with no hepatosplenomegaly or
masses palpated. A computerized tomography
(CT) scan of the abdomen reveals a 3-cm mass
in the pancreas. Which of the following statements
regarding cancer of the pancreas is true?
(A)
(B)
(C)
(D)
(E)
tumors of the pancreas are divided
almost equally between those arising
from the exocrine portion and those
arising from the endocrine portion
most endocrine tumors of the pancreas
are malignant
the body of the pancreas is the most
common site of malignancy
adenocarcinoma is the most common
pancreatic cancer
extension is through local invasion;
metastases are a late manifestation
10. A 73-year-old man was born in Taiwan and came
to the United States 3 years ago. He is known to
be HBsAg positive. Which of the following findings
suggests the development of HCC?
(A)
(B)
(C)
(D)
(E)
hepatomegaly
hepatic bruits
ascites
jaundice
all of the above
11. A 47-year-old man presents with dark black
stools and vague crampy abdominal pain. On
examination he is pale, blood pressure 100/70
mm Hg, pulse 110/min, and the abdomen is
soft and nontender. Rectal examination confirms
melena, and the patient is transfused
2 units of packed red blood cells. Upper
endoscopy does not identify the source of
bleeding, so a small bowel barium study is
ordered. It reveals a small bowel tumor. Which
of the following statements concerning small
bowel tumors is correct?
(A)
(B)
(C)
(D)
(E)
carcinoid is a common cause of small
bowel tumors
malignant adenocarcinoma most
frequently occurs in the duodenum
malignant tumors bleed more frequently
than benign tumors
Peutz-Jeghers syndrome is characterized
only by benign hamartoma
most primary gastrointestinal (GI)
lymphomas are located in the ileum
12. A 58-year-old man is newly diagnosed with
colon cancer and undergoes surgical resection
of the tumor. The pathology result reports no
lymph node involvement, the lesion is 4 cm in
size and involves the muscularis layer. His preoperative
evaluation for distal metastases was
negative. Which of the following factors is most
important in predicting prognosis and survival
in patients with colon cancer?
(A) age under 40
(B) male gender
(C) rectal bleeding
(D) small tumor size
(E) depth of tumor penetration
13. A 64-year-old woman presents with abnormal
vaginal discharge and postmenopausal bleeding.
Pelvic examination reveals a bulky uterus
and no adnexal masses. She undergoes a dilation
and curettage (D&C), and the pathology is
positive for adenocarcinoma. Which of the following
is correct about carcinoma of the uterine
endometrium?
(A)
(B)
(C)
(D)
(E)
not associated with diabetes mellitus
and obesity
most common in postmenopausal
woman
associated with multiparity
common in Jews and Muslims
associated with herpes simplex virus
type 2 (HSV-2) infection