Internal-Medicine

122 6: Oncology
14. You are seeing a 62-year-old woman with a
family history of breast cancer. She is worried
about her future risk of breast cancer, since her
mother died of breast cancer at the age of 63.
Which of the following features is also a recognized
risk factor for breast cancer?
(A)
(B)
(C)
(D)
(E)
early onset of menopause
early onset of menarche
late-life radiation exposure
multiparity
early full-term pregnancy
15. A 67-year-old man complains of shortness of
breath on exertion and right-sided chest pain.
The pain is constant in nature; he has no fever
or chills and no sputum production. On examination,
air entry to the left lower lobe is
reduced and the area is dull on percussion. The
CXR reveals left lower lobe pleural effusion,
pleural thickening with calcification (plaques),
and lower lobe fibrosis. Further history from
the patient is significant in that he is a lifetime
nonsmoker, and that he worked as a pipe fitter
until retiring 2 years ago. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
adenocarcinoma
squamous cell carcinoma
sarcoidosis
lymphoma
mesothelioma
16. A 23-year-old notices left leg pain after returning
from a ski trip. The pain persists for 2 months,
and he presents for medical evaluation after
noticing a lump on his calf. On examination,
there is a 2-cm nonmobile mass in his anterior
shin. A magnetic resonance imaging (MRI) scan
suggests the lesion is arising from the tibia, and
a biopsy reveals bone sarcoma. Which of the
following statements about bone sarcoma is
correct?
(A)
(B)
(C)
distal bone sarcomas have a better
prognosis
lung metastases are a late sign
local lymph node involvement is very
common
(D)
(E)
articular cartilage is a common plane for
tumor spread
skip metastases within the same bone
are common and unrelated to prognosis
17. A 19-year-old woman notices axillary lymphadenopathy
and presents for evaluation. She
has noticed the lymph nodes for over a month.
She has no fever, chills, weight loss, or night
sweats. On examination, she has multiple
mobile nontender lymph nodes in both axilla,
and no cervical or inguinal lymph nodes. No
spleen is palpable, and the rest of the examination
is normal. A monospot test is negative, and
a complete blood count (CBC) and biochemistry
are normal. A biopsy of one lymph node reveals
Hodgkin’s disease (HD), nodular sclerosing
variety. A bone marrow biopsy is arranged.
Which of the following tests is also part of the
routine staging evaluation for patients with HD?
(A)
(B)
(C)
(D)
(E)
positron emission tomography (PET) scan
gallium scan
CT of chest, abdomen, and pelvis
staging laparotomy
bone scan
18. A 23-year-old man is newly diagnosed with
Hodgkin’s lymphoma. Which of the following
is the most likely presenting symptom of this
type of lymphoma?
(A)
(B)
(C)
(D)
(E)
coincidentally detected mediastinal
mass
fixed tender inguinal lymph node
involvement
mobile nontender cervical lymph nodes
fixed nontender axillary nodes
mobile tender axillary nodes
19. A 68-year-old man presents with left axillary
adenopathy that on biopsy reveals a low-grade
lymphocytic lymphoma. Which of the following
statements is correct?
(A)
(B)
staging in this type of disorder is not
relevant
if disease is widespread, early aggressive
chemotherapy will result in an improved
prognosis for survival