Internal-Medicine

Questions: 14–24 123
(C)
(D)
(E)
the disease is likely to be widespread at
the time of diagnosis
untreated, the prognosis is measured in
months
his age is not a relevant factor in
treatment
20. A 63-year-old man presents with a new skin
rash on his chest. The lesions are well-defined
red-colored plaques. A skin biopsy of the lesion
reveals lymphoma. Further diagnostic evaluation
does not reveal any evidence of a visceral
malignancy. Which of the following characteristics
about this disease is correct?
(A)
(B)
(C)
(D)
(E)
it is invariably a precursor to leukemia
it is of T-cell origin
it has no specific geographic distribution
it has a high likelihood of cure
it is related to sun exposure
21. A 65-year-old man, with a 45-pack-per-year
history of smoking, presents with hematuria
and flank pain. He reports no fever, chills, or
dysuria, but he has lost 15 lb. On examination
the abdomen is soft, no mass is felt, and there
is no flank tenderness on percussion. His
hemoglobin (Hb) is 18.5 g/dL, and his liver
enzymes are normal. A CT scan of the abdomen
reveals a mass in the left kidney with involvement
of the renal vein. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
renal cyst
renal cell carcinoma
renal metastases
renal abscess
lymphoma
22. A 53-year-old woman presents with a 1-cm
invasive carcinoma of the breast, detected on
mammography. She feels well and has no other
symptoms. On examination the lump is palpable,
and there are no axillary lymph nodes.
Which of the following is the most appropriate
local therapy for her tumor?
(C) local excision plus radiation therapy
(D) local excision and axillary dissection
followed by radiation therapy
(E) local excision and axillary sampling
23. A 68-year-old woman presents to her attending
physician feeling unwell and having lost
10 lb. Physical examination reveals left axillary
lymphadenopathy. Biopsy reveals welldifferentiated
adenocarcinoma. Liver scan and
bone scan suggest widespread metastases.
Which statement concerning her further management
is correct?
(A)
(B)
(C)
(D)
(E)
the response rate for metastatic
adenocarcinoma (well-differentiated) of
unknown primary site is so poor that no
investigation or treatment is indicated
special stains might guide management
extensive workup, including
colonoscopy, abdominal CT scan, and
mammography, will define subsets that
benefit from treatment
special studies of the excised lymph
node are not useful in determining the
site of origin
metastatic breast cancer is the most
common cause of adenocarcinoma of
unknown primary site in women
24. A 47-year-old woman with cancer phobia
comes to the office for counseling. Which of
the following statements is true?
(A)
(B)
(C)
(D)
(E)
cancer is the most common cause of
death in the United States
cancer is the most common cause of
death in middle-aged women
incidence rates for cancer are generally
higher in women than men
colon and rectum cancers have the
highest mortality rate when considering
both men and women
about 25% of all cancers in the United
States are due to environmental factors
(A)
(B)
simple mastectomy with axillary
dissection
radiation therapy to breast and axilla