Internal-Medicine

Questions: 25–37 125
28. A 45-year-old man is worried about a dark pigmented
skin lesion on his arm. The “mole” is
3 mm wide, symmetric with a regular border
and even pigmentation. He reports no change
in size or other symptoms. Which of the following
is the most appropriate next step in
management? (See Fig. 6–2.)
(A)
(B)
(C)
(D)
(E)
observation only
excisional biopsy
punch biopsy
chemotherapy, then surgical excision
surgical excision and regional node
dissection
29. A 73-year-old man presents with fatigue and
multiple lymph nodes in his neck. He has multiple
large nontender lymph nodes in his neck
and axilla. The spleen is not palpable, and the
remaining examination is normal. A biopsy of
the lymph node reveals lymphocytic lymphoma.
Which of the following factors predicts
poor prognosis?
(A) no extranodal involvement
(B) poor performance status
(C) age