A 55-year-old woman has a bloody discharge from her left breast. A mammogram discloses a cluster of microcalcifications 3 cm beneath her left nipple.Which of the following is the best predictor of survival after appropriate treatment of breast cancer?
Answer(s): A
In women with a primary tumor of 11.5 cm or less, the recurrence risk is approximately 15%, primarily because the likelihood of complete excision is greatest. Women with positive sex- steroid receptors in the tumor also have a better prognosis for several reasons: the tumor tends to be better differentiated, and 5- year therapy with tamoxifen significantly reduces recurrence. Although survival decreases as the number of positive axillary lymph nodes increases, the role of sentinel lymph node biopsy and axillary lymphadenectomy has become controversial. There appears to be a trend against axillary lymphadenectomy, especially with ductal carcinoma in situ less than 1.5 cm diameter.
A39-year-old woman known to have fibrocystic disease of the breast complains of persistent fullness and pain in both breasts. Which of the following drugs will be most effective in relieving her symptoms?
Answer(s): D
Danazol, in oral doses of 100, 200, or 400 mg daily for 46 months, relieves breast pain and reduces nodularity in 90% of women. The beneficial effects often last for several months after discontinuation of the drug. Tamoxifen is a synthetic antiestrogen that competes with estrogen receptors in the breast. Relief of symptoms symptoms has been achieved in approximately 70% of women in small studies, and seems to be ore effective in women with cyclic rather than continuous pain. Bromocriptine inhibits prolactin secretion, not recognized as a cause of fibrocystic breast disease and mastodynia. Oral progestins (e.g., medroxyprogesterone acetate), depot medroxyprogesterone acetate (Depo Provera), or OCs may provide symptomatic relief, but symptoms usually return after these are stopped. Hydrochlorothiazide provides unpredictable relief of symptoms.
A couple consults you because each has neurofibromatosis and wish to know what their reproductive possibilities are. You should tell them which of the following?
This is an autosomal dominant disorder. Both parents are carriers of the abnormal gene (N), which is on chromosome 17. If each parent is a heterozygote (Nn, where n is the normal gene), 25% of their offspring will have a normal genotype, nn. Fifty percent of their offspring will be affected heterozygotes (Nn), and the remaining 25% will be homozygous affected (NN). If either parent or both are homozygous for the abnormal gene (NN), 100% of the offspring will be affected. As an autosomal disorder, there is no sex predilection; males and females are affected with equal frequency. Prenatal diagnosis is available.
A 26-year-old woman complains of a vaginal discharge causing burning and itching of the perineum. The pH of the discharge is 4.5. Which of the following is the most likely cause of her discharge?
The normal pH of the vagina is 3.84.2. In women with a vaginal discharge, a pH less than 5.0 suggests monilial vaginitis or a physiologic discharge of normal squamous cells desquamated from the vaginal epithelium. A pH greater than 5.0 suggests some type of bacterial infection, such as bacterial vaginosis or trichomonas vaginitis. The diagnosis of bacterial vaginosis is based on the presence of 3 of 4 characteristics: pH greater than 4.5, a homogenous thin appearance of the vaginal discharge, a fishy amine odor after the addition of 10% potassium hydroxide (KOH) to the discharge, and clue cells present in 2050% of vaginal epithelial cells. Clue cells are bacteria adherent to the surface of vaginal epithelial cells.Lactobacilli are absent from the vagina in women with bacterial vaginosis. Both chlamydia and gonorrhea infect the cervix and do not change the vaginal pH.
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