QUESTION: 117

A 45-year-old male has received intravenous contrast dye prior to CT scan of the abdomen. Twenty minutes later the patient reports severe pruritus. He denies respiratory distress, syncope, or palpitations. His blood pressure is 98/54, pulse is 90, and respiratory rate is 22. On physical examination, he has widespread urticaria. His lungs are clear to auscultation. The next appropriate step would be which of the following
This intervention works well in cases such as this due to activity directed toward which of these receptors?

dopaminergic receptors
muscarinic receptors
nicotinic receptors
adrenergic receptors
N-methyl D-aspartate (NMDA) receptors

Answer(s): D

Explanation:

Anaphylaxis is an acute multisystem allergic reaction to a particular antigen in a sensitized patient. The reaction may be mild or severe. Clinical manifestations may include urticaria and angioedema; laryngeal edema with dyspnea; bronchospasm; tachycardia and hypotension; and vomiting and diarrhea. The correct initial step in the treatment of mild anaphylaxis is the administration of 0.30.5 mL of 1:1000 epinephrine subcutaneously. (Kaspar et al., 2005, pp. 19491950) Epinephrine is the drug of choice for treating severe anaphylactic shock because it is active at both alpha- and beta- adrenergic receptors. The alpha- adrenergic effects constrict the smaller arterioles and precapillary sphincters, thereby markedly reducing cutaneous blood flow. Veins and large arteries also respond to epinephrine. The beta-adrenergic effects of epinephrine cause relaxation of the bronchial smooth muscle and induce a powerful bronchodilation, which is most evident when the bronchial muscle is contracted, as in anaphylactic shock

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QUESTION: 118

the Breslow depth of the tumor
the Clark level of the tumor
the location of the tumor
the age of the patient
the number of prior severe blistering sunburns

Answer(s): A

Explanation:

In patients who have melanoma that is confined to the skin (i.e., no evidence of metastatic disease), the most important prognostic factor is the Breslow histologic depth of the tumor. The age of the patient and location of the tumor also play a role in prognosis, but to a lesser degree. The forearm and leg tend to have a better prognosis; scalp, hands, feet, and mucous membranes have a worse prognosis. Older persons tend to have poorer prognoses, as well. Standard treatment for melanoma involves surgical excision. Sentinel lymph node biopsy should also be performed in any patient who has a melanoma that is at least 1 mm thick. This aids in determining whether melanoma cells have metastasized to the local lymph node basin. If the sentinel lymph node biopsy is negative for melanoma cells, no further lymph node studies are necessary. However, a positive biopsy warrants complete lymph node dissection. In addition to this situation, complete lymph node dissection is indicated in the setting of clinical lymphadenopathy regardless of evident distant metastasis. High dose interferon alpha-2 therapy is aviable option for use as adjuvant therapy in patients at high risk for disease recurrence, having been shown to prolong periods of remission and possibly improve mortality. Single-agent chemotherapy is generally used in patients with stage IV melanoma and is considered more for palliative purposes.

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QUESTION: 119

A20-year-old male has had a recent wide local excision of a 1.5 mm melanoma from the right ankle. There is no evidence of metastatic disease. The most important prognostic factor for this patient is which of the following?
Which of the following interventions is most appropriate in addition to wide local excision of the patient's melanoma?

sentinel lymph node biopsy
no further intervention is warranted
adjuvant therapy with interferon alpha-2 for 1 year
single-agent chemotherapy
complete lymph node dissection

Answer(s): A

Explanation:

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QUESTION: 120

A20-year-old male has had a recent wide local excision of a 1.5 mm melanoma from the right ankle. There is no evidence of metastatic disease. The most important prognostic factor for this patient is which of the following? One year after his initial diagnosis and treatment, the patient develops a palpable right inguinal lymph node. Inguinal lymph node dissection reveals one node positive for metastatic melanoma; the remaining nodes are negative. Acomplete restaging workup shows no evidence of any additional metastatic disease.
What is the correct stage for this patient?

stage I
stage IIa
stage IIb
stage III
stage IV

Answer(s): D

Explanation:

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QUESTION: 117

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QUESTION: 119

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QUESTION: 120

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