Numerous types of cancers are associated with infectious diseases. For which of the following cancers is there a vaccine currently available against the infectious agent which leads to the tumor?
Answer(s): C
Burkitt's lymphoma and nasopharyngeal carcinomas are associated with the Epstein- Barr virus. Gastric carcinoma is associated with H. pylori infection. Kaposi's sarcoma is associated with human herpesvirus 7. The rate of hepatocellular carcinoma is greatly increased in those with chronic hepatitis B and C. Hepatitis B virus infection is the leading cause of hepatocellular carcinoma worldwide, usually after congenital infection in Asia and Africa. Of these infections, only hepatitis B has a widely available, routinely recommended vaccine.
A 24-year-old male presents to the office for evaluation of a nodule on his left testicle. He noticed the mass while washing in the shower. He has had no pain, no weight loss, no change in sexual functioning, and no blood in his semen. Examination reveals the presence of a firm, nontender, 1 cm nodule on the testicle. No other masses and no inguinal adenopathy are noted. Ultrasound of the scrotum confirms that the mass is on the testicle.What would be the next step in management?
Answer(s): B
A painless, firm testicular mass is a classic presentation of testicular cancer, although some men have pain or scrotal swelling as well. When such a mass is found on examination, ultrasound is the next indicated study to confirm whether the mass is truly located on the testicle or if it is associated with another structure, most commonly the epididymis. Once the presence is confirmed, an inguinal orchiectomy is the procedure of choice for both diagnostic and therapeutic purposes, as the vascular and lymphatic drainage of the testis is through the inguinal canal. Antibiotic therapy may play a role if the enlarged area is in the epididymis and not the testicle. Semen cytology plays no role in the work-up of suspected testicular malignancy
A 25-year-old man presents to the ER with a 3-month history of intermittent pounding headaches, sweating, and palpitations. He denies any symptoms of depression or anxiety. On examination, he is a thin gentleman, BP 240/120, heart rate 110/minute, thyroid not enlarged. There is no prior history of hypertension.The most likely diagnosis is which of the following?
The classic triad of pheochromocytoma is sweating, headache, and palpitations. When these are associated with hypertension, they have a sensitivity and specificity of >90% for the diagnosis. Paroxysms are not a component of aldosterone secreting tumors or renal artery stenosis. Hyperthyroidism and panic attacks would be in the differential diagnosis, but thyroid cancer is not associated with hypertension.
A40-year-old woman presents with headaches and visual disturbances for the past 6 months. She suddenly developed amenorrhea 2 years ago. One year ago, she noticed milky discharge from her left breast. The most likely diagnosis is which of the following?
Answer(s): A
Galactorrhea with amenorrhea is consistent with hyperprolactinemia. The additional history of headache and possible visual field changes or cranial nerve abnormalities is strongly suggestive of a pituitary tumor. In this setting, the most likely diagnosis is prolactinoma. Ovarian failure, Kallman syndrome, and Sheehan syndrome would not present with galactorrhea. Kallman syndrome is associated with primary amenorrhea and anosmia. PCOS presents with a long history of irregular cycles and hyperandrogenism
A28-year-old woman was noted to have a 3 cm thyroid nodule at the time of a well-woman examination. Her mother and maternal aunt died of thyroid cancer. On examination, her BP was 160/105, heart rate 90/ minute. Laboratory studies:Which of the following is the most likely diagnosis?
The patient has a strong family history of thyroid cancer and has a thyroid nodule, hypertension, tachycardia, and hypercalcemia. These are hallmarks of Multiple Endocrine Neoplasia Type 2 (MEN-2) syndrome, which is associated with medullary thyroid cancer, pheochromocytoma, and hyperparathyroidism. The very high calcitonin level is an excellent tumor marker for medullary thyroid cancer and a fine needle aspiration is not indicated. She will need to have an evaluation and treatment for pheochromocytoma prior to treatment of her thyroid cancer.
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