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Free STEP3 Exam Braindumps (page: 52)

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PDF with 804 Questions

A 72-year-old previously healthy woman was diagnosed with Stage II breast cancer and was initiated on FAC chemotherapy (5-fluorouracil, doxorubicin, cyclophosphamide) 3 months ago. She now presents to the emergency room complaining of exertional dyspnea, orthopnea, and lower extremity edema. Her vital signs are normal, her EKG is normal, and her chest x-ray shows cardiomegaly and pulmonary vascular congestion.

What is the most likely cause of the patient's new symptoms?

  1. malignant pericardial effusion with cardiac tamponade
  2. acute pericarditis due to viral infection
  3. anthracycline-induced cardiomyopathy
  4. valvular aortic stenosis
  5. acute myocardial infarction

Answer(s): C

Explanation:

This patient has clinical signs of congestive heart failure. Cardiomyopathy may be a complication of chemotherapy containing anthracyclines (doxorubicin, daunorubicin, idarubicin, epirubicin). The cumulative anthracycline dose is the most widely recognized risk factor for this problem, although it is more common in patients over 70, patients with any other history of heart disease, or those with a history of thoracic radiation treatment. Other reversible causes of heart failure such as ischemic cardiomyopathy should be investigated. Patients with anthracycline cardiomyopathy frequently have recovery of systolic function with standard medical heart failure therapy. Lack of chest pain and a normal EKG make acute pericarditis or acute myocardial infarction unlikely. Pericardial effusion with tamponade might cause dyspnea and edema, but not pulmonary vascular congestion or pulmonary edema.



A previously healthy 34-year-old man, a lifelong nonsmoker, sought medical care at an Urgent Care Center for an upper respiratory infection. A chest x-ray was obtained, which revealed a peripherally located right lower lobe lung nodule. A follow-up CT of the chest showed the 1.8 cm nodule with multiple nonspecific calcifications, and no associated hilar or mediastinal adenopathy.

What is the most appropriate next step?

  1. Refer the patient to a thoracic surgeon to evaluate for wedge resection for suspected malignancy.
  2. Repeat the CT chest in 3 months to assess for stability of the nodule.
  3. Refer the patient for a percutaneous needle biopsy of the lesion to rule out malignancy.
  4. Refer the patient to a pulmonologist to evaluate for possible bronchoscopy with transbronchial biopsy.
  5. Treat with empiric antibiotics for possible pneumonia and repeat the chest x-ray in6 weeks to see if the nodular opacity has resolved.

Answer(s): B

Explanation:

This patient has a solitary pulmonary nodule. Overall, 35% of these lesions are malignant, usually primary lung cancers. In patients under 35 years of age without a smoking history, <1% of such lesions are malignant. Certain patterns of calcification within the nodule suggest a benign cause ("bulls-eye" pattern in granulomas, and "popcorn ball" in hamartomas), but these features alone cannot exclude malignancy. For low-risk patients such as this man, if the lesion remains stable on serial imaging studies (such as serial CT every 36 months) for 2 years, then no biopsy is deemed necessary to exclude malignancy.



A32-year-old female presents for her first pap smear in more than 10 years. She has a history of heavy alcohol use and IV drug use and has performed sexual acts for drugs on numerous occasions. Testing performed today reveals her to have chlamydia cervicitis and trichomonas vaginalis and to be seropositive for hepatitis B and hepatitis C. HIV testing is negative. Her pap smear subsequently returns with carcinoma in-situ of the cervix.

Infection with which of the following agents is most likely to have resulted in her cancer?

  1. human papillomavirus type 16
  2. hepatitis C virus
  3. hepatitis B virus
  4. Chlamydia trachomatis
  5. human papillomavirus type 11

Answer(s): A

Explanation:

Human papillomavirus has been associated with the development of multiple squamous cell malignancies, including cervical cancer (HPV types 16, 18, 31, 45, and 5153), as well as anal, penile, and vulvar cancers. Recent evidence has also linked some oropharyngeal squamous cell cancers to HPV infection as well. The risk for HPV-associated cancer is increased in patients with HIV co- infection. HPV type 11 may cause genital warts but is not a likely cause of cervical cancer. The presence of other sexually transmitted diseases, such as Chlamydia or hepatitis B, may help to identify women at high risk for cervical cancer, but they are not direct causes of cervical cancer. Following the abnormal pap smear findings, the next step in the diagnosis of this patient would be a colposcopy with biopsy of any visualized cervical abnormalities. At this point, HPV testing and typing would not add to or change the work-up, so they would not be necessary. HPV testing and typing can be helpful in the evaluation of women with lower grade cervical cytological abnormalities, such as ASCUS. The other tests noted may be performed later in the diagnostic work-up, after the results of the biopsies are known.



A32-year-old female presents for her first pap smear in more than 10 years. She has a history of heavy alcohol use and IV drug use and has performed sexual acts for drugs on numerous occasions. Testing performed today reveals her to have chlamydia cervicitis and trichomonas vaginalis and to be seropositive for hepatitis B and hepatitis C. HIV testing is negative. Her pap smear subsequently returns with carcinoma in-situ of the cervix.

What should be the next step in her work-up?

  1. human papillomavirus testing virus typing
  2. CT scan of the pelvis
  3. ultrasound of the uterus and ovaries
  4. cone biopsy of the cervix
  5. colposcopy and directed cervical biopsy

Answer(s): E

Explanation:

Human papillomavirus has been associated with the development of multiple squamous cell malignancies, including cervical cancer (HPV types 16, 18, 31, 45, and 5153), as well as anal, penile, and vulvar cancers. Recent evidence has also linked some oropharyngeal squamous cell cancers to HPV infection as well. The risk for HPV-associated cancer is increased in patients with HIV co- infection. HPV type 11 may cause genital warts but is not a likely cause of cervical cancer. The presence of other sexually transmitted diseases, such as Chlamydia or hepatitis B, may help to identify women at high risk for cervical cancer, but they are not direct causes of cervical cancer. Following the abnormal pap smear findings, the next step in the diagnosis of this patient would be a colposcopy with biopsy of any visualized cervical abnormalities. At this point, HPV testing and typing would not add to or change the work-up, so they would not be necessary. HPV testing and typing can be helpful in the evaluation of women with lower grade cervical cytological abnormalities, such as ASCUS. The other tests noted may be performed later in the diagnostic work-up, after the results of the biopsies are known.






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