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Free STEP3 Exam Braindumps (page: 53)

Page 52 of 202
PDF with 804 Questions

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.

Subsequent work-up confirms the presence of micro-invasive cervical carcinoma [Stage Ia].
What would be the most appropriate treatment?

  1. simple hysterectomy
  2. radical hysterectomy with pelvic lymph node dissection
  3. cervical radiation therapy
  4. cervical radiation followed by chemotherapy
  5. hysterectomy followed by chemotherapy

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.



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?

  1. Burkitt's lymphoma
  2. gastric carcinoma
  3. hepatocellular carcinoma
  4. nasopharyngeal carcinoma
  5. Kaposi's sarcoma

Answer(s): C

Explanation:

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?

  1. 30-days of antibiotic for possible epididymitis followed by repeat examination
  2. radical inguinal orchiectomy
  3. needle biopsy of the mass
  4. trans-scrotal orchiectomy
  5. semen analysis and cytology for malignant cells

Answer(s): B

Explanation:

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?

  1. carcinoid syndrome
  2. thyroid cancer
  3. pheochromocytoma
  4. aldosteronoma
  5. renal artery stenosis

Answer(s): C

Explanation:

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.






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