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Free STEP3 Exam Braindumps (page: 65)

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PDF with 804 Questions

A 25-year-old male presents to your office for evaluation of a testicular mass that he found in the shower. On examination, his left testicle is larger than his right with a firm palpable mass. Ascrotal ultrasound confirms the presence of a solitary intraparenchymal testicular mass. The most likely diagnosis in this patient is which of the following?

  1. benign fibroma
  2. epididymitis
  3. seminoma
  4. teratocarcinoma
  5. androblastoma

Answer(s): C

Explanation:

Testicular cancer is the most common malignancy in men between the ages of 15 and 35. It typically presents as unilateral scrotal swelling. On examination, it is important to distinguish intraparenchymal masses (usually malignant) from extraparenchymal masses (usually benign). This is easily done with scrotal ultrasound. Upon the diagnosis of an intraparenchymal testicular mass, a staging CT scan of the chest, abdomen, and pelvis should be obtained. It is reasonable to evaluate the serum levels of beta- HCG and AFP as they may be elevated in 8085% of patients with nonseminomatous germ cell tumors. LDH, on the other hand, can be elevated in patients with seminomas and can be of prognostic significance. Finally, if elevated, these serum markers can serve as a means to monitor the presence of residual disease and should be measured after resection of the tumor. Additionally, the mass should be excised in order to establish a histologic diagnosis. Aradical orchiectomy should be performed from an inguinal approach. Less invasive approaches such as biopsies or a scrotal approach to the tumor should be avoided as they can alter the lymphatic drainage and potentially adversely affect overall outcomes



Which of the following is characteristic of Hirschsprung's disease?

  1. Constipation is the most frequent presenting feature.
  2. Severity of the symptoms corresponds with the extent of bowel involvement.
  3. Acetylcholinesterase activity is decreased in the aganglionic segment.
  4. The proximal colon is most commonly affected.
  5. It presents most commonly in young adults.

Answer(s): A

Explanation:

Although constipation is the most common presenting feature of Hirschsprung's disease, some patients suffer from diarrhea. The severity of symptoms does not correlate well with the extent of bowel involvement. Enterocolitis, a major cause of death, requires vigorous treatment. This complication can occur even after removal of the aganglionic segment of the bowel. Increased acetylcholinesterase activity has been noted in the serum, affected aganglionic bowel, and erythrocytes of afflicted persons.
Eighty percent of affected infants are male.



A 25-year-old male comes to the ER after a motor vehicle collision, complaining of vague left-sided abdominal pain. After initial evaluation, a CT of the abdomen is obtained as shown in Figure. Which of the following statements is true concerning the injury?

  1. Hemodynamically unstable patients can be managed nonoperatively.
  2. Patients should be vaccinated against tetanus before hospital discharge.
  3. Splenic salvage is contraindicated in the presence of other major abdominal injuries.
  4. Pseudomonas aeruginosa is the most frequent organism responsible for postsplenectomy sepsis.
  5. Most patients require operative management.

Answer(s): C

Explanation:

Because of the risk of postsplenectomy sepsis, attempts should be made for splenic salvage when possible. Most patients are managed nonoperatively. Nonoperative management is contraindicated in the presence of hypotension or persistent bleeding. If patients are treated operatively, attempts are still made at splenic salvage if possible instead of splenectomy. Attempts at splenic salvage are contraindicated in hemodynamically unstable patients or patients with multiple concomitant injuries, as it prolongs the operation and increases blood loss. The risk of postsplenectomy sepsis from encapsulated organisms persists throughout life, but the highest incidence is in the first 2 years following splenectomy. Patients should be vaccinated against Pneumococcus, Meningococcus, and Haemophilus influenzae prior to discharge from the hospital.



A 50-year-old male presents with difficulty swallowing. Esophageal manometry demonstrates absence of peristaltic waves and a nonrelaxing lower esophageal sphincter (LES). Which of the following is the most likely diagnosis?

  1. Barrett's esophagus
  2. diffuse esophageal spasm
  3. achalasia
  4. Plummer-Vinson syndrome
  5. esophageal cancer

Answer(s): C

Explanation:

Esophageal achalasia is characterized by the findings of aperistalsis/atony and a failure of the LES to relax normally, resulting in esophageal dilatation proximally with a functional obstruction at the LES. Long- standing achalasia results in the characteristic barium swallow finding of a "bird's beak." Iatrogenic or tumor-related elevation of LES pressure can result in a "pseudoachalasia," but should have normal peristaltic patterns on manometry. Patients with Barrett's esophagus may have a "cobblestone" appearance on barium swallow, with normal peristalsis, and do not characteristically demonstrate esophageal dilatation; LES pressures may be normal or low. Finally, patients with Plummer-Vinson syndrome develop cervical dysphagia due to irondeficiency anemia; patients often present with cervical esophageal webs and can be at higher risk for developing esophageal squamous cell carcinoma.






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