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Free STEP3 Exam Braindumps (page: 73)

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PDF with 804 Questions

A 65-year-old woman complains that she has become increasingly light-headed after playing golf. She also has had some cramping type pain in her left arm, which coincides with the episodes. She undergoes arteriogram and is found to have a stenotic lesion of her subclavian artery.
Which of the following is true?

  1. The stenotic lesion is distal to the take off of the vertebral artery.
  2. It is unusual for these patients to have coronary artery disease as well.
  3. The patient's light-headedness is caused by an incomplete Circle of Willis.
  4. The operation of choice for this patient is a carotid-subclavian bypass.
  5. Radial pulses in this patient will be equal bilaterally.

Answer(s): D

Explanation:

This patient is presenting with subclavian steal syndrome, which is caused by subclavian stenosis proximal to the take off of the verterbral artery. Exertion of the extremity causes blood to be shunted away from the brain to the arm resulting in vertigo or even syncope. These patients usually have diminished radial pulses on the affected side and also have other evidence of atherosclerotic disease. A carotidsubclavian bypass is the operation of choice for these patients.



Apatient with a known family history of multiple endocrine neoplasia (MEN) I, now presents with intractable ulcer disease.

Which of the following statements about his condition is most accurate?

  1. Diarrhea is a frequent complaint.
  2. Tumors are rarely multiple.
  3. Tumors are rarely malignant.
  4. An elevated fasting gastrin level is diagnostic for the Zollinger-Ellison syndrome.
  5. CT is useful in localizing the tumor in greater than 75% of patients.

Answer(s): A

Explanation:

The Zollinger-Ellison syndrome was described in 1955, in two patients with the triad of gastroduodenal ulcerations, gastric hypersecretion, and nonbeta islet cell tumors of the pancreas. Gastrinomas arise from neuroendocrine cells and represent the third most common neuroendocrine tumors (after carcinoids and insulinomas). These tumors are associated with MEN I. These tumors occur predominantly in the pancreas, duodenum, antrum, and peripancreatic lymph nodes, but can also occur at distant sites like the ovary. Isolated tumors are found in 50%, and multiple tumors in 50%, but there is a higher incidence of multiple tumors in MEN I. Tumors are malignant in 50%, with metastases to the regional lymph nodes and the liver. Once the diagnosis has been established, tumor localization can be achieved with indium-labeled octreotide scan, CT with fine cuts through the pancreas, ultrasound, MRI, or selective angiography. None of these tests are highly sensitive, and often the tumors are not localized until the time of exploration and intraoperative-directed ultrasonography.



A 60-year-old Asian male presents with early satiety and 40-lb weight loss over 3 months.Upper endoscopy shows an irregular mass in the antrum of the stomach. What can you tell him and his family about his situation?

  1. Weight loss indicates distant metastases, and surgical resection is not indicated.
  2. Antral tumors have a worse prognosis than tumors at other sites in the stomach.
  3. CT is the most effective imaging modality for determining TNM (tumor, nodes, and metastases) stage.
  4. 5-year survival for patients with gastric adenocarcinoma confined to the mucosa with no nodal metastasis approaches 90%.
  5. Chemotherapy is an effective treatment modality in stage IV gastric adenocarcinoma, with significant benefit in overall survival.

Answer(s): D

Explanation:

Gastric adenocarcinoma is associated with dismal overall prognosis, with long-term survival seen only in patients with early stage disease. Surgical resection remains the mainstay of potentially curative therapy, with poor responses to chemotherapy in the majority of clinical trials. Patients often present with vague epigastric discomfort, occult GI bleeding/anemia, anorexia, weight loss, and even hematemesis/ vomiting. Patients are staged with endoscopic ultrasound, which is the most effective imaging modality for determining T and N stage. CT may also be useful for determining nodal metastases, but is more accurate for determining distant metastases (liver). Antral tumors may have a better prognosis than more proximal gastric tumors, with a decreased incidence of nodal metastases. Five-year survival rates for stage I disease is excellent, approaching 8090% in both the Western countries and in Asia. However, 5-year survival rates are dismal for stage III and stage IV disease, and most Western series report overall 5-year survival rates for gastric cancer of 1021%.

In contrast to gastric adenocarcinoma in the United States, the incidence of gastric lymphoma is rising. Gastric lymphoma accounts for two-thirds of GI lymphomas. Symptoms are similar to gastric adenocarcinoma, but obstruction, perforation, and massive bleeding are very uncommon symptoms. Because gastric lymphoma spreads by submucosal infiltration, mucosal biopsies at the time of upper endoscopy can often be nondiagnostic. Repeated biopsies to obtain submucosal tissue are needed to establish a diagnosis. Treatment protocols vary among institutions, but most often center on chemotherapy; surgical resection of isolated or localized gastric lymphoma can be curative, but is rarely seen. Fortunately, survival rates for gastric lymphoma are much better than those seen in gastric adenocarcinoma, with cure rates of 70% seen in patients with stage IE and IIE disease treated with chemotherapy alone.



A 60-year-old Asian male presents with early satiety and 40-lb weight loss over 3 months.Upper endoscopy shows an irregular mass in the antrum of the stomach. He follows up in the clinic a few days later, and you see that the results of the endoscopic biopsies are suggestive of a gastric lymphoma. Which of the following is true regarding this condition?

  1. The incidence of gastric lymphoma is increasing.
  2. Obstruction, perforation, and bleeding are common presenting symptoms.
  3. Upper endoscopy with biopsy is highly accurate for diagnosis.
  4. Gastric involvement of systemic lymphoma is best treated with gastric resection.
  5. Survival rates are dismal with overall prognosis similar to that seen in gastric adenocarcinoma.

Answer(s): A

Explanation:

Gastric adenocarcinoma is associated with dismal overall prognosis, with long-term survival seen only in patients with early stage disease. Surgical resection remains the mainstay of potentially curative therapy, with poor responses to chemotherapy in the majority of clinical trials. Patients often present with vague epigastric discomfort, occult GI bleeding/anemia, anorexia, weight loss, and even hematemesis/ vomiting. Patients are staged with endoscopic ultrasound, which is the most effective imaging modality for determining T and N stage. CT may also be useful for determining nodal metastases, but is more accurate for determining distant metastases (liver). Antral tumors may have a better prognosis than more proximal gastric tumors, with a decreased incidence of nodal metastases. Five-year survival rates for stage I disease is excellent, approaching 8090% in both the Western countries and in Asia. However, 5-year survival rates are dismal for stage III and stage IV disease, and most Western series report overall 5-year survival rates for gastric cancer of 1021%.

In contrast to gastric adenocarcinoma in the United States, the incidence of gastric lymphoma is rising. Gastric lymphoma accounts for two-thirds of GI lymphomas. Symptoms are similar to gastric adenocarcinoma, but obstruction, perforation, and massive bleeding are very uncommon symptoms. Because gastric lymphoma spreads by submucosal infiltration, mucosal biopsies at the time of upper endoscopy can often be nondiagnostic. Repeated biopsies to obtain submucosal tissue are needed to establish a diagnosis. Treatment protocols vary among institutions, but most often center on chemotherapy; surgical resection of isolated or localized gastric lymphoma can be curative, but is rarely seen. Fortunately, survival rates for gastric lymphoma are much better than those seen in gastric adenocarcinoma, with cure rates of 70% seen in patients with stage IE and IIE disease treated with chemotherapy alone.






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