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Free STEP3 Exam Braindumps (page: 81)

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PDF with 804 Questions

You are asked to see a 74-year-old man who has been admitted for evaluation of abdominal pain. During his workup, he was found to have hemoccult positive stool and a CT scan that was concerning for a mass in his sigmoid colon.

Which should be the next step in his treatment?

  1. cardiology consultation for preoperative clearance
  2. contrast enema to evaluate the lesion
  3. colonoscopy to biopsy the mass and rule out synchronous lesions
  4. sigmoidectomy to resect the mass and obtain mesenteric lymph nodes for staging
  5. positron emission tomography (PET) scan to determine if the lesion is cancerous

Answer(s): C

Explanation:

In the workup of a lesion identified within the colon, the gold standard for diagnosis is colonoscopy. Colonoscopy allows for biopsy of the tissue to establish a diagnosis of cancer prior to removing the mass. Furthermore, it also enables examination of the rest of the colon to rule out synchronous lesions. Barium enemas continue to have a role in diagnosis, but are more useful identifying the level of the lesion particularly in the setting of obstruction. You would not proceed straight to surgical resection unless the patient presented with an obstruction. Finally, PET scans have no role in the diagnosis of colon cancer



You are seeing a 48-year-old female in followup in your clinic. She originally presented for evaluation of a suspicious nonpalpable lesion in her right breast that was seen on her annual mammogram. A stereotactic core biopsy was done. She now returns to your office to review the results of the pathology report that confirms the presence of lobular carcinoma in situ (LCIS).

How do you counsel her at this time?

  1. Tamoxifen can prevent this cancer from spreading but may increase your risk of developing cancer in the other breast.
  2. You can consider nonoperative treatment with close observation, annual mammograms, and semiannual clinical examinations.
  3. The recommended treatment is a right breast mastectomy.
  4. Further staging workup at this time will include a chest x-ray and bone scan. E. Because you are at such high risk for future cancers, bilateral mastectomies should be performed to prevent this from happening.

Answer(s): B

Explanation:

LCIS is a benign diagnosis and alone does not have a risk of progression to an invasive cancer. However, a diagnosis of LCIS does increase the risk for development of future breast cancer at a rate of about 1% per year. It is important to remember that the risk is increased for both breasts. It has been shown that chemoprevention with tamoxifen can decrease the incidence of breast cancer by 49%. It is also sufficient to follow this population closely with annual mammograms and semiannual clinical examinations. Prophylactic bilateral mastectomies are an option and result in a 90% decrease in the risk of subsequent breast cancer. Since a diagnosis of LCIS increases the risk of cancer in both breasts, a mastectomy of the affected side is insufficient treatment



A 52-year-old female has been referred to you for consultation following a core biopsy of an area of calcifications seen on a screening mammogram. She has no family history of breast or ovarian cancer. She has not been taking hormone replacement therapy and has no reproductive risk factors. On physical examination, there is no palpable mass. The core biopsy results demonstrate atypical ductal hyperplasia.
What should be the next step in her treatment?

  1. close observation with semiannual mammograms and clinical examinations
  2. treatment with tamoxifen for 5 years
  3. needle localized excisional biopsy
  4. unilateral mastectomy
  5. bilateral mastectomy

Answer(s): C

Explanation:

The management of a breast lesion has become more complex as our knowledge regarding breast cancer development and treatment has continued to grow. The gold standard for evaluation of a suspicious lesion on mammogram is a core needle biopsy. This can be performed on palpable lesions directly, but can also be used on nonpalpable lesions using ultrasound or stereotactic guidance. A diagnosis of atypical ductal hyperplasia cannot be established on core biopsy alone. Studies have demonstrated that nearly 20% of patients with this diagnosis on core biopsy go on to have evidence of ductal carcinoma in situ or invasive ductal carcinoma after excisional biopsy. As such, if a core biopsy demonstrates evidence for atypical ductal hyperplasia, the standard of care is to proceed with an excisional biopsy to establish the diagnosis. Once this diagnosis has been confirmed, management decisions can be made including close observation with frequent screening mammograms, chemoprevention with tamoxifen, or prophylactic bilateral mastectomy.A unilateral mastectomy is not an option as a diagnosis of atypical ductal hyperplasia increases the risk of breast cancer in both breasts



You had previously seen a 24-year-old male in your office for evaluation of a suspicious looking mole. He had undergone a punch biopsy, which demonstrated a melanoma. He has no prior history of skin cancer, no family history of skin cancer, nor any history of blistering sunburns. Which of the following results in the pathology report are most predictive of outcome?

  1. size of the melanoma
  2. color of the melanoma
  3. depth of the melanoma
  4. presence of ulceration
  5. site of the melanoma

Answer(s): C

Explanation:

When assessing the prognosis for a patient diagnosed with melanoma, there are many factors that are involved. Tumor thickness, the presence of ulceration, the location of the lesion, the age of the patient, and the gender can all contribute. The most predictive factor is the tumor thickness. There are two measurement systems that have been developed to classify melanoma. The Clark level refers to the depth of invasion of the melanoma in terms of the anatomical layers of the skin. A second system, known as the Breslow depth, simply measures the overall tumor thickness in millimeters. Since the Breslow depth is more reproducible among pathologists, it has proven to be more accurate in the prediction of outcomes.






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