Breast/Uro

Question 1

A 65 year old woman with a family history of breast cancer is worried about her odds of developing breast cancer. What would also increase her risk?

Answer 1

Early onset of menarche

Question 2

A 55 year old woman presents with a 0.5 CN invasive carcinoma of the breast detected on mammography. What would be the appropriate local therapy for the tumor?

Answer 2

Local excision and axillary dissection followed by radiation therapy

Question 3

A 15 year old black girl has her left breast removed because of a large mass.The tumor weighs 1350g and has a bulging, very firm, lobulated, surface with a whorl-like pattern. What is the most likely diagnosis?

Answer 3

Fibroadenoma

Question 4

A 60 year old woman who has a history of severe depression and a radical mastectomy for carcinoma of the Breast one year previously develops nocturia, polyuria, and excessive thirst. Laboratory values are

Serum electrolytes- Na 149meq/ml, K- 6meq/ml
Serum calcium- 9.5 mg/dl
Blood glucose- 110mg/dl
Urine osmolality- 159mOsm/Kt

What is the most likely diagnosis?

Answer 4

Diabetes insipidus

Question 5

A 54 year old woman with a history of left mastectomy and subsequent radiation therapy for Breast cancer two years ago presents with a 3 Cm mass along the edge of the surgical suture line. She denies fever, chills, weight loss, and night sweats.Physical examination reveals some generalized induration and a tanned appearance of the skin overlying the mastectomy secondary to radiation therapy. There is a non mobile, nontender mass along the suture line that is not warm or fluctuant. She has no axillary lymphadenopathy. A biopsy specimen of the breast mass is most likely to show what?

Answer 5

Malignancy

Question 6

What side effect is relatively common immediately after isosulfan blue dye injection for mapping and Sentinal node identification?

Answer 6

Spurious pulse oximeter reading

Question 7

What best describes the long thoracic nerve?

Answer 7

If damaged causes winged scapula

Question 8

Axillary lymph nodes are classified according to their relationship with which muscle?

Answer 8

Pectoralis minor

Question 9

What best describes the Breast Cancer Type 2 gene?

Answer 9

It is associated with a 40% lifetime risk of ovarian cancer

Question 10

A 40 year old female presents to the clinic with a palpable mass. On physical examination, the mass is a 1 cm, mobile, firm nodule at the 2:00 position. What is the next best step in management for this new mass?

Answer 10

Mammogram

Question 11

What best describes Breast MRIs?

Answer 11

They allow for east acquisition of tissue for pathologic diagnosis

Question 12

What is the most common cause of bloody nipple discharge?

Answer 12

Intraductal papilloma

Question 13

What statement is most characteristic of phyllodes tumors?

Answer 13

They tend to recur

Question 14

A 34 year old woman is referred for the evaluation of Breast pain. It is described as burning, occasionally sharp and located in the subareolar area. It is always present and unilateral. On physical exam, she Has dense tissue in both breasts but no discrete nodules. What is the best working diagnosis?

Answer 14

Noncyclic Breast pain

Tx: Reassurance

Question 15

Following a mile localized excisional biopsy for Microcalcifications, pathology is found to be fibrocystic changes associated with Sclerosing adenosis and ductal hyperplasia. There was no atypia but lobular carcinoma in situ was present. What is the next best step in management?

Answer 15

Tell the patient that she has a future Cancer risk of 1% per year

Question 16

A woman had a mastectomy and Sentinal node biopsy for a diagnosed invasive breast cancer. Her Sentinal node was positive and she had an axillary dissection. The final pathology showed a 4cm invasive lobular carcinoma. Five of thirteen lymph nodes were positive. Additional therapy would include which of the following?

Answer 16

Radiation

Question 17

A young patient had a mass removed from her Breast that was thought to be a fibroadenoma. On the final pathology, it was found to be malignant phyllodes tumor with margins less than 1 mm. Which of the following should be included in additional therapy?

Answer 17

Margin re-excision

Question 18

Appropriate management of a patient with a positive sentinel lymph node might include what action?

Answer 18

Systemic chemotherapy and axillary lymph node dissection

Question 19

A 45 year old man presents with a 2 cm painless subareolar mass of his left Breast with nipple retraction. Physical examination shows no lymph node involvement. A biopsy revealed infiltrating ductal carcinoma wi positive hormone receptors. There is no evidence of metastatic disease. What is the most appropriate treatment plan?

Answer 19

Modified radical mastectomy

Question 20

A 22 year old woman in her 9th week of pregnancy presents with a painless lump of her left breast. On physical examination, there is a 3 cm mass in the left breast with no palpable lymph nodes. What imaging study should be performed first?

Answer 20

Ultrasound

Question 21

A 22 year old woman in her 9th week of pregnancy presents with a painless lump of her left breast. On physical exam there is a 3 cm mass in the left breast with no palpable lymph nodes. The mass is found to be solid and a biopsy is performed. It returns as infiltrating ductal carcinoma. Around what topic should the treatment discussion center?

Answer 21

Mastectomy with axillary sampling

Question 22

What is an acceptable treatment for ductal carcinoma in situ?

Answer 22

Mastectomy

Question 23

Lobular carcinoma in situ may be treated by which of the following methods?

Answer 23

Bilateral mastectomies

Question 24

A 45 year old woman is referred for an abnormal mammogram. It shows a cluster of calcifications in the central left breast for a span of 1.5 cm read by the radiologist as a BRADS4. There is no associated mass and nothing is palpable on physical examination. What is the next best step in management?

Answer 24

Stereotactic biopsy

Question 25

A woman has a core needle stereotactic biopsy that shows fibrocystic condition and adenosis. There was evidence of atypical ductal hyperplasia. What is the next best step in management?

Answer 25

Wire localized excisional biopsy

Question 26

️BRCA 2 gene mutation is associated with a higher risk of developing which Cancer?

Answer 26

Male breast

Question 27

A 65 year old woman with a large mass encompassing her whole right Breast with Peu d’orange, redness, and thickened skin. There are palpable lymph nodes in the right Axilla. She has no fever and the breast itself is not painful. What is the working diagnosis?

Answer 27

Inflammatory Breast cancer

Question 28

A 65 year old woman presents with a large mass encompassing her whole right Breast with Peu d’orange,redness, and thickened skin. There are palpable lymph nodes in the right Axilla. She has no fever and the breast itself is not painful. What is the next step in the evaluation of this patient?

Answer 28

Core biopsy

Question 29

A 49 year old woman presents with a 2 cm mass in hear right breast detected by mammogram. Core biopsy shows infiltrating ductal carcinoma. She has no palpable axillary lymph nodes. Appropriate therapy for the patient would include which of the following?

Answer 29

Sentinel node biopsy, radiation therapy, and lumpectomy

Question 30

A 49 year old woman presents with a 2 cm mass in her right breast detected by mammogram. Core biopsy shows infiltrating ductal carcinoma. She has no palpable axillary lymph nodes. The patient has a negative sentinel node biopsy and no evidence of metastatic disease. In what stage is the patient?

Answer 30

I

Question 31

A 40 year old woman presents with a 2 cm mass in her right breast detected by mammogram. Core biopsy shows infiltrating ductal carcinoma. She has no palpable axillary lymph nodes. If the patient had a positive sentinel node biopsy and no evidence of metastatic disease, what would her stage be?

Answer 31

II

Question 32

Which region of the Prostate is most responsible for symptoms of benign Prostate hyperplasia?

Answer 32

Transition zone

Question 33

What is the mainstay of therapy for stage D Prostate cancer?

Answer 33

Androgen ablation therapy

Question 34

What disorder must be considered in patients who have irritative bladder symptoms such as frequency, hesitancy, dysuria, and irritability in the absence of urinary tract infection?

Answer 34

Bladder cancer

Question 35

What substance composes most renal stones?

Answer 35

Calcium oxalate

Question 36

What is characterized by leakage of urine that occurs while coughing?

Answer 36

Stress incontinence

Question 37

What is a serum marker for Seminoma?

Answer 37

BhCG

Question 38

What medication is contraindicated in patients who take sildenafil?

Answer 38

Nitrates

Question 39

What treatment is the best management for obstructive pyelonephritis secondary to an obstructing urethral stone?

Answer 39

IV antibiotics and emergency stent placement

Question 40

What substance composes infection stones?

Answer 40

Magnesium ammonium phosphate

Question 41

What produces fructose?

Answer 41

Seminal vesicles

Question 42

An adult patient presents with blunt trauma and gross hematuria and is hemodynamically stable. What is immediately required?

Answer 42

Computed tomography scan

Question 43

What statement is characteristic of testicular torsion?

Answer 43

It is commonly associated with loss of the Ipsilateral Cremasteric reflex

Question 44

A 54 year old man comes to the urgent care clinic with the acute onset of back pain. His vital signs are stable. He has point tenderness over the spinous process of T11. Rectal examination shows normal tone,brown, Guaiac negative stool, and a large nodule.vthere is a 3/5 strength the on the left and 5/5 strength on the right to dorsiflexion of the great toes. An MRI of the spine shows multiple lesions consistent with metastatic disease in the spine, and a compression deformity of T11 with spinal cord impingement. The patient is felt to have metastatic Prostate cancer. An MRI of the Prostate can be done in patients for preoperative staging. It has a sensitivity of 38% for spread of disease beyond the capsule of the prostate but a specificity of 97%. Based on this data,chat is true concerning the MRI of the prostate?

Answer 44

It would be a poor screening test to pick up disease in this patient

Question 45

A 25 year old ma is admitted to the hospital for chemotherapy treatment of metastatic Seminoma. He presented three weeks ago with painless testicular mass and underwent orchiectomy, yielding a diagnosis of Seminoma. A ct scan of the abdomen confirmed metastatic disease to the Retroperitoneal lymph nodes. A ct scan of the abdomen confirmed metastatic disease to the Retroperitoneal lymph nodes. His temperature is 98.8 F. He is well appearing, hear is regular without murmurs, lungs are clearer, and abdomen is benign. Some post surgical changes are present on inspection of the genitals. Laboratory studies show a leukocyte count of 6000/L, hematocrit of 45%, platelets of 359,000/L blood urea nitrogen 12 mg/dl and creatinine of 0.6 MGN/dl. Soon after his admission, chemotherapy orders are finished, he states that he has changed his mind with regard to therapy and says that he now “has found God and feels that God alone will cure his disease.” What’s the most appropriate management at this time?

Answer 45

Discuss his religious beliefs and point out the benefits chemotherapy will offer him

Question 46

A 33 year old construction worker was walking along a steel beam when he fell, straddling the beam. There was no loss of consciousness. Complains of pain to testes and perineum. No evidence of flank or back Ecchymosis. Genital exam reveals gross blood at the urethral meatus. There is a butterfly pattern of Ecchymosis over the scrotum and perineum,his testicles are palpable and mildly tender. complains of urge to urinate but only a few drops of fresh blood appear at the Meatus. What is the next best step in management?

Answer 46

Order a retrograde urethrogram

Question 47

A 65 year old African American man comes to the clinic complaining of urinary hesitancy. He has been treated for BPH with tamsulosin for the past two months. States that for the past two days his urinary stream has become progressively weaker until the day of presentation when all he can do is dribble a few drops of urine. He feels the constant urge to urinate and admits to episodes of incontinence when he was unable to get to the bathroom in time. He is not leaking urine when he coughs or sneezes. In the lower abdomen there is a palpable mass dull to percussion, extending from the Suprapubic area Superiorly to the level of the umbilicus. The mass is nontender, smooth, slightly mobile, and firm. PSA is 11.4. He is unable to provide a urine sample. What is the next appropriate step in management?

Answer 47

Place a Foley catheter

Question 48

A 64 year old man comes to the office complaining of red urine. For the past 11 years, he’s been treated for diabetes and HTN. There is no pain associated with the blood and it ️Occurs about once a week and persists through the entire urinary stream. Urinalysis shows 12-14 rbcs. Urine culture shows no growth. CBC is normal. PSa is 1.1. A cystoscope reveals a raised,papillary frond, 1cm in size, over the Trigone.it is consistent with transitional cell carcinoma of the bladder, what is the next appropriate step in management?

Answer 48

Resect the lesion through the cystoscope

Question 49

A 90 year old man comes to e clinic for follow up appointment. He has a history of COPD and HTN. A Prostate nodule was discovered on DRE. He was referred to a urologist. A trans recital biopsy of the prostate was performed two weeks ago and reveals a Gleason grade 7 carcinoma. What is the next appropriate step in the management of this patient?

Answer 49

Order a bone scan

Question 50

A just completed study sponsored by the NIh examined differences in rates of survival for men ages 65-75 who were diagnosed with prostate cancer. The cart shows a 10 year survival rate for patients receiving standard radiation treatment,vtarget radiation pellets, and surgical intervention. Based on the data derived from this study, life expectancy for patients diagnosed with prostate cancer who elect surgical intervention is best estimated at?

Answer 50

8 years

Question 51

A 60 year old man is diagnosed with prostate cancer and elects therapy with radiation pellets. He asks “will i be alive in 10 years to see my daughter graduate from college?” Based on the available graph, what is the most appropriate response?

Answer 51

It is possible but less than a 50/50 chance

Question 52

A previously healthy 12 year old boy is brought to the Ed by his mother because of a 4 hour history of acute right testicular pain. The patient denies a history of trauma and has never experience this type of dull, achy visceral pain before. A urinalysis is negative. His right testicle is tender to palpation and larger compared to the other side. There is probable blue dot sign with normal lie to the testicle. The Cremasteric reflex is not observed. What is the most appropriate next step?

Answer 52

Prepare the patient for immediate surgery for exploration

Question 53

A previously healthy 43 year old man comes to the office complaining of a 1 week history of left scrotal swelling.bon examination, he has an enlarged left hemi scrotum with a reducible mass that is clearly distinct from the testicle. With the mass reduced, the patient performs the Valsalva maneuver and a protrusion at the external inguinal ring is noted. Also, the testicles appear normal in size and consistency when the mass is reduced. What statement is correct regarding this patient’s condition?

Answer 53

The mass may become strangulated

Question 54

A 30 year old healthy man comes to the employee health clinic complaining of a constant dull, achy feeling in his left testicle. On PE, the right testicle is normal in location, size, and consistency. This left testicle is enlarged, hard, irregular, and nontender to palpation. There is no Transilluminating of light through his scrotal mass. Serum beta hCG and AFP levels are elevated. At this time, what statement is most correct about this condition?

Answer 54

Radical orchiectomy is the first line of treatment