Neoplasia — MCQs

A 69-year-old man comes to the physician because of a 4-month history of progressive fatigue, cough, shortness of breath, and a 6.6-kg (14.5-lb) weight loss. For the past week, he has had blood-tinged sputum. He is a retired demolition foreman. There is dullness to percussion and decreased breath sounds over the left lung base. A CT scan of the chest shows a left-sided pleural effusion and circumferential pleural thickening with calcifications on the left hemithorax. Pathologic examination of a biopsy specimen of the thickened tissue is most likely to show which of the following findings?

A 57-year-old woman with a long-standing history of liver cirrhosis presents to her primary care provider with a complaint of unintended weight loss of 8.2 kg (18.0 lb) within the last month. She has a history of intermittent right upper quadrant pain in her abdomen with decreased appetite for a few years and occasional shortness of breath. The past medical history is significant for hepatitis E infection during her first pregnancy when she was 28 years old, and a history of blood transfusion after an accident 25 years ago. She drinks about 2–3 pints of beer every week on average and does not use tobacco. The vital signs include: blood pressure 110/68 mm Hg, pulse rate 82/min, respiratory rate 11/min, and temperature 37.7 °C (99.9°F). The physical exam is normal except for moderate icterus and tender hepatomegaly. The blood tests show mild anemia with decreased iron stores. Serum electrolytes, blood sugar, and renal function are normal. The chest X-ray is normal. An ultrasound of the abdomen revealed a mass in the liver, which was confirmed with a biopsy to be hepatocellular carcinoma. Which of the following is the strongest causative factor that can be linked to her diagnosis?

A 75-year-old male presents to his primary care physician complaining of epigastric pain. He has developed progressively worsening epigastric pain, heartburn, and nausea over the past five months. The pain does not change with meals and is not positional. He also reports that he is rarely hungry and has lost ten pounds. The patient immigrated from Japan two years ago to live with his son in the United States. He worked as a fisherman and dock worker for most of his life. His past medical history is notable for gout and gastroesophageal reflux disease. He takes allopurinol and cimetidine. He has a 30 pack-year smoking history and drinks 1-2 alcoholic beverages per day. Physical examination reveals mild epigastric tenderness to palpation and a hard lymph node near his left shoulder. Which of the following substances is most strongly associated with this patient’s condition?

A 52-year-old woman comes to the physician because of a 1-month history of mild fever, fatigue, and shortness of breath. She has no history of serious medical illness and takes no medications. Cardiopulmonary examination shows a mid-diastolic plopping sound heard best at the apex and bilateral rales at the base of the lungs. Echocardiography shows a pedunculated, heterogeneous mass in the left atrium. A biopsy of the mass shows clusters of mesenchymal cells surrounded by gelatinous material. Further evaluation of this patient is most likely to show which of the following?

A 3-year-old girl is brought to the physician by her parents due to observations of rapid, random, horizontal and vertical eye movements along with occasional jerking movements of her limbs and head. CT scan reveals an abdominal mass that crosses the midline. Further work-up reveals elevated 24-hour urinary homovanillic acid and vanillylmandelic acid. Neuroblastoma is suspected. Which of the following diseases pathologically originates from the same type of cells as Neuroblastoma?

A 40-year-old man comes to the physician because of a 1-month history of a painless lump on his neck. Two years ago, he underwent surgery for treatment-resistant hypertension, episodic headaches, and palpitations. Physical examination shows a firm, irregular swelling on the right side of the neck. Ultrasonography of the thyroid gland shows a 2-cm nodule with irregular margins and microcalcifications in the right thyroid lobe. Further evaluation of this patient is most likely to show increased serum concentration of which of the following substances?

A 66-year-old man presents to his family physician complaining of a sandpaper-like sensation when he touches the lesion on his forehead. His medical history is relevant for hypertension and hypercholesterolemia, for which he is taking losartan and atorvastatin. He used to work as a gardener, but he retired 3 years ago. His vital signs are within normal limits. Physical examination of his forehead reveals male-pattern baldness and thin, adherent, yellow-colored skin lesions that feel rough to the touch (see image). His family physician refers to him to a dermatologist for further management and treatment. Which of the following conditions would the patient most likely develop if this skin condition is left untreated?

A 75-year-old woman comes to the physician because of a 3-month history of involuntary weight loss and a painless lump on her neck. Physical examination shows a firm, irregular swelling on the right side of the neck. Ultrasonography of the thyroid gland shows a 2-cm nodule with irregular margins and microcalcifications in the right thyroid lobe. A biopsy of the thyroid nodule is performed. Which of the following changes would be most consistent with anaplasia?

A 44-year-old man comes to the physician because of fatigue and increased straining during defecation for 3 months. During this time, he has lost 5 kg (12 lb) despite no change in appetite. He has a family history of colon cancer in his maternal uncle and maternal grandfather. His mother died of ovarian cancer at the age of 46. Physical examination shows conjunctival pallor. His hemoglobin concentration is 11.2 g/dL, hematocrit is 34%, and mean corpuscular volume is 76 μm3. Colonoscopy shows an exophytic mass in the ascending colon. Pathologic examination of the resected mass shows a poorly differentiated adenocarcinoma. Genetic analysis shows a mutation in the MSH2 gene. Which of the following is the most likely diagnosis?

A 32-year-old woman presents to her primary care physician for an annual checkup. She reports that she has been feeling well and has no medical concerns. Her past medical history is significant for childhood asthma but she has not experienced any symptoms since she was a teenager. Physical exam reveals a 1-centimeter hard mobile mass in the left upper outer quadrant of her breast. A mammogram was performed and demonstrated calcifications within the mass so a biopsy was obtained. The biopsy shows acinar proliferation with intralobular fibrosis. Which of the following conditions is most likely affecting this patient?