A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor?What serum marker can be used to monitor therapy?
Answer(s): B
Testicular cancer is the most common cancer in men between the ages of 20 and 40. Predisposing factors include cryptorchidism, hernias, and testicular atrophy. Abdominal testes are at higher risk than inguinal cryptorchid testes. Family history of testicular or prostate cancer, radiation exposure, or maternal DES seems to play no role. Testicular cancers are divided into nonseminoma and seminoma subtypes.Seminoma represents about 50% of all tumors and generally follows a more indolent course. The primary tumor is treated by inguinal orchiectomy regardless of cell type. Pure seminomas do not require retroperitoneal lymph node dissection, because radiation is usually adequate therapy. Nonseminomatous testicular tumors (embryonal cell, teratocarcinoma, choriocarcinoma, endodermal sinus) are usually treated by retroperitoneal dissection. Serum alpha-fetoprotein (AFP) and hCG levels are markers that are important for diagnosis and as prognostic indicators and are used to monitor therapy. Serum LDH level is often elevated with bulky tumors but is not as specific as either AFP or hCG. CEA is a nonspecific marker elaborated by many adenocarcinomas. PSA is a marker associated with prostate cancer
A55-year-old man with a 50 pack-year history of smoking presents with hemoptysis. CXR shows a left upper lobe mass and laboratory evaluation reveals hypercalcemia. Which of the following is the most likely diagnosis?
Answer(s): C
Although 515% of patients with lung cancer are identified while they are asymptomatic, most patients present with signs and symptoms including cough, hemoptysis, wheeze, stridor, shortness of breath, and postobstructive pneumonia. Paraneoplastic syndromes are common among patients with lung cancer.Endocrine paraneoplastic syndromes are seen in 12% of patients. Hypercalcemia may result from ectopic production of PTH or PTH-related peptides by squamous cell carcinomas. Small cell cancers may secrete ACTH or excessive amounts of ADH leading to hyponatremia and SIADH. Other nonendocrine paraneoplastic manifestations may include anorexia, cachexia, weight loss, fever, suppressed immunity.peripheral neuropathy, and the myasthenic Eaton-Lambert syndrome.
A 25-year-old man has the sudden onset of chest pain on the right side and dyspnea. On CXR, his trachea is deviated to the left. Which of the following should be anticipated on examination?
Answer(s): D
In the patient described in the question, the movement of the trachea to the left suggests a difference between right and left pleural pressures, either a reduction in pressure on the left or a rise in pressure on the right. The acute onset of right-sided chest pain in an otherwise healthy young man suggests a pneumothorax. On the side of the pneumothorax, we would expect increased resonance and distant or absent breath sounds because of the air trapped in the pleural space between the lung and chest wall and possible compression of the normal lung. No rales or rhonchi would be expected. Apleural friction rub suggests an inflammatory process involving the left chest, a finding not likely on the basis of the patient's presentation.
A 65-year-old woman with a long history of uncontrolled hypertension and valvular heart disease presents for evaluation. She is fatigued and complains of swelling in her legs and shortness of breath. Which of the following is the distinguishing feature of left ventricular failure?
Physical findings are often helpful in distinguishing left-sided from right-sided heart failure. When the left ventricle is either overloaded or weakened, patients develop dyspnea and orthopnea as a result of pulmonary congestion. When the underlying abnormality is primarily right ventricular failure symptoms related to pulmonary congestion are uncommon and patients experience edema, venous distention, and hepatic congestion. Liver enzymes may be elevated secondary to hepatic congestion
A 42-year-old man admitted with a high fever and leukocytosis is transferred to the intensive care unit in shock. Which of the following is a common finding in the early stages of septic shock?
The usual early hemodynamic response to sepsis is a hyperdynamic circulation. This includes tachycardia, elevated cardiac output, and decreased systemic resistance. Septic shock may then progress with intractable hypotension, metabolic acidosis, reduced cardiac output, oliguria, and death. The initial resuscitation of patients with all forms of shock requires rapid expansion of circulating blood volume to help maintain BP and tissue perfusion. This is usually achieved with the infusion of crystalloid fluids. When septic shock is suspected, cultures of blood, urine, and other sources along with antibiotic therapy targeted toward the most likely source is critical. Mechanical ventilation may be required when altered mental status, acidosis, and hypoxia are present. Beta-blockers and diuretics may have specific indications that cardiac ischemia and pulmonary edema are present
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q252: dns poisoning is the correct answer, not locator redirection. beaconing is detected from a host. this indicates that the system has been infected with malware, which could be the source of local dns poisoning. location redirection works by either embedding the redirection in the original websites code or having a user click on a url that has an embedded redirect. since users at a different office are not getting redirected, it isnt an embedded redirection on the original website and since the user is manually typing in the url and not clicking a link, it isnt a modified link.
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for this question - "which three type of basic patient or member information is displayed on the patient info component? (choose three.)", list of conditions is not displayed (it is displayed in patient card, not patient info). so should be thumbnail of chatter photo
q52 should be d. vm storage controller bandwidth represents the amount of data (in terms of bandwidth) that a vms storage controller is using to read and write data to the storage fabric.